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Maida Taylor, MD, is an associate clinical professor in the Department of Obstetrics and Gynecology and Reproductive Sciences at the University of California at San Francisco.  Dr. Taylor has written many original research papers and articles on herbal medicine, and is an author of the American College of Obstetrics and Gynecology Guidelines on the "Use of Botanicals for the Management of Menopausal Symptoms."

Black Cohosh:  A Safe Alternative For Menopause Symptom Management

A third of American women - more than 35 million - are now perimenopausal (the time surrounding menopause).  Women typically begin perimenopause between the ages of 40 and 50, with the average age for true menopause being 51.  Sooner or later, 50 to 80 percent of them may experience symptoms like hot flashes, night sweats and difficulty sleeping. Here are some answers to common questions about options for menopause symptom management:

The recent news about the risks associated with hormone replacement therapy concerns me.  Should I avoid taking estrogen for my menopause symptoms?

Hormone replacement therapy (HRT) can be very helpful for some women.  What we are finding is that it may not be a safe solution for every woman's menopausal symptoms.  For years, HRT has been the treatment doctors most often recommended for alleviating menopause symptoms. HRT also prevents and treats osteoporosis and relieves thinning and dryness of the vagina and external genitalia. On the downside, estrogen also has been associated with a small increased risk (unrelated to family history) of breast cancer, and increases the risk of blood clots in the legs and lungs.

In March the American Cancer Society published research in the Journal of the American Medical Association (JAMA) showing an association between estrogen use and an increased risk of ovarian cancer. In June an editorial in JAMA questioned whether HRT really plays as huge a role in preventing osteoporosis as scientists and health professionals claim. In July a New England Journal of Medicine article reviewed a large body of evidence on HRT and found there was insufficient scientific evidence to support the idea that women should go on HRT in order to treat or to protect against heart disease. 

So what are the alternatives? Are herbal treatments safe and effective?

Over the years, well-studied herbal products have become an important treatment option for many women's health conditions.  For women who cannot or choose not to take hormone replacement therapy, some herbals offer a safe and effective option for menopause symptom relief.

Black cohosh (cimicifuga racemosa) is one of the most widely studied herbal remedies for menopausal symptoms.  Black cohosh has a history of use that goes back hundreds of years in Native American Indian medicinal practice, where it was used for  "female problems." It was a major ingredient in Lydia Pinkham's famous women's tonic, sold for over 50 years in the late 19th and early 20th century. The herb has been widely used in Europe for over 40 years. The German Commission E, a regulatory body for herbals similar to the FDA, has approved black cohosh as a short-term treatment for menopausal symptoms. 

Black cohosh is also recognized as an effective remedy in the United States.  Guidelines on the use of botanical menopause treatments were released in May by the American College of Obstetricians and Gynecologists (ACOG).  The ACOG Guidelines considered black cohosh potentially helpful for menopause symptoms like hot flashes.

In March, GlaxoSmithKline began national marketing of a black cohosh supplement in the United States. Sold under the name Remifemin Menopause, the product contains an exclusive extract of black cohosh that has been the subject of placebo-controlled trials and shown to be safe and effective in treating hot flashes.

What kind of research has been done on black cohosh?

The black cohosh preparation used in RemiFemin has been the subject of numerous placebo-controlled clinical trials as well as open clinical monitoring trials in physicians' practices. Over 20 clinical trials have been completed spanning more than 40 years with over 3,000 subjects.  In a recent clinical study, the majority of women taking black cohosh saw the following overall reductions in their menopausal symptoms: 56% reduction in 4 weeks, 65% reduction in 8 weeks, and 70% reduction in 12 weeks.  This was 25% better than the response seen in women taking a placebo. No drug interactions have been reported in 40 years of worldwide use and adverse events have been limited to mild, transient stomach upset. 

How can I be sure the black cohosh product I find in the health food store is safe?

There are many varieties and brands of black cohosh on the market with a range of strengths and ingredients. In order to be sure the product is safe and effective, you should look for products like RemiFemin that have been clinically tested.  It may also be helpful to look for products that are distributed by a reputable company. When choosing herbals, it is important to speak with an experienced doctor or health care professional who is knowledgeable about botanicals and herbals to be sure the product is right for you. 

You can learn more about research that has been conducted on black cohosh and RemiFemin Menopause at www.remifemin.com.

For more on hot flashes and menopause, click here.

Created: 10/6/2001  -  Donnica Moore, M.D.
Reviewed: 1/23/2003  -  Donnica Moore, M.D.

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