I have tried it all, because I had hot flashes in my 40's right after a pregnancy that ended in miscarriage and then my system seemed to go directly into perimenopause with hot flashes, night sweats, palpitations, etc. Black Cohosh calmed that down. And my system regained balance. Then came the light spotting periods at 48 and here came the hot flashes back with a vengence. So I tried progestrone cream, that worked, then it stopped, tried vitex, that didn't. Went to sepia, and that helped my moodiness, then that stopped helping. I read the books, tried all the suggestions and finally had success with omega 3-6-9-taking 8 pills daily. Tried maca, did nothing, rhubarb did nothing, deep breathing didn't help. Acupressure didn't help, nor did the essential oils. Hot flashes were becoming an all day event and forget about quality sleep at 50. Then a series of deaths and funerals in my family, grieving put me into hot flash overdrive, so I had to find something to survive. Added black currant oil to omega dose, and tried burdock root at night, and that has been a godsend combo. Burdock root is a cooling herb and my system was TOO acidic and too hot, despite trying to maintain an aklaline diet. It seemed to tame the fires within. So I recommend giving it a try. It helped me, and continues to cool me off so I can sleep through the night. I have occasional hot flashes if under stress, it seems to wake them up. And so I thought adding the Apple Cider Vinegar might just be the final ingredient needed to balance out my crazy hormones. I do have hypothyroidism, and that makes everything difficult. I recently gave up on prescriptions for that, and am doing WAY better with herbs, meds were just not accomplishing anything anymore. This whole change of life isn't fun, because finding the balance that works for you is a challenge. Every menopause is different, so HANG IN THERE and keep trying what is suggested, if it doesn't help move on. Just stay away from HRT, that is a proven BAD idea. But make sure you start with the basics, a good diet-real food people not the stuff that is laced with junk, regular exercise, and let stuff go, most of what makes us crazy and affects our health isn't WORTH the energy. Focus on serenity, you've earned it at this season of your life!!!!