You're in your mid-40s, maybe early 50s. You know that your body is behaving differently than it once did. You're still having periods, but they're not the same. They're shorter, longer, less painful, more painful, and you can no longer set your clock by them. In fact, very little about your monthly cycle is the way it used to be. What's happening? Simple. You're on the cusp of menopause.

It's not a bad thing, and you know it. But the way your body reacts to this most natural transition can be a royal pain. The hot flashes, the insomnia, and oh-my-god, those mood swings and crying jags. It's enough to make a strong woman take hormones.

And for some women, hormone replacement therapy (HRT) is absolutely the right choice. But not every woman can or should take HRT. Some women believe that a more natural approach, using herbs and maybe some dietary changes, makes better sense for them.

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An Herbalist's Approach to HRT

Your doctor may recommend that you go on HRT, because there's good evidence that these drugs, which maintain your estrogen supply, can help reduce menopausal symptoms and may also protect against osteoporosis and, for some women, heart disease. And these days, you don't have to be as concerned about side effects. Fortunately, there's no longer a one-size-fits-all approach to HRT, and some newer choices have fewer side effects than others.

Here's what I recommend: Examine your personal risk factors for heart disease and osteoporosis. If you have high cholesterol or low bone density or a strong family history of heart disease or osteoporosis, and you're at low risk for some of the possible side effects of HRT such as breast cancer, then using HRT might be a good choice for you.

If you choose not to use HRT, you can reduce your risks for heart disease and osteoporosis by eating a good, low-fat diet (with plenty of fruits and vegetables), getting regular exercise, taking recommended amounts of vitamin D and calcium, and using herbs that naturally ease your transition to lower estrogen levels. These include black cohosh and flaxseed; an herbal practitioner might recommend other herbs, such as red clover or dong quai, in a formula blended especially for you.

The herbal menopause remedies that follow can help with the other troubling symptoms of menopause.

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Over the past 15 years, I've developed a variety of herbal formulas that effectively relieve menopausal symptoms for many of the women I've treated. Some are delicious teas; others are blends of liquid extracts.

In some of the formulas, I recommend using tinctures, which are liquid herbal extracts, because I believe they act more quickly, are more potent, and generally offer better results than capsules. If you don't like their taste, try diluting tinctures in a little fruit juice. These doses are appropriate for tinctures in 1:3, 1:4, and 1:5 concentrations.

You can find most of these herbs at health food stores; increasingly, herbs are sold at pharmacies and even supermarkets. Choose only single-herb products. Some formulas take time to work, so you must take them for as long as indicated to feel better. For all remedies, when a range of doses is noted, start with the smaller dose, and increase if necessary.

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Hot Flashes and Night Sweats

Hot flashes may occur when hormonal changes cause a sudden, temporary spike in body temperature. About two-thirds of American women experience them. They can occur anytime and may embarrass you when your face suddenly reddens or you perspire profusely. At night, hot flashes can lead to sweating that soaks your pj's and sheets, aggravating (or causing) insomnia. The good news is that hot flashes and night sweats eventually disappear over time.

1 oz chaste tree tincture

1 oz motherwort tincture

1 oz hawthorn tincture

1/2 oz black cohosh tincture

1/2 oz sage leaf tincture

Combine tinctures in a bottle. Take 1 teaspoon in 1/4 cup hot water, three times daily. You should notice an improvement within a week or two. You can take this formula until hot flashes are no longer a problem.

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Memory Problems

Hormonal changes can also poke holes in your memory and make you feel like you're losing your grip. Disturbed sleep and emotional stress can make the situation worse. In my experience, this simple, reliable, and delicious tea, when taken daily for 4 to 6 weeks or so, will help improve your memory. The aroma and taste are immediately invigorating.

1/2 tsp dried rosemary

1/2 tsp dried lemon balm

Steep for 10 minutes in a cup of water, covered; strain, and sweeten with honey to taste. Drink 1 to 3 cups daily.

If after 4 to 6 weeks, you're still having trouble finding your car keys, try this: 1/2 teaspoon each of gotu kola and ginkgo tinctures 2 or 3 times daily. These can be added to the above tea or taken in 1/4 cup hot water.

Insomnia

Night sweats, hormonal rushes, and stress can cause insomnia, which also aggravates memory problems. Sip this lovely tea an hour before bedtime to help you relax.

Mix 1 teaspoon each of these dried herbs: chamomile flowers, lavender flowers, and lemon balm leaf. Steep in 1 cup boiling water for 10 minutes, covered; strain, and sweeten as desired. If you still can't sleep, try this easy remedy:

1 oz skullcap tincture

1 oz motherwort tincture

1/2 oz lavender tincture

1/2 oz passionflower tincture

Combine in a bottle, and take 1/2 teaspoon every 30 minutes for 2 hours before bed. If necessary, take two additional 1/2-teaspoon doses during the night.

Caution: This should not be taken with prescription tranquilizers.