Menopause - Black Cohosh

Black Cohosh for Menopause Complaints

This article discusses the use of the herb, black cohosh, as a self-care measure to reduce hot flashes, vaginal thinning and depression in menopausal women. Let's take a look at the research on black cohosh and see how good it really is.

According to Clinician Reviews (April, 2000), black cohosh is a herb from the buttercup family. The herb exerts its effects on the endocrine regulatory (hormonal) mechanism in your body. It's a phytoestrogen, but by definition that means it's weaker than the estrogens your body creates. Structurally, black cohosh more closely resembles estriol, which researchers believe offers protection against cancer of the endometrium, ovaries and breast.

That's a real plus. You can take black cohosh for menopausal symptoms and may get protection against cancer at the same time.

The most commonly used preparation of black cohosh extract is Remifemin. It is standardized (that's good because you know just how much of the herb you're getting each time you take a tablet) to contain 40 mg of black cohosh extract.

Let's examine the research on how well it works for menopausal symptoms. In a study of 704 women, 49% of the women who took the preparation experienced complete relief of menopausal symptoms (hot flashes, sweating, headache, vertigo, heart palpitation, and ringing in the ears.) An additional 37.8% reported significant improvement. According to the physicians who participated in the study, 72% of the women who took the black cohosh treatment experienced advantages over those given hormonal treatment (as measured by results on the Kupperman Menopausal Index and the Hamilton Anxiety test.)

In another controlled study, of 629 women with menopausal complaints who took a standardized extract of black cohosh twice a day, 76 to 93% had an overall improvement in hot flashes, headache, irritability, heart palpitations, mild depression and sleep disturbances. The reduction in headache, sleep disturbances and heart palpitations is understandable because black cohosh also contains a small amount of salicylic acid (used to make aspirin) that has anti-inflammatory and pain-relieving qualities.

But black cohosh hasn't only been helpful for women going through natural menopause. It also helped women who had undergone hysterectomy with partial removal of their ovaries.

Results of animal studies in Japan suggest that one variety of black cohosh may increase bone mineral density. No human studies have been done yet, but the results point in the direction of black cohosh also helping protect against osteoporosis.

How safe is this herb? More than 40 years' of use in Germany has shown no evidence of serious adverse effects, contraindications or drug interactions. The only side effect shown appeared in only 7% of the participants in one of many studies. In this case, the women experienced a short-term stomach upset, but not enough to stop taking the herb and the problem didn't continue for long.

Another study critically evaluated the safety of black cohosh. The researchers examined all published studies, the FDA and World Health Organization adverse-event reporting systems, monographs, data from major manufacturers, and anecdotal reports. Human trials of more than 2,800 women demonstrated a very low incidence of adverse events (5.4%). Of these, 97% were minor and the only severe events weren't due to taking black cohosh at all.

An important consideration for long-term use of black cohosh, or any substance, is its potential toxicity and cancer-causing attributes. Researchers a Northwestern Medical School found that black cohosh extracts do not demonstrate any estrogenic activity (associated with breast cancer) so in that respect black cohosh is safe. An alarm was sounded in the summer of 2003 in an Australian case report, but the findings were not sufficiently substantiated; also, a case report of one person's reactions does not provide strong evidence while a human trial of thousands of women does.

So far, no overdose amount has been found for black cohosh in humans. In one study involving animals who were given 90 times the daily human equivalent, no negative results were found.

Black cohosh may be a herb you may want to consider taking if you have hot flashes, vaginal pain or itching, depression, or bone loss due to natural or surgically-induced menopause. And don't forget, it also may protect against breast, ovarian and endometrial cancer.

Check it out at your local health food store and look for a standardized product. The manufacturers of Remifemin suggest one 20-mg tablet twice a day. There are also combination products, such as Femtrol, by Enzymatic Therapy, that contain other herbs and vitamins. E-mail me (use the purple "email the host" box at the bottom of this page) for more information.

CAUTIONS: The research shows that for the majority of menopausal women taking black cohosh, it is safe and effective. Because each of you is unique, it is possible to have a unique reaction to this or any substance. For that reason, if you have a negative reaction, stop taking the herb and consult with your health care practitioner. (If you have liver disease or are pregnant, this is not a herb for you.) In any event, it's always a good idea to talk to your health care practitioners about herbs you are taking or planning to take and why, to make sure they do not negatively interact with any drugs (either prescribed or over-the-counter) you may be taking or conditions you have.