Menopause: A Nutrition and Natural-Health Reference
1. Definition and Overview
Menopause refers to the natural and permanent cessation of menstruation caused by estrogen deficiency unrelated to a pathologic process. Amenorrhea persisting for 12 months marks the end of a woman's reproductive and childbearing years. Menopause typically occurs between the ages of 45 and 55, with the average age being 51.
Menopause is due to exhaustion of ovarian follicles, ultimately leading to a drop in estrogen and progesterone. This loss of estrogen and other feedback hormones of the hypothalamic-pituitary-ovarian axis causes follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to rise sharply, while circulating estradiol (E2) falls on average 70% to approximately 30 pg/mL and progesterone becomes virtually undetectable.
Increasing life expectancy results in women spending approximately 40% of their lives in the postmenopausal stage, which corresponds to more than 30 years for many individuals.
1.1 Stages of the Menopausal Transition
Prior to menopause, women often experience a transitional phase known as perimenopause, which can last several years and is marked by irregular menstrual cycles, memory lapses, and mood swings. In the perimenopause, ovarian function and therefore the production of the hormones oestrogen, progesterone and testosterone can fluctuate greatly, leading to a wide variety of symptoms, affecting multiple organ systems.
To standardize the stages of menopause, the Stages of Reproductive Aging Workshop + 10 (STRAW+10) system was designed with five distinct categories corresponding to symptom presentation and numerical years.
During the postmenopause, the period that follows menopause, menopausal symptoms may diminish while the long-term detrimental effects of hormonal changes in multiple organs become increasingly more apparent.
2. Body Systems Involved
Aside from the reproductive system, menopause also affects heart and bone health, brain function, sleep patterns, hormones, and more. The spectrum of menopausal symptoms ranges from acute vasomotor, urogenital, and psychological issues during perimenopause to chronic reproductive, cardiovascular, neurological, skeletal, dermatologic, immune, and digestive changes postmenopause.
2.1 Vasomotor System
Vasomotor symptoms represent the most common manifestations during the menopausal transition, experienced by approximately 75% to 80% of women with varying severity. Common manifestations include hot flashes, night sweats, palpitations, and migraines. Hot flashes occur unpredictably during both daytime and nighttime, typically lasting about 3 to 4 minutes. Each episode begins with a sensation of flushing that spreads across the upper body, reflecting central nervous system alterations in thermoregulation. Vasomotor symptoms persist for an average duration of 1 to 6 years and continue for as long as 15 years in 10% to 15% of postmenopausal women.
2.2 Skeletal System
Estrogen deficiency is a major risk factor for osteoporosis. After menopause, estrogen levels decrease dramatically, resulting in formation of osteoclasts and bone turnover increase with subsequent rapid bone loss. The lumbar spine is particularly sensitive to changes in estrogen levels, and bone density declines faster. The main reason for the decrease in bone density in women during menopause is the decrease in estrogen levels, which causes the skeletal system to lose its protective effect.
2.3 Cardiovascular System
Estrogen deficiency is an important factor leading to the increased risk of cardiovascular disease in postmenopausal women. Changes in estrogen levels can also affect endothelial function and inflammatory response. A decrease in estrogen can lead to lipid metabolism disorders in the human body and aggravate dyslipidemia. The decline in production of estrogen causes secretion of pro-inflammatory cytokines such as IL-6, IL-1, and TNF-alpha.
2.4 Genitourinary System
Most women experience vasomotor symptoms, but menopause affects many other areas of the body, including urogenital, psychogenic, and cardiovascular systems. Genitourinary syndrome of menopause (GSM) encompasses vaginal dryness, atrophy, dyspareunia, and changes in urinary frequency. The decline in estrogen levels among menopausal women can trigger multisystem dysfunction, significantly increasing the risk of osteoporosis, cardiovascular disease, cognitive impairment, and genitourinary syndrome (GSM).
2.5 Neurological and Psychological Systems
Oestrogens, androgens, and progesterone are ovarian hormones that have a variety of impacts on the neurological system. Through androgen-specific receptors and the aromatization of testosterone to estradiol, androgens' effects on the neural system are controlled. Changes in the levels of androgens in the blood are crucial for the psychological and sexual transformations that follow menopause.
