WOMEN'S HEALTH
January 31, 2013

Black Cohosh for Hot Flashes

Complementary and alternative (CAM) therapies may provide relief for women transitioning to menopause. HRT helps, too.

The physical changes that accompany menopause are at best unpleasant and often quite disruptive. Women experience vaginal dryness and the unpredictable and often profuse sweating best known as hot flashes which can interfere with daily life. As the woman's body adjusts to the gradual loss of the hormones estrogen and progesterone during perimenopause, sexual pleasure can suffer.

A recent review paper looks at the advantages and disadvantages of CAM and HRT to treat the symptoms of menopause.

Hormone replacement therapy (HRT) remains the most effective way to treat hot flashes, one of the most common symptoms of menopause, improving symptoms in 80 to 90 percent of women. It is also an effective treatment for vaginal dryness. However, there are potential health risks associated with HRT, such as breast cancer, blood clots, stroke, and cardiovascular problems. Such risks may lead women to investigate other non-pharmaceutical treatment options like behavior modification and CAM therapies.

Lately, the focus has been on complementary and alternative medicine (CAM) therapies to treat menopausal symptoms, used either instead of, or in addition to, traditional (pharmacological) methods. A recent review paper looks at the advantages and disadvantages of CAM and HRT to treat the symptoms of menopause.

The CAM therapies most often used to treat menopausal symptoms are soy, black cohosh, and red clover, which may be helpful for women who are experiencing hot flashes. Soy, the most common plant containing estrogen, is found in food and supplements. Red clover, a legume, also contains estrogen; so does black cohosh, a plant originating from the eastern United States and Canada. Both have been reported to ease postmenopausal symptoms.

Women who are currently taking tamoxifen, who have a personal history of breast cancer, or who are at high risk for breast cancer, should avoid these herbal agents.

Hormone replacement therapy can still be a good treatment choice for most women, Iris Tong, author of the paper and director of women's primary care at the Warren Alpert Medical School of Brown University, told TheDoctor in an e-mail. If HRT is effective, women who are already using HRT likely do not need to use CAM in addition to HRT treat their symptoms.

The plant estrogens, or phytoestrogens, in soy, black cohosh, and red clover can interfere with the chemotherapy agent tamoxifen and can theoretically stimulate breast tissue, says Tong. Therefore, women who are currently taking tamoxifen, who have a personal history of breast cancer, or who are at high risk for breast cancer, should avoid these herbal agents.

Tong, who is also Director of Women’s Primary Care at the Women’s Medicine Collaborative, advises women to discuss HRT and CAM with their healthcare provider. Menopausal women are at higher risk for cardiac disease and osteoporosis and eventually, bone loss and fractures. Lifestyle modifications such as eating well, exercising regularly, and quitting smoking can decrease these risks. Women should speak to their healthcare providers about specific lifestyle modifications that they can make to reduce their risk for cardiac disease and osteoporosis.

According to Jason Waugh, an obstetrician and gynecologist in the U.K. and editor of the journal in which Tong's article appears, “Even simple behavior modification can make a difference to postmenopausal symptoms, including keeping the room temperature cool, wearing layered clothing, relaxation techniques, and smoking cessation.” The review was published online in the journal, The Obstetrician & Gynaecologist.
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