Ever since the publication of the first study out of the Women’s Health Initiative in 2002 on hormone replacement therapy, women have increasingly sought herbal alternatives in search of safe and effective therapies for their menopause symptoms.
In the last 25 years, black cohosh has emerged as the most studied of the herbal alternatives to hormone replacement therapy for menopause symptoms. Since the 1980s and up through 2005, numerous studies, including several randomized controlled trials have studied a standardized extract of black cohosh with encouraging, but mixed results. Since 2003, there have been about 11 clinical studies on black cohosh, and all but one were positive. Although not all studies done in the last 25 years clearly show benefit, the majority of the evidence supports the efficacy of black cohosh for treating perimenopause and menopause symptoms.
The most recent study, called the Herbal Alternatives for Menopause Trial (HALT) study, was a one-year randomized, double-blind, placebo-controlled trial with five different groups studied. The results showed no benefit of black cohosh, or soy, or an herbal combination. The study was well designed, but half the women in this study were perimenopausal women which have fluctuating symptoms, fluctuating hormone levels, and presents a particular challenge as a study group. This one negative study should be considered in the context of all the other studies on black cohosh, the majority with positive outcomes.
The collective findings on black cohosh studies teach us that it is most effective for menopause symptoms of hot flushes day time or night time, mood swings, sleep disorders and body aches.
Standardized extracts of black cohosh continue to be one of the most reliable herbal approaches to treating a wide array of peri-menopausal and menopausal symptoms. The most common dosage utilized is 40 mg daily but many achieve better results with 40 mg twice daily. One should expect results within 4 weeks. In my experience, about 85 % of women will receive benefit and maybe 50% will achieve complete amelioration of their hot flashes and nightsweats. This is consistent with the largest, yet un-controlled study ever done on black cohosh on 1982. Treating menopausal women is rewarding, and black cohosh is our most well researched and important botanical therapy to date.
