OTHER THERAPIES available "OVER THE COUNTER"

Be careful what you buy over the counter. Although seemingly "natural" this does not necessarily mean "safe". These products are not subject to the strict regulations which apply to drugs. There is little control or regulation of the quality and contaminants. Some herbal preparations have been found to contain contaminants such as arsenic, lead and mercury which are extremely toxic to the liver and kidneys. Be especially careful of Chinese Medicines which have been found to contain small amounts of active drugs and cases of kidney toxicity have been documented.

AGNUS CASTUS This is a compound known as Monks Pepper or Chasteberry extract. Agnus Castus has been well studied and is available as a tincture or in tablet form. The tablets have a very strong smell and most people find the tincture easier to take. Studies reported in the British Medical Journal have shown its value for the treatment of Pre-menstrual Tension/Syndrome. It has a hormone regulating effect and is particularly useful in the peri- menopausal phase to help settle the hormone fluctuations. Agnus Castus is only useful if hormones are not already being taken. It has been used in Germany widely where herbal medicines are often used alongside traditional medicines. It is used for impaired ovarian function, period problems and PMS. Little is known about its effect on specific menopausal symptoms.

BLACK COHOSH Cimicifuga Racemosa, also known as bugbane is a member of the buttercup family and a woodland perennial. It was used by the North American Indians who called it "black snake root" because of its gnarled black root. They boiled up the root and drank the tea, when it was used to ease menstrual cramps and childbirth pains. It was thought that it had similar properties to plant estrogens and binds to the same receptors in the body that estrogen does, although recent research suggests more of a serotonin effect. Black Cohosh may be effective for the emotional symptoms which accompany the menopause. It is thought to help with the mood swings, depression and weepiness that are associated with hormone fluctuation. It also may help alleviate hot flushes, though studies have shown varying results.
UPDATES:

1. Black cohosh does not relieve menopausal hot flushes – British Medical Journal updates and summary of study on our news page here. 
2. Safety and effect of Black Cohosh and Red Clover for hot flushes here

Black cohosh is available as a "tincture" putting drops into water to drink, and also as tablets, e.g. Remifemin. The doses vary with the product. Caution for those on blood pressure treatments and those sensitive to ASPIRIN OR SALICYLATES
One case has been reported of a woman developing autoimmune hepatitis while taking black cohosh.
From the BBC News - Liver warning over Black Cohosh: 18 July 2006 - BBC News Online

DONG QUAI is derived from a perennial plant found in southwest China. It is often found in combination products claiming to relieve menopausal symptoms. No evidence exists to show a beneficial effect on menopausal symptoms and there have been reports of bleeding when taken with warfarin.

EVENING PRIMROSE OIL is well known for its breast pain relieving properties. Evening primrose oil was available as EFFAMAST or EPOGAM on prescription for breast pain and eczema respectively. Unfortunately, it has now been withdrawn as a prescription drug but can be bought over the counter, either as Evening Primrose Oil or Borage Oil. There are a variety of strengths and potencies. Look for the amount of GLA (gamma linoleic acid) in each capsule. Aim for 240mg per day for at least 2 months and then try reducing the dose. It has been found to be useful for breast pain and mood swings but is unlikely to be helpful for hot flushes. Adverse effects include headache, skin rashes and nausea.

FEMAL is a herbal remedy made from pollen extracts and has been shown to reduce menopausal symptoms in a trial comparing it with an inactive tablet. The main effect was on hot flushes but there was also an improvement in tiredness, mood swings, dizziness, libido and general mood. It does not appear to have an estrogenic action but its mechanism of action is currently unclear.

GINKGO BILOBA is known as Maidenhair Tree or the "Memory Tree" extract. It is reported to be helpful with circulation and therefore memory. It helps improve glucose and oxygen supply to the brain. Caution: risk of increased clotting time and thus haemorrhage. Should not be taken with drugs that reduce clotting such as Warfarin, Aspirin or coumarins.

KAVA KAVA - WITHDRAWN This was first described by Captain Cook who was offered this as a "welcome drink" when he arrived on the Polynesian islands. It was helpful in alleviating anxiety without being addictive. Unfortunately it has been withdrawn due to reported liver damage as a side effect.

MACA is a root from Peru which contains high amounts of vitamins, minerals, enzymes and essential amino acids. It is said to enhance hormone production and is promoted as a libido enhancing agent, but very little scientific information on its effect is available.

SAGE This herb can be taken as a tea or as an extract to help with hot flushes. There are studies ongoing into its effectiveness but does seem to have a regulating effect on hormones. Caution with HIGH BLOOD PRESSURE and if taking TAMOXIFEN

ST JOHN'S WORT Hypericum perforatum or commonly known as St John's Wort or "Nature's Prozac". This extract acts by inhibiting neurotransmitters in the brain to have an anxiety reducing and anti-depressant effect. Shown in studies to be as effective as some traditional anti-depressants but better tolerated without the side effects. It may be useful for women suffering mild to moderate anxiety and depressive symptoms at the menopause. Caution: many drug interactions-Check with your pharmacist. Common drugs affected: DIGOXIN, THE ORAL CONTRACEPTIVE PILL, MIGRAINE DRUGS, ANTI ASTHMA (THEOPHYLLINE) AND ANTI EPILEPTIC DRUGS, WARFARIN, CYCLOSPORIN, HIV DRUGS AND OTHERS. DO NOT TAKE WITH OTHER ANTI DEPRESSANT DRUGS. St John’s Wort can cause a rash that develops in sunlight.

WILD YAM Although many HRT preparations are extracted from Yams the human body is incapable of breaking down the Yam into the sex hormones therefore they CANNOT have any effect on estrogen or progesterone in women. The sex steroids are only produced in the test tube!