Alternative therapies for hot flashes
In 2002, the Women’s Health Initiative (WHI) stopped its hormone
therapy study because of potential health risks. These included increases
in breast cancer, heart attack, and stroke. The WHI decision does not
apply to women taking hormones for the relief of menopausal symptoms.
However, it has spurred many to seek out natural alternatives to estrogen.
Some of the most popular are black cohosh, red clover, evening primrose
oil, and phytoestrogens such as soy. But a review published in November
2002 found little evidence that any of them do much good. The one exception
to these findings is black cohosh.
Researchers examined the results of 29 clinical trials of alternative
and complementary products used for menopausal symptoms. They found that
only black cohosh has any effect. In some studies, women who ate foods
(such as tofu) or supplements containing phytoestrogens found some relief.
Phytoestrogens are estrogen-like molecules from plants. But the benefits
largely disappeared after six weeks, and in some of the studies, women
taking a placebo fared as well as those receiving a phytoestrogen product.
Black cohosh, one of the most popular alternative treatments for menopausal
symptoms, showed the greatest promise. In three of the four studies reviewed,
it appeared to reduce hot flash frequency and intensity.
RemiFemin is the black cohosh product used in most published studies.
It is available over-the-counter in the United States. And in Germany,
where herbs are an integral part of conventional medicine, black cohosh
is approved for both menstrual and menopausal discomforts. However, its
mechanism of action is unknown.
In the March 2002, researchers funded by the manufacturer of RemiFemin
reported on a six-month trial involving 150 peri- and postmenopausal
women. Those taking the standard dose (40 mg/day) experienced a 70% reduction
in symptoms. These included hot flashes, mood swings, night sweats, and
occasional sleeplessness. Women on a higher dose (127 mg/day) got no
additional relief. Side effects include mild stomach upset, low blood
pressure, and — in high doses — headaches, vomiting, and
Although the results so far are encouraging, most clinical studies have
been brief and yielded inconsistent data. Also, different studies have
used different doses and parts of the herb, making it difficult to compare
To help clarify matters, the National Center for Complementary and Alternative
Medicine (part of the National Institutes of Health) has funded a 12-month
trial at Columbia University. This study will compare the effects of
black cohosh to a placebo in women ages 45–70. More information
is available at http://www.clinicaltrials.gov/.
March 2003 Update
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