Will Black Cohosh Stop Hot Sweats?

According to a May 2000 report by Drug Store News, black cohosh is one of the most popular herbal remedies currently on the market. Although it is used for a variety of conditions relating to the female reproductive and endocrine system, its most popular use is the treatment of menopausal symptoms. Millions of women have used black cohosh to treat the discomforts associated with menopause, including hot flashes and night sweats. While preliminary data indicates that black cohosh is an effective treatment for hot flashes, its effectiveness remains controversial.

Clinical Evidence

• According to the National Centers for Complementary and Alternative Medicine, dozens of studies have yielded encouraging results regarding black cohosh's role in reducing the severity of menopausal symptoms, especially hot flashes. One placebo-controlled study, published by NCCAM in 2002, documented the overall well-being of 85 women taking black cohosh compared to placebo. Women taking black cohosh reported significantly fewer hot flashes and night sweats.

  Many other studies have also been performed on women experiencing menopausal symptoms for a variety of reasons. Trials have investigated black cohosh's ability to fight hot flashes in breast cancer survivors, women who have had hysterectomies, and women experiencing "natural" menopause during middle age. Most have yielded encouraging results.

Controversy

• Though extensive research has been performed regarding black cohosh's efficacy, there are many limitations to the currently published trials. While acknowledging that preliminary studies have been encouraging, the National Institutes of Health caution that most studies that have been performed have had no placebo controls and very small groups of test subjects.

  For a medical trial to be accepted as scientific fact, it must be performed on a double-blind, placebo-controlled basis, and must include hundreds of human tests subjects. Only after extensive peer review can evidence be considered unbiased fact. Since such comprehensive research is still limited, it is not yet known if black cohosh is truly effective in combating symptoms of menopause.

Pharmacology

• Doctors and alternative health professionals do not yet fully understand how black cohosh affects the endocrine system or reproductive organs. One compound found in black cohosh, called fukinolic acid, seems to have an estrogenic effect on the body. During menopause, depleted estrogen levels are the primary cause of hot flashes and night sweats. The natural estrogen mimickers found in black cohosh may prevent night sweats by "tricking" the body into producing more estrogen.
  Additionally, black cohosh seems to have some effect on seratonin and dopamine, two key neurotransmitters that may adjust or weaken their function during menopause. Other plant-based compounds, like glycosides and species-specific resins, seem to increase circulation to the reproductive organs, possibly stimulating heightened activity in the ovaries.

Potential Risks

• Side effects from black cohosh are usually mild. People taking black cohosh are slightly more likely to experience headache and upset stomach, though these side effects are less common than in patients taking conventional estrogen therapy. Rarely, women taking black cohosh pay experience weight fluctuation and heaviness in the legs.

  Liver disease is a very serious potential side effect of black cohosh. According to a report published by the Medical Journal of Australia, one 47-year-old woman experienced acute hepatitis after taking black cohosh supplements and required a liver transplant. Although it is unclear if the herb was the cause of her condition, people at risk of developing liver disease are advised to avoid the herb except under medical supervision.

Worth a Try?

• While it is not completely clear how well black cohosh can prevent hot flashes, millions of women have reported positive results from using it. Overall, the likelihood of side effects and interactions are significantly lower for women taking black cohosh than women using hormone replacement therapy, and black cohosh extracts are surprisingly affordable. Given this, most doctors and patients find that black cohosh therapy is worthwhile.

  Some women should not take black cohosh or should take it only under the direct supervision of a health care provider. Women with liver disease, or who are at risk of developing liver disease, should avoid any herbal supplement metabolized by the liver. Additionally, until black cohosh's effects on breast tissue are better understood, it is best avoided by patients with a history of breast cancer.