Cool Hot Flashes with Black Cohosh

A woman is considered post-menopausal if one year has elapsed since her last menstrual period, which typically occurs at about age 52. With the approach of menopause, the ovaries begin to produce fewer hormones, particularly estrogen and progesterone. A fall in these hormones causes an increase in the levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH). Physicians may test the levels of FSH and LH to determine a woman’s menopausal status.

Lower levels of circulating estrogen and progesterone can lead to symptoms that include hot flashes, sleep disturbances, vaginal dryness, discomfort with intercourse, urinary incontinence, joint or muscle aches, dizziness, nervousness, anxiety, depression, memory loss, and heart palpitations. Hormone replacement therapy has been used extensively to treat menopausal symptoms. Recent studies, however, point to the dangers of hormone replacement therapy, including an increased risk of cardiovascular disease, blood clots, dementia, and breast cancer. Because of concern over these negative effects, more women are seeking alternatives for managing menopausal symptoms.

Black cohosh has been used historically to treat arthritis, respiratory ailments, and a variety of female reproductive tract disorders. Over the past 50 years, it has gained popularity as a treatment for menopausal symptoms. In the current study, which evaluated the safety and efficacy of black cohosh, 268 women were assigned to receive either 5 mg of an alcohol extract of black cohosh (equivalent to 40 mg of dried herb) per day or placebo for 12 weeks. Symptoms were assessed at the beginning of the study and again after 4 and 12 weeks of treatment using the Menopause Rating Scale. This scale measures the intensity of symptoms such as hot flashes, mental and emotional dysfunction, cardiac symptoms, joint and muscle complaints, and disorders related to urination and vaginal dryness. Because some recent reports have suggested that black cohosh may cause liver toxicity, liver enzyme levels were also measured.

Compared with placebo, black cohosh significantly relieved menopausal symptoms, particularly hot flashes. The effects of black cohosh were most pronounced among women with lower FSH levels and among women who had gone through menopause more recently compared with those who had been in menopause for longer periods of time. There were no significant differences between the groups with respect to adverse events, and no serious side effects were noted. The use of black cohosh was not associated with elevations in liver enzymes, suggesting that if it does adversely affect liver health, such a reaction is uncommon.

These results suggest that black cohosh is a safe alternative to hormone replacement therapy for the treatment of menopausal symptoms. Other preliminary studies have found that black cohosh may also be useful for preventing age-related bone loss that can lead to osteoporosis.

Kimberly Beauchamp, ND, received her bachelor’s degree from the University of Rhode Island and her Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. She is a co-founder and practicing physician at South County Naturopaths, Inc., in Wakefield, RI. Dr. Beauchamp teaches holistic medicine classes and provides consultations focusing on detoxification and whole-foods nutrition.

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