No, unfortunately for millions of women seeking alternatives to hormone replacement therapy.
In a study published in December in the Annals of Internal Medicine, researchers from Washington state concluded that black cohosh does not work for menopausal symptoms such as hot flashes. The only thing that did, as has been shown repeatedly, was estrogen, either alone or with another hormone called progestin.
In the randomized, double-blind clinical trial, epidemiologist Katherine M. Newton, associate director for external research at Group Health, a large, integrated health plan headquartered in Seattle, assigned 351 women to one of five groups. One group got a placebo, or dummy medication. One group got hormone replacement therapy. The other three groups got either black cohosh alone, black cohosh in combination with other herbs, or the combination plus phone counseling to increase consumption of soy products. (Data is mixed on whether soy effectively combats hot flashes.)
Decreases in hot flashes were no different between the placebo and black cohosh groups, said Newton. Black cohosh, she said, “had no promise for relieving ” these symptoms in menopausal women.
That’s no surprise, said Dr. JoAnn Manson, chief of the division of preventive medicine at Brigham and Women’s Hospital and author of the book, “Hot Flashes, Hormones and Your Health.”
“When subjected to rigorous testing in clinical trials, black cohosh and other botanicals have been disappointing for hot flashes,” she said. “What’s more, even though black cohosh is ‘natural’ and seems to be safe, it has actually been linked to liver damage. Estrogen does have risks, but it is well-established as the most effective treatment available for hot flashes.”
For women with bad hot flashes that disrupt quality of life, it’s back to trying to balance the benefits of hormone therapy (symptom management, bone protection) against the risks, including a slightly higher risk of breast cancer, blood clots and stroke. Use the lowest dose possible for the shortest possible amount of time.