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Black Cohosh a Bust for Hot Flashes

Millions of women have taken black cohosh to reduce hot flashes and other menopause-related symptoms, but the most rigorous study of the herbal supplement ever conducted shows no evidence that it works.

Studying Treatments for Menopause Symptoms

In an effort to address this, Newton and colleagues with the Seattle-based health care system Group Health Cooperative recruited 351 menopausal and newly postmenopausal women for their study.

The women were between the ages of 45 and 55 when they entered the trial, and all were experiencing at least two menopause-related symptoms a day.

Without knowing which treatment they were getting, all of the women took one of five therapies for a year. The treatments were:

  • Black cohosh alone (160 milligrams daily)
  • A combination herbal supplement that included 200 milligrams of black cohosh daily, plus alfalfa, boron, dong quai, ginseng, and other herbal ingredients
  • A combination herbal supplement that did not include black cohosh but did include recommendations to increase the consumption of soy-based foods
  • Traditional hormone therapy
  • Placebo

The researchers found no significant difference in the number of daily hot flashes experienced by women on any of the treatments, with the exception of hormone therapy.

Women taking herbal supplements had an average of half a hot flash a day less than women taking placebo -- an amount not considered significant. By comparison, the women on hormone therapy had about four fewer hot flashes a day.

What Can You Do?

So what can women who don't want to take hormone therapy do to avoid hot flashes? There is some evidence that certain antidepressants help some. And lifestyle measures can make a big difference, Newton says. These include:

  • Dressing in layers so that you can take off clothing when you feel a hot flash coming on.
  • Keeping ice water or a fan nearby.
  • Sleeping in a cool bedroom.
  • Avoiding triggers, which may include spicy food, alcohol, or hot beverages.

Women who feel they need hormone therapy should take it in the lowest effective dosage for the shortest time necessary, says Sherry Sherman, PhD, of the National Institute on Aging (NIA).

"It may be that hormone therapy is more risky for some women than for others," she tells WebMD. "We would love to be able to identify those women who can safely take estrogen and those who shouldn't."

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