An herb used by American women for more than 100 years, black cohosh (Actaea racemosa) continues to be a popular natural remedy for hot flashes, irritability, night sweats, depression, anxiety, vaginal dryness, insomnia, irregular or heavy bleeding, and other symptoms of menopause. In younger women, it can reduce PMS, menstrual cramps, low back pain, muscle aches, anxiety, and depression related to monthly cycles.
In the natural progression of things, hormonal shifts (called perimenopause) begin years before menopause, which is defined as a full year without periods. And for some women, a hysterectomy or other medical treatment can induce menopause earlier in life. Symptoms vary from one woman to another. "Menopausal women think, ‘oh well, I'm just getting old,' and they just put up with it," says Nancy Evans, ND, of Torrance, Calif.-based Holtorf Medical Group. "I want them to not be satisfied with anything less than optimum health."
What It Does
Black cohosh can help with monthly hormonal fluctuations or imbalances and drops in hormone levels, says Evans. It calms the nervous system, which helps reduce cramps, aches, and anxiety. It also acts as a uterine tonic, helps relieve depression, and reduces hot flashes and other symptoms. "It can also help with headaches that are associated with low estrogen-monthly, right before menses and/or during menses in a younger woman," Evans says, "and then again chronically in perimenopause and menopause."
"Black cohosh can be used long term," says Evans, "perimenopause through menopause." Published studies with more than 2,500 women found that 20 mg, twice daily, of a standardized black cohosh extract called Remifemin dramatically reduced hot flashes and other menopausal symptoms as much as hormone replacement therapy in many cases.
Studies found that black cohosh reduced other menopausal symptoms as much as hormone replacement therapy.
How It Works
For many years, the mechanism of black cohosh remained a mystery. First, it was viewed as a phytoestrogen, a plant ingredient that acts like estrogen. But later studies found that at low doses it doesn't act like a hormone and doesn't pose the risks of hormone therapy.
A cell study found that unlike estrogen, black cohosh did not induce growth of estrogen-sensitive breast cancer cells. In the journal Menopause, researchers concluded that this "suggests a favorable safety profile for use in women with a history of breast cancer."
Estrogen replacement therapy increases the density of breasts, making it more difficult to accurately diagnose cancer on mammograms. However, black cohosh does not increase breast density, according to a study of 65 women, published in the same journal.
Menopause Remedy kit
A variety of herbs can help ease perimenopausal and menopausal symptoms, including:
Black cohosh: 20 mg of Remifemin, twice daily. Expect relief within a few weeks. For other products, follow label directions.
Soy or red clover isoflavones: Since these are phytoestrogens, they are not generally recommended without medical supervision if estrogen is contraindicated due to breast cancer risk or other health conditions, but they can be alternatives for other women. Follow directions on labels or from a health professional.
Progesterone cream: Evans has found that it brings relief for about two-thirds of women. For PMS or menstrual difficulties, she recommends using it during the second half of each monthly cycle, starting on day 14. Women who no longer have periods can use it every day. Progesterone can be used with black cohosh or a phytoestrogen supplement.
Over the years, researchers observed that black cohosh affects the central nervous system. And finally, a study by the University of Illinois and the National Institutes of Health discovered that black cohosh binds with opiate receptors. The opiate receptor system regulates levels of sex hormones, pain, appetite, and the central nervous system, which, in turn, controls core body temperature.
Multiple studies have also examined the safety of black cohosh. A review of research and other clinical data, including adverse event reports from the FDA and the World Health Organization, was published in the journal Menopause. Looking at data on more than 2,800 women who took black cohosh for menopausal symptoms, it concluded that the herb is safe "for use in women experiencing menopausal symptoms and is a safe alternative for women in whom estrogen therapy is contraindicated."
Sage Advice for Hot Flashes
Supplements of sage leaves can relieve hot flashes, according to a study of 69 menopausal women who were experiencing at least five hot flashes per day. In the study, published in Advances in Therapy, sage supplements reduced hot flashes, on average, by 50 percent within 4 weeks and by 64 percent within 8 weeks. Sage teas have also been reported to reduce menopausal symptoms.
HarmonX with lifenol
Organic Cooling Sage Tea