The Metagenics Estrovera has been very effective in managing my perimenopause symptoms such as hot flashes and fluctuating heartbeats per minute. Before taking Estovera my BPM would climb from a resting rate of 60 BPM to upward of 120 BPM within 15 minutes. Since taking the Estrovera pills daily, I have not experienced any extreme fluctuations in BPM and have also not had any hot flashes!