Depression is a significant comorbidity. A systematic review (55 studies, 76,817 participants) found a pooled depression prevalence in menopausal women of 35.6% (95% CI: 32.0–39.2%).
3. Contributing and Associated Factors
3.1 Genetic Factors
Research suggests that the onset of menopause is strongly influenced by genetics, but non-genetic factors can also play a role. There is little consensus, however, on the influence of non-genetic factors on the timing of the menopause. Early menopause, described as cessation of ovarian function before the age of 45, affects roughly 5%–10% of women in Western populations.
3.2 Smoking
Women with over 30 pack-years of smoking had about 1.5 times higher early-menopause risk. Mendelian randomization confirmed daily cigarette consumption as a causal factor in early menopause. Smoking is positively correlated with early menopause, while regular exercise and moderate frequency of alcohol drinking in women's early thirties are associated with a reduced risk of early menopause.
3.3 Early Life and Developmental Factors
Women born in lower social class families, whose mother smoked during the pregnancy or who were short-term breastfed (one month or less) were more likely to undergo menopause before 45. Early menopause is also associated with poorer cognitive ability and smoking in childhood. Previous research has hypothesised that poor intrauterine growth, manifested as low birthweight, may lead to a decreased peak number of primordial follicles, which in turn may be associated with earlier menopause.
3.4 Body Weight and BMI
Associations between BMI and obesity with ovarian reserve and menopause have been inconsistent across studies, and the mechanisms underlying the associations remain unclear. Many studies used a BMI measure in midlife only, whereas the effects of BMI may depend on the stage of menopause transition. Past research has also shown that change in weight rather than weight at a particular point impacts the timing of menopause.
3.5 Consequences of Early Menopause
Women with early menopause experience an extended period with loss of ovarian function and oestrogen deficiency and have an increased risk of cardiovascular disease, osteoporosis, type 2 diabetes, premature decline in cognitive function, decreased life expectancy and increased all-cause mortality.
3.6 Shared Risk Factors for Downstream Conditions
Common etiologic factors besides age — such as smoking, physical activity, alcohol consumption, menopause, and hypertension — can simultaneously promote or inhibit atherosclerosis and bone demineralization. The Mediterranean diet and other plant-forward approaches may effectively reduce vasomotor symptoms, and stress can directly impact menopausal symptoms by increasing the frequency and intensity of hot flashes and other symptoms.
4. Nutrients and Natural Ingredients: Traditional Use vs. Scientific Evidence
4.1 Phytoestrogens
Phytoestrogens are plant-derived compounds with structural and functional similarities to estradiol. The major classes include isoflavones (found primarily in soy and red clover), lignans (found in flaxseed, whole grains, and berries), and coumestans.
Soy Isoflavones (Glycine max)
Traditional Use: Soy foods — including tofu, miso, and tempeh — have been central to East Asian diets for centuries and were traditionally consumed as staple foods. Their use for health maintenance, including supporting women's health, has long been documented in traditional Chinese dietary medicine, though the specific application to menopausal symptom management is a more recent framing derived from epidemiological observations rather than classical texts.
Scientific Evidence: Soy isoflavones are phytoestrogens found mainly in soy and its derivatives. Given their estrogen-like and antioxidant and anti-inflammatory effects, they have been hypothesized to be effective in treating menopausal symptoms.
A 2025 meta-analysis (screening 2,099 articles, 12 eligible for meta-analysis) found that soy isoflavones were effective for treating menopausal symptoms (seven studies, 533 participants, Hedges' g = −0.25, 95% CI [−0.42 to −0.08]). However, the effect size was small-to-moderate. An earlier systematic review published in Molecular Nutrition and Food Research (Jacobs et al., 2009) concluded that there is no conclusive evidence, but only some indication of a benefit of soy isoflavones on hot flush frequency or severity.
Regarding bone health, the SPARE (Soy Phytoestrogens As Replacement Estrogen) study enrolled 283 women and randomized women ages 45 to 60 without osteoporosis and within five years from menopause to receive soy isoflavones 200 mg daily or placebo for 2 years. The results of most soy studies in this population have had limitations because of poor design, small sample size, or short duration.
