Black Cohosh and Hot Flashes
Does it help or doesn’t it?
Black cohosh (Cimicifugae racemoscae) is plant whose root has been used to ease hormonal imbalance symptoms in women for centuries. The Complete German Commission E Monographs, a thick volume commissioned by the German government to standardize herbal medicine and assure people of its safety and efficacy, lists its uses as including, “Premenstrual discomfort, dysmenorrheal or climacteric [menopausal]…” Its actions are listed as, “Estrogen-like actions, luteinizing hormone suppression, binding to estrogen receptors.”
Michael Moore on Black Cohosh
Michael Moore, one of the all-time great herbalists, recommends black cohosh in his book, “Medicinal Plants of the Pacific West,” saying in part, “The antispasmodic effects of Black Cohosh help ease regular, spasmodic cramps in the tube muscles, and many women will attest to its value for uterine and fallopian cramps. With its effect on skin vasodilation helping to increase the organizing secretions of menstruation—those fluids that add volume, prevent coagulation and inhibit bacteria—Black Cohosh is especially useful for cramps that accompany a slow, spotty-clotty menstruation. …The estrogenic compounds of the root are not the type that have an effect on the uterus or the breast tissue, but rather they are perceived by the hypothalamus of the brain as an estrogen metabolite and tend to lessen the pituitary surges of luteinizing hormone (LH) in the absence of ovarian estrogens. This makes is useful for women who are in menopause and have hot flashes….”
One Negative Does Not Outweigh Ten Positives
Between 2003 and 2006 there have been 10 clinical trials with black cohosh showing a positive effect on hot flashes.
What happened, then, in a widely publicized study of black cohosh published in December 2006 in the journal Annals of Internal Medicine that concluded, “Black cohosh, used in isolation, or as part of a multibotanical regimen, shows little potential as an important therapy for relief of vasomotor symptoms.”
One answer may be that it was given to the participating women daily for 12 months. As Michael Moore points out, it tends to stop working when it’s overused. In other words, it’s best used to treat symptoms, not as a long-term daily treatment. It’s not meant to be hormone replacement. Another answer may be that the study participants were divided into 5 groups, leaving relatively small numbers in each group, which makes it harder to show real effects.
According to information published by the American Botanical Council, the herbs used in the trial did not meet stability standards, and the amounts given were four times higher than those used in previous trials. It’s a truism in hormone balance that more is not better, and excessive doses of any medicine that affects hormones will often cause more problems than it solves.
Regardless of the reasons for the negative outcome in this study, it doesn’t negate the positive outcomes of the other 10 studies and centuries of use in folk medicine.
Hot Flash Relief
In my experience, black cohosh isn’t necessarily the best choice for women who are having severe hot flashes, such as those caused by a complete hysterectomy. However, for many women having mild to moderate hot flashes, black cohosh—used as directed—can be a wonderfully mild, safe and effective remedy.
Progesterone cream—in the dosage and timing recommended by Dr. John Lee—will also often relieve or lessen mild to moderate hot flashes.
There’s no doubt that nothing relieves hot flashes as reliably as estradiol (an estrogen), but estrogen is a prescription-only hormone that can lead to numerous health problems if it’s not used properly. Black cohosh is less complicated, safer and less expensive.
Remifemin is a black cohosh brand from Germany that’s well known, widely available, well researched and standardized. I know many women who have happily used it to smooth their menopausal transition.
Hot flashes can be caused by a combination of factors and no one remedy works for every woman. Dr. Lee always advised starting with the simplest solutions first, and black cohosh certainly qualifies.
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