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Could Grape Seed Extract Be an Alternative Treatment in the Management of Hot Flashes? To the Editor I congratulate Dr Gupta on his clearly communicated Patient Page1 on management of hormone therapy– related hot flashes. He noted that safety and effectiveness information is lacking for herbal products, soy, and acupuncture. However, in common practice, grape seed extract is used as an herbal product that may alleviate hot flashes. Thus far, only 1 study in the literature may support use of grape seed extract in the management of hot flashes. In this randomized, doubleblind, placebo-controlled study, women taking grape seed extract with concentrated amounts of the polyphenol antioxidant proanthocyanidin showed improved menopausal symptoms (including hot flashes, anxiety, and insomnia).2 However, more studies are needed to confirm its use as an alternative treatment for hormone therapy–related hot flashes.