Regarding estrogenicity safety concerns, a systematic review of RCTs in postmenopausal women concluded that consumption of soy isoflavones results in no effects on four measures of estrogenicity: endometrial thickness (ET), vaginal maturation index (VMI), FSH, and estradiol. Certainty in the evidence was high for FSH and estradiol. Despite their common classification as phytoestrogens, these results provide a strong rationale for not assuming that soy isoflavones will exert health effects similar to the hormone estrogen.
Evidence Strength: Modest and inconsistent. Meta-analyses show small but statistically significant reductions in hot flash frequency. Effects on bone are under active investigation. No hormonal-estrogenic effects on endometrium or circulating estradiol have been confirmed at typical dietary or supplemental doses.
Red Clover Isoflavones (Trifolium pratense)
Traditional Use: Red clover has been used in traditional European and North American herbal medicine as a "blood purifier" and for respiratory and skin conditions. Its specific application to menopausal symptom management is relatively modern and largely driven by its high isoflavone content (biochanin A, formononetin, daidzein, genistein).
Scientific Evidence: Studies on the effects of red clover on menopause symptoms, such as hot flashes, and on blood levels of cholesterol and other lipids have had inconsistent results. A 2016 systematic review and meta-analysis found that red clover significantly improved vaginal dryness and vaginal atrophy, but showed less therapeutic effect on psychological status, sexual problems, and sleeping disorders. The review concluded that red clover consumption may decrease the frequency of hot flashes, especially in women with severe hot flashes (5 or more per day).
In four RCTs (n=370), only one RCT reported a significant reduction in the frequency of hot flushes compared with placebo; the other three reported no significant difference between red clover and placebo.
Evidence Strength: Mixed and moderate. There is some evidence for benefit on vaginal symptoms and severe vasomotor symptoms, but overall the evidence is inconsistent across trials.
Flaxseed Lignans (Linum usitatissimum)
Traditional Use: Flaxseed (linseed) has been used in traditional European and Ayurvedic medicine since antiquity, primarily as a digestive aid and topically for skin inflammation. Its relevance to menopause is a more contemporary focus driven by its lignan content.
Scientific Evidence: Chemicals in the cell wall of flaxseed called lignans produce enterodiol and enterolactone when acted on by gut bacteria. These lignans are only bioavailable after extensive crushing; thus, milled flax flour and meal, but not whole flaxseeds or flaxseed oil, are sources of these lignans. Flaxseed is a naturally rich source of lignans — plant compounds with chemical structures and functions similar to those of the hormone estrogen. A 2024 study cited in the literature found flax was associated with relief of hot flashes, night sweats, and difficulty sleeping, though the current data is promising but more evidence is necessary.
Evidence Strength: Preliminary. Current evidence is limited to small trials. Bioavailability is form-dependent (ground/milled only).
4.2 Black Cohosh (Actaea racemosa / Cimicifuga racemosa)
Traditional Use: Black cohosh is an herb native to North America. The roots and rhizomes (underground stems) of the plant are used in dietary supplements. Its use predates European settlement of North America; Indigenous peoples of eastern North America used it for various gynecological complaints. It was later adopted in 19th-century North American botanical medicine for "female complaints" and was incorporated into the U.S. Pharmacopeia. In Europe, particularly in Germany, standardized extracts have been used since the 1950s.
Scientific Evidence: A 2023 review of 22 studies of products containing black cohosh extracts, alone or in combination with other herbs, found that they were potentially beneficial for overall menopause symptoms. Data on specific symptoms showed improvements in hot flashes but not anxiety or depressive symptoms.
A meta-analysis of six different randomized controlled trials investigated the efficacy of a single formulation of isopropanolic black cohosh extract (iCR) in reducing climacteric symptomology in perimenopausal and postmenopausal women. Patients who received iCR displayed significant reductions in climacteric symptoms when compared with patients who received placebo.
Despite these findings, studies that tested black cohosh for menopause symptoms have had inconsistent results, and a 2012 research review concluded that there is not enough evidence to support its use for menopause symptoms.
Regarding safety, rare cases of liver damage — some of them very serious — have been reported in people taking commercial black cohosh products. It is uncertain whether black cohosh was responsible for the liver damage. Nevertheless, people with liver disorders should be aware of this signal. It is uncertain whether black cohosh can reduce hot flashes related to breast cancer treatment.
Evidence Strength: Inconsistent. Some RCTs and a 2023 meta-analysis suggest potential benefit for vasomotor symptoms, but earlier Cochrane-level reviews found insufficient evidence. Rare hepatotoxicity signals in case reports warrant caution; causation remains uncertain.
