Women vary widely in the frequency and severity of menopausal symptoms like hot flushes and night sweats. Some barely notice any symptoms, while others are severely troubled.
Estrogen replacement has been shown to reduce the frequency of these symptoms by about 80 percent, but its use has fallen dramatically after a major study showed that estrogen replacement therapy increases the risk of breast cancer and other serious disorders.
As a result, more women have turned to black cohosh, a dietary supplement long touted for its effectiveness in preventing menopausal symptoms. In general, the results of previous studies were inconclusive although some small and poorly designed trials had shown that black cohosh reduced menopausal symptoms.
Unfortunately, however, 160 mg of black cohosh a day proved no better than placebo in a recent, well-designed, year-long trial supported by the National Institutes of Health. The study enrolled 351 women between 45 and 55 years of age who averaged 6 episodes of hot flushes a day.
Black cohosh can be purchased as pills or a liquid in health food stores or through Internet ads.
The cover of "The Complete Encyclopedia of Natural Healing" emphasizes that its author, Gary Null, is a New York Times bestselling author. Inside, the book states "studies have credited it [black cohosh] with helping relieve menopausal symptoms in a high percentage of menopausal women."
Black cohosh has also been promoted for snakebites, sore throats, insect bites, arthritis, and menstrual cramps. Null says black cohosh "is a potent agent for reducing the suffering that accompanies painful menstrual periods." I can't help but believe that reliable studies would show black cohosh is no more effective for these conditions than for menopausal symptoms. It's hard to understand how enough people could buy Null's 70 or more books to make him a bestselling author, if like this one, they are replete with unproven treatments plus almost 250 pages of testimonials, which are a waste of paper.
What can women do to relieve menopausal symptoms, then? Women with significant symptoms should be reassured by the finding that the women taking the placebo - an ineffective pill - in this NIH study had about a 30 percent decline in the severity and frequency of symptoms over the course of a year. The study author also suggests that symptoms may be relieved by sleeping in a cooler room, keeping a fan and ice water close by, wearing layers of clothing, and avoiding hot liquids or alcohol that may trigger symptoms.
Other studies are under way that are looking for other ways to diminish menopausal symptoms. For now, the best choice for women with truly bothersome symptoms is taking estrogen replacement in the smallest dose and for the shortest possible period of time.
