context: Complementary and alternative therapies are treatments that are considered nontraditional. They include dietary and herbal supplements, acupuncture, chiropractic, and massage therapy, biofeedback, homeopathy, and eating certain foods that are thought to prevent disease or heal. Alternative treatments are often used alone, while complementary treatments are alternative treatments that are used in combination with traditional treatments, such as medication or surgery. Many women going through menopause try to get relief from their symptoms by including phytoestrogens, or natural estrogens, in their diet. There are also other nutritional supplements that are touted to help relieve menopausal symptoms, such as black cohosh and flaxseed. Botanicals are medicines that are derived from plants. They have been used for centuries by "folk healers" and are the foundation for nearly half of prescription drugs used today. Botanicals are sold in the form of herbs and nutritional supplements and make up a large part of alternative medicine therapies. Because supplements are not regulated by the government like prescription drugs, there is lack of standardization in their production. Different manufactures can have different ingredients in their supplements, which can lead to accidentally taking too much or too little. More research is needed to determine the safety and effectiveness of botanical treatments. To make an informed decision about the use of these treatments, be sure to discuss them with your doctor. Some botanicals, such as phytoestrogens, may help relieve menopause symptoms, although research findings are contradictory and women who have their uterus or have had breast cancer should exercise caution. Phytoestrogens are substances found in plant-based foods that are thought to have weak estrogen-like effects. Some may help lower cholesterol levels and have been suggested to relieve hot flashes and night sweats, but more research is needed. Examples of plant estrogens include isoflavones. Isoflavones can be found in foods such as soy products (tofu, soymilk, soybeans). Black cohosh is a botanical that is widely available. The North American Menopause Society reports that black cohosh may be helpful in the very short term (six months or less) for treatment of hot flashes, night sweats, and vaginal dryness, but the evidence of its effectiveness is mixed. Safety beyond six months of use is not known. Side effects are rare and include gastrointestinal upset. Evening primrose oil is another botanical that is often used to treat hot flashes, although there is no scientific evidence to support this. Side effects include nausea, diarrhea, problems with the immune system, and blood clotting . Many women with other conditions, or those who take certain medications, should not take evening primrose oil. Dong quai is another botanical that is touted to relieve hot flashes and night sweats, and has been used in traditional Chinese medicine for over 2,000 years. There is little scientific evidence to support this claim, however, and more studies are needed to determine its effectiveness. There are many other herbal supplements available -- none of which have been proven scientifically to relieve menopause symptoms. They include: fish oil, omega-3 fatty acids, red clover, ginseng, rice bran oil, wild yam, calcium, gotu kola, licorice root, sage, sarsaparilla, passion flower, chaste berry, ginkgo biloba, and valerian root. Most women experience accelerated bone loss during menopause. This increases their risk of developing osteoporosis. Adequate calcium (1,200 to 1,500 mg/day) and vitamin D (400 IU/day) can help reduce the loss of bone. A study published in June 2012 in the journal Heart suggests that taking calcium supplements may increase the risk for heart attacks -- but not if the calcium source comes from the diet. If you think you may need to take a supplement to get enough calcium, check with your doctor first. Studies have shown that vitamin K, magnesium, and boron are among the nutrients that also play a role in maintaining bone health. Dietary sources of these nutrients are best, although they are also available in supplement form. Check with your doctor before taking any of these supplements; they are not appropriate for everyone. Menopause is also associated with an increased risk of heart disease. A heart-healthy diet is plant-based and low in fat. It is rich in whole grains, fruits, vegetables, legumes, and nuts. These foods are also good sources of vitamin E, potassium, and magnesium, which may also provide heart health benefits. While food sources are best, supplementation may be recommended in select cases; check with your doctor to see if this applies to you. Omega-3 fatty acids are known to have a favorable effect on heart health by decreasing cholesterol, decreasing inflammation, thinning blood, and decreasing the growth of plaque. Supplement sources of omega-3 fatty acids include fish oil capsules and flaxseed oil. Fatty fish such as salmon, tuna, mackerel, and sardines are excellent dietary sources of omega-3 fatty acids. Ground flax meal and walnuts are also good sources of omega-3s. Omega-3 fatty acids should not be taken before surgery and by those on blood-thinning medication such as Coumadin. Check with your doctor to learn if omega-3 fatty acid supplements are right for you. The following foods are high in isoflavone and may help symptoms of menopause: Isoflavone Amount ( Mg) In Food (100g) Soybeans, green, raw 151.17 Soy flour (textured) 148.61 Soybeans, dry roasted 128.35 Instant beverage soy, powder, not reconstituted 109.51 Miso soup mix, dry 60.39 Soybean chips 54.16 Tempeh, cooked 53.00 Soybean curd cheese 28.20 Tofu, silken 27.91 Tofu, yogurt 16.30 Soymilk 9.65 While safe when taken in moderate amounts through diet, there remains some questions about the safety of consuming extraordinary amounts of soy and isoflavone supplements in women with a history of estrogen-dependent cancer, like breast cancer. Clinical trials are underway to answer these questions. Because little is known about many botanicals, the best way to evaluate their safety and effectiveness is to become an educated consumer. Ask yourself the following questions about alternative therapies: What is the treatment? What does it involve? How does it work? Why does it work? Are there any risks? What are the side effects? Is it effective? ( Ask for evidence or proof) How much does it cost? Once you answer these questions, discuss the therapy with your doctor. Make sure your doctor knows what therapy you are considering in order to discuss possible interactions or side effects with your current treatment. Your doctor can also provide you with information on other people who may have tried the same therapy. When trying to determine whether or not a product is what it says it is, one of the elements you may want to look at is how the product is promoted. Be cautious of products promoted through: Telemarketers Direct mailings Infomercials Ads disguised as valid news articles Ads in the back of magazines Additional red flags to look for include: Big Claims. If products claim to be a "cure" for your condition, or the manufacturer makes too-good-to-be-true claims, be cautious. Source. Be wary if the product is only offered through one manufacturer. Ingredients. Make sure all of the active ingredients are listed, and don't trust "secret formulas." Testimonials. Product testimonials may come from people who are paid for their endorsement. Also, be cautious of testimonials given by people who are only listed by initials, locations, or first names.