4.3 Dong Quai (Angelica sinensis)
Traditional Use: Dong quai is a herb extensively used in traditional Chinese medicine to treat several reproductive conditions in women. It is extracted from the root of the Angelica sinensis plant and used as an oral supplement. In China, Korea, and Japan its dried root is used for medicinal purposes including promoting healthy blood and for menstrual cramps. In Traditional Chinese Medicine (TCM), it is rarely prescribed alone; it is used in complex multi-herb formulas intended to nourish blood and restore balance.
Scientific Evidence: In an RCT investigating the effects of dong quai on vaginal cells, endometrial thickness, and menopausal symptoms among 71 women, dong quai was not superior to placebo for the reduction of menopausal symptoms (including vasomotor symptoms) and did not show any estrogenic effects in endometrial tissues or vaginal cells. When tested as part of multi-herb formulas, results have been more mixed. Studies have only looked at dong quai use by itself, whereas in Chinese medicine it is prescribed with other herbs; when used alone, it does not seem to be effective.
There is no evidence of estrogen-like activity in human studies.
Evidence Strength: Weak for standalone use. As a single agent, current RCT evidence does not support efficacy for menopausal symptoms. Combination preparations show preliminary mixed signals but are difficult to attribute to dong quai specifically.
4.4 Evening Primrose Oil (Oenothera biennis)
Traditional Use: Evening primrose is a North American wildflower. Oil is expressed from the plant's seeds, and this oil has been used by some women to treat hot flashes. Its historical use in formal herbal medicine is relatively recent (20th century), largely driven by its gamma-linolenic acid (GLA) content.
Scientific Evidence: A 2018 study found that EPO reduced the severity of hot flashes in women, but a 2021 study found that it had no significant effect on the frequency or severity of hot flashes. Evening primrose oil contains GLA that may support vasomotor symptoms, especially hot flashes; however, one study found that evening primrose performed only slightly better than placebo when it came to the severity of hot flashes, and a review found no additional benefit.
Evidence Strength: Weak and conflicting. Current evidence does not consistently support efficacy for vasomotor symptoms.
4.5 Other Herbs Traditionally Used in Menopause Contexts
Many other botanicals are commonly used for menopause and menopause-related complaints, including licorice root (Glycyrrhiza glabra), chastetree (Vitex agnus-castus), wild yam (Dioscorea villosa), ginkgo (Ginkgo biloba), ginseng (Panax ginseng), kava (Piper methysticum), valerian (Valeriana officinalis), motherwort (Leonurus cardiaca), and St. John's Wort (Hypericum perforatum).
- Valerian (Valeriana officinalis): Used primarily for sleep disturbances, nervousness, depression, mood swings, and memory loss. Studies do not show valerian root to be a useful treatment for menopausal symptoms specifically.
- Wild Yam (Dioscorea villosa): One small study found no difference between wild yam cream and placebo cream in treating hot flashes. Chastetree, wild yam, and evening primrose are more commonly used for premenstrual syndrome (PMS) and early menopausal symptoms. Scientific evidence for wild yam in menopause remains very limited.
- Korean Red Ginseng (Panax ginseng): Several types of ginseng exist, but Korean red ginseng is most frequently studied in relation to menopause. A 2024 review of studies found that Korean red ginseng may improve menopausal symptoms and quality of life. Evidence is preliminary and study populations are small.
- St. John's Wort (Hypericum perforatum): Used primarily for sleep disturbances, nervousness, depression, and mood swings. Most of these products have not been studied in the general population and not specifically in menopausal women.
Most of these botanical products have not been studied in the general population and not in menopausal women specifically.
4.6 Calcium
Scientific Evidence: Calcium intake is well-established as integral to bone health in the context of postmenopausal bone loss. Evidence-based recommendations specify ≥1,200 mg calcium daily for postmenopausal women for bone mineral density support and fracture risk attenuation. Food-first approaches — emphasising dairy products, fortified plant-based milks, and leafy green vegetables — are unequivocally preferred, as they minimise the gastrointestinal intolerance frequently associated with high-dose supplements.
There is also epidemiological data suggesting a relationship between calcium intake and the timing of menopause: a large American study found that high dietary intake of vitamin D and calcium is associated with a lower risk of early-onset menopause, where menstrual periods cease before age 45.
