The combination of black cohosh and St John' s wort (300mg a day) is particularly effective for women who experience depression, irritability and fatigue. St John' s wort, reknowned for its anti-depressant effects, has been demonstrated to relieve other menopausal symptoms including headaches, palpitations, lack of concentration and decreased libido. A medical trial in Germany found that 80 per cent of women felt their symptoms had gone or substantially improved at the end of 12 weeks.

The other ' hot' herb for hot flushes is dong quai, officially called Angelica sinensis. One placebo-controlled experiment giving dong quai plus camomile to 55 postmenopausal women who complained of hot flushes and refused hormonal therapy found there was a big reduction, almost 80 per cent, in the number of hot flushes. These results became apparent after one month. Try 600mg a day. The best results are often achieved by a combination of herbs, in which case you can often use half the therapeutic amount of the herb. Whatever you try give it six weeks for a fair trial.