Black cohosh battles the Black cloud

Menopause: As one caring husband reassures his wife, "Honey, you are still hot; it just comes in flushes now!" Quickly refuting, the wife replies, "Yes, Dear, and it’s my new 007 licence to kill - one that holds up in court!"

Jokes aside, approximately two thirds of women in menopause develop menopausal symptoms, and this can be a dismal time in life, both physically and emotionally. Menopause is the cessation of fertility, evidenced by lack of menstrual cycle and a decrease in hormones like estrogen. These changes can cause symptoms like vaginal dryness, mood swings and ‘hot flushes’, driving ladies, and their families alike, to seek help.

We live in an age of abundant medical knowledge, coupled with growing acceptance for alternative therapies. However, amidst the cornucopia of Menopausal treatments and alternatives available, confusion can appear when deciding what treatment is the right one for me?

The first decision that many women approach is the cross-roads of alternative therapy as apposed to the road of traditional medical (like Hormone Replacement Therapy (HRT)).

In the middle of 2002, significant public panic resulted when the media released American studies highlighting the threat that HRT treatment increased the risk of breast cancer and heart disease. Amid the alarm, experts of the scientific community justified the results as having been misinterpreted by the media and not in context. Following the hype, whether the HRT risks were justified or not, it became a catalyst that saw many Australian women seeking alternative therapies, in the hope of a providing safer transition through the problems of menopause.

Professor John Eden, director of the Sydney Menopause Centre and the Natural Therapies Unit at the Royal Women’s Hospital in Sydney, is not strange to recommending high quality herbal therapies in conjunction to his medical treatments. Today the use of alternative therapies is gaining wider acceptance in the scientific and medical community.

Amid concerns that Hormone Replacement Therapy (HRT) increased the risk of cancer, Black Cohosh has been sought as a safer treatment alternative. In 2006 studies were conducted on a few complementary therapies, including Red Clover, Ginseng and Black Cohosh. The International Journal of Cancer stated that, "Use of Black cohosh had a significant breast cancer protective effect" and that, "Black cohosh may be effective in treating menopausal symptoms, and has antiestrogenic, antiproliferative and antioxidant properties".

Cimicifuga racemosa (Black Cohosh) is a perennial plant native to North America. It had been traditionally used by Native Americans as a remedy for menstrual, menopausal and other conditions. For more than 50 years the European community, particularly the Germans, have utilised extracts of the root to treat menopausal symptoms.

Unfortunately, at a similar time that HRT was under scrutiny as a potential threat for increasing cancer, Black Cohosh came under the spotlight as potentially causing liver damage. However, controversy reigned in the alternative therapies sector, as to the extent of the results posed. As with most scare mongering campaigns, devised to discredit alternative therapies, the results found were ambiguous.

To clear the matter, Australia’s Therapeutic Goods Administration (TGA) put together a group of experts from Australia and New Zealand to advise on the matter. After consideration of the available information, it was concluded that, "there appears to be an association between the use of Black Cohosh and liver damage, but that it is very rare. It was not possible to identify, with any certainty, the strength of the association, or any particular group, type of preparation, dose, duration of use or specific products." The article stated that, "Considering the widespread use of Black Cohosh, the incidence of liver reaction appears to be very low."

The World Health Organisation (WHO) also, states there is only a potential association between hepatotoxicity (liver toxicity) and herbal medicine containing Cimicifuga (Black Cohosh). It was said of The European Medicines Agencies (EMEA) of the sixteen of the worldwide reported case reports studied for hepatotoxicity, five cases were excluded, seven were thought to be unlikely related and there was a temporal association in four cases evaluated.

The National Herbalists Association of Australia (NHAA) supports the usage of Black Cohosh. They refuted in a media release that a systematic review of the safety of Black Cohosh, analysing data from the World Health Organisation and National drug safety bodies, concluded that Black Cohosh is a safe medicinal herb.

There is massive amount of support for Black Cohosh, its efficacy proved by years of scientific and anecdotal evidence. The value of Black Cohosh is underestimated, especially in cases where Estrogen Replacement Therapy is contraindicated. In these cases The Journal of Women’s Health reports it as a ‘safe, effective alternative on alleviating menopausal symptom’s’.

Sound scientific evidence for treating menopausal symptoms appears to be the clinch in setting Black Cohosh apart from the other botanicals supplements on the shelves. Many preparations make claim to help, but few have proven their effectiveness or have limited evidence to demonstrate safety.

Most studies support that Black Cohosh is one of the most effective botanical supplements for the relief of the menopausal vasomotor symptoms (like hot flushes). The North American Menopause Society reviewed herbal medicinal products for the treatment of Menopausal symptoms, and concluded that, "the evidence for black Cohosh is promising". Many scientific reports also supporting the use of Black Cohosh in conjunction with depression alleviating therapies, such as a quality St John’s Wort formula.

The evidence for the safety and benefit of Black Cohosh, out of the plethora of botanical preparations available, is conclusive for the relief of menopausal-related symptoms. It is backed by years of anecdotal evidence and scientifically sound findings. As with any intervention program, whether medical or alternative, care should be taken and any adverse reactions reported to your Health Care professional.