A note of caution applies to supplementation: a review of the literature found that postmenopausal women with osteoporosis were at increased risk of experiencing cardiovascular events such as myocardial infarction, and this increased CVD risk has been linked to the use of calcium supplements. This area remains under active research.
Evidence Strength: Strong for bone health maintenance when combined with vitamin D, particularly in contexts of deficiency. The cardiovascular risk signal associated with supplemental (not dietary) calcium warrants consideration.
4.7 Vitamin D
Scientific Evidence: Low circulating 25-hydroxyvitamin D (25(OH)D) levels related to menopause are linked to diet, lifestyle, changes in body composition, insulin sensitivity, and reduced physical activity. Reports have indicated that the prevalence of metabolic syndrome is higher in postmenopausal women with either deficient or insufficient serum 25(OH)D levels (both 57.8%) compared with those with normal vitamin D levels (39.8%).
Evidence-based recommendations specify 800–2,000 IU vitamin D daily when combined with calcium for postmenopausal osteoporosis management. A comprehensive 2025 systematic review confirms that titrated regimens of vitamin D and calcium yield clinically meaningful benefits, albeit with efficacy modulated by baseline deficiency status and adherence. There is evidence that vitamin D over-treatment to reach extremely high circulating levels does not result in better clinical outcomes. The identification and treatment of vitamin D deficiency in postmenopausal women may improve their general health and health outcomes.
Evidence Strength: Strong in the context of deficiency correction and bone health in combination with calcium. Evidence for effects on menopausal symptoms per se (hot flashes, mood) is less established.
4.8 Omega-3 Fatty Acids
Scientific Evidence: Anti-inflammatory micronutrients, notably omega-3 fatty acids, vitamin K (particularly menaquinone-7), selenium, and magnesium, exert critical roles in counteracting the heightened inflammatory and cardiovascular burden of menopause.
For vasomotor symptoms specifically, omega-3 fatty acids were not effective for hot flashes in a large randomized trial. However, omega-3s (EPA/DHA at 1–2 g/day) may be considered for cardiometabolic health and potential mood support in menopause, though they are not effective for hot flashes.
Evidence Strength: Moderate for general cardiovascular and cardiometabolic support in postmenopausal women. Not supported as a treatment for vasomotor symptoms by large RCT evidence.
4.9 Magnesium
Scientific Evidence: Postmenopausal women exhibit heightened susceptibility to deficiencies in calcium, vitamin D, magnesium, iron, and antioxidant micronutrients — deficiencies exacerbated by diminished dietary intake, impaired absorption, and sedentary lifestyles. Magnesium glycinate (200–400 mg nightly) has been considered for general sleep support, but evidence is mixed and low-quality and not menopause-specific.
Evidence Strength: Preliminary for menopause-specific applications. Deficiency correction may support sleep and bone health indirectly. High-quality menopause-specific RCT evidence is lacking.
4.10 Vitamin K
Scientific Evidence: Common pathophysiological mechanisms linking osteoporosis and cardiovascular disease in the postmenopausal context include inflammatory cytokines, endogenous sex hormones, oxidized lipids and dyslipidemia, vitamin K and vitamin D deficiency, low calcium intake, and oxidative stress. Vitamin K2 (menaquinone-7) in particular has been identified in the literature as relevant to menopausal bone and vascular health, though large-scale RCT evidence specific to menopause remains limited.
Evidence Strength: Preliminary. Mechanistic plausibility is supported; robust menopause-specific clinical trial evidence is limited.
4.11 Vitamin E
Traditional Use: Vitamin E supplementation for hot flashes was proposed in the mid-20th century as an alternative to hormone therapy, based on observational reports.
Scientific Evidence: Vitamin E appears to have at best a mild effect on hot flashes; high doses can increase bleeding risk.
Evidence Strength: Weak for vasomotor symptoms. Effects, if any, are modest. Not strongly supported by current systematic evidence.
5. Dietary and Lifestyle Factors
5.1 Dietary Patterns: The Mediterranean Diet
Menopause onset is linked to a heightened prevalence of obesity, metabolic syndrome, cardiovascular disease, and osteoporosis. Diet is particularly relevant during menopause given its impact on quality of life and longevity and its modifiability.
