Brief Answer: macafem is better but gynecologist check up needed Detailed Answer: Hello XXXXX, Remifemin is a herbal medicine but it doesn't work on hormone levels and is just a kind of dietary supplement which helps relieving some mild symptoms of menopause and almost negligible effect on bones and hot flashes. Macafem is a better supplement because besides being a herbal drug it also causes increase in levels of endogenous hormones and thus helps in relieving menopausal symptoms. But ever since macafem increases hormone levels you need a gynecologist check up to rule out any hormone responsive mass in pelvis or breast. Therefore you can start this drug only if you can be monitored by your doctor. I hope I have answered your question; but if you have any other query I will be happy to help. Regards

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