Nutrition has emerged as a cornerstone of menopausal health management, offering evidence-based, non-pharmacological modalities capable of modulating hormonal, inflammatory, and metabolic pathways. Diets enriched with anti-inflammatory and phytoestrogen-containing foods have been repeatedly linked to amelioration of vasomotor symptom severity and preservation of bone integrity.
Better adherence to the Mediterranean dietary pattern is associated with a better nutritional intake profile, including a high intake of fiber, vitamins, minerals, and phytochemicals (e.g., flavonoids, polyphenols, and carotenoids), along with a low glycemic index, a high monounsaturated:saturated fat intake ratio, and low omega-6:omega-3 fatty acid intake ratio.
A 2024 systematic review of Mediterranean diet interventions in menopausal women (published in PMC) concluded that the Mediterranean diet and other plant-forward approaches may effectively reduce vasomotor symptoms.
5.2 Plant-Forward and Phytoestrogen-Rich Diets
Diets enriched with anti-inflammatory and phytoestrogen-containing foods have been repeatedly linked to amelioration of vasomotor symptom severity and preservation of bone integrity. Moreover, optimal nutrient intake counteracts sarcopenia, supports cognitive resilience, and promotes healthy longevity.
5.3 Smoking and Alcohol
Alcohol consumption, smoking, and obesity are identified in the menopause literature as factors associated with more severe or earlier menopausal outcomes. As noted above, cigarette smoking has consistently been associated with early menopause. Moderate alcohol consumption appears to be associated in some cohort data with a reduced risk of early menopause, though the overall picture is complex given alcohol's independent adverse health effects.
5.4 Physical Activity and Exercise
Evidence on the impact of physical activity and exercise on vasomotor symptoms is mixed, although moderate activity and strength training show some benefit. Exercise is consistently supported in the literature for its role in preserving bone mineral density, cardiovascular health, body weight regulation, and mood during and after the menopausal transition, even when direct effects on hot flash frequency are less certain.
5.5 Body Weight Management
Higher adiposity is associated with greater symptom burden in some studies, while lower body weight (low BMI) is associated with greater osteoporosis risk. Studies have found that women with lower body weight are more likely to have a higher risk of osteoporosis. During perimenopause and menopause, significant changes in female hormone levels are seen; women with a low BMI may be at greater risk of osteoporosis after menopause.
5.6 Stress and Sleep
The evidence examining the 6 pillars of lifestyle medicine in menopause — including nutrition, physical activity, restorative sleep, stress management, positive social connection, and avoidance of risky substances — has found that stress can directly impact menopausal symptoms by increasing the frequency and intensity of hot flashes, and that the incidence of sleep disturbances is high during the menopause transition.
5.7 Gut Microbiome and Equol Production
Research has identified that the ability to convert daidzein (an isoflavone found in soy) into equol — a more potent phytoestrogenic metabolite — depends on the composition of gut microbiota. Only approximately 25–50% of individuals in Western populations harbor equol-producing bacteria. This may partly explain the heterogeneity in response to phytoestrogen interventions. A systematic review suggests vaginal phytoestrogen formulations outperform oral forms in alleviating vaginal atrophy, incontinence, and sexual dysfunction. This highlights how bioavailability and route of delivery are critical variables when interpreting phytoestrogen research.
6. Summary of Evidence Levels
- Strong evidence (consistent RCTs and systematic reviews): Calcium + vitamin D co-supplementation for postmenopausal bone health; smoking cessation for reducing early menopause risk.
- Moderate evidence (some RCTs, inconsistent results): Soy isoflavones for modest hot flash reduction; Mediterranean dietary pattern for menopausal symptom management and cardiometabolic health; omega-3 fatty acids for cardiometabolic (not vasomotor) support.
- Preliminary or mixed evidence: Black cohosh (inconsistent RCTs; 2023 meta-analysis suggests potential benefit for hot flashes only; rare hepatotoxicity signal); red clover isoflavones (some benefit for vaginal symptoms and severe hot flashes); flaxseed lignans (small studies, promising preliminary data); Korean red ginseng (preliminary quality-of-life data).
- Weak or absent evidence: Dong quai as a single agent; evening primrose oil for vasomotor symptoms; valerian for menopausal symptoms; wild yam cream; vitamin E for hot flashes.
References
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