| Furthermore, on the basis of herb and supplement studies I do not recommend the use of soy, black cohosh, dong quai, evening primrose oil, or any other supplement for hot flashes. So called "natural" female hormones, like estrogenlike compounds derived from plants, if they have any active properties, will also have the negative properties of HRT and therefore should not be used. I do recommend use of SSRIs, clonidine, or gabapen-tin for hot flashes if needed, since these drugs are safe and nonaddictive and have been shown in clinical trials to reduce hot flashes. |
Herbert Ross, DC with Keri Brenner, L.Ac.
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 Herbal Therapy
Herbs that are helpful for balancing women's hormones include unicorn root, an herb used in folk remedies for premenopausal women, and black cohosh. These herbs promote the normal production of estrogen and contribute to the proper balance of estrogen and progesterone. Other herbs that may be helpful include dong quai, licorice (to avoid any potentially toxic effects, use deglycyrrhizinated licorice supplements), and Siberian ginseng, all of which help balance hormone levels.40
Linda Ojeda, CNC, Ph.D. |
C. W. Randolph, M.D.
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 Phytoestrogens are naturally occurring estrogenic compounds that are found in a variety of herbs of and spices, such as red clover, black cohosh, chasteberry, and dong quai. Some of the strongest phytoestrogen-containing foods are soy products, including soybeans, soy milk, tofu, tempeh, textured vegetable protein, roasted soybeans, soy granules, miso, and edamame. Although their chemical structure resembles estrogen, it is much less powerful than human estrogen; in fact, its effectiveness is just a thousandth of human estrogen's effectiveness. |
Brigitte Mars, A.H.G.
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 The common name black cohosh makes reference to the dark color of the rhizome; cohosh is Algonquin for "rough with hairs," in reference to the bumpy texture of the rhizome. |
Tori Hudson, N.D.
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 As mentioned earlier, in a double-blind, randomized, placebo-controlled study using a combination of black cohosh and Saint John's wort, the study group was significantly superior to the placebo group on both a general menopause rating scale and a depression scale.111
Saint John's Wort
Standardized extract of 3 percent hypericin: 300 mg 3 times per day
Kava {Piper Methysticum). Kava is a plant indigenous to Melanesia, Micronesia, and Polynesia. Its properties have been most often associated with analgesic, sedative, anxiolytic, muscle relaxant, and anticonvulsant effects. |
| They are often used in combination with each other or in formulations with some of the more dominant choices such as crampbark, black haw, valerian, and black cohosh.
Additional herbs may also be considered for their different actions. For example, herbs that have an anti-inflammatory effect, such as white willow and ginger; diuretic herbs that decrease the pelvic congestion, such as parsley, dandelion leaf, or horsetail; and herbs that promote circulation, such as ginkgo, may also have a role in reducing the pain experienced from dysmenorrhea.
Natural Progesterone. |
Herbert Ross, DC with Keri Brenner, L.Ac.
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| Herbs that have estrogenic effects in the body, such as licorice, black cohosh, and damiana
3. Birth control pills that have high levels of estrogen
4. Environmental toxins that mimic the actions of estrogen (xenoestrogens), most notably pesticides
5. Exposure to radiation, which increases estrogen levels in the blood
6. Chronic constipation, which Interferes with the body's ability to eliminate estrogen properly
7. Supplemental estrogen as part of hormone replacement therapy for menopausal symptoms
Too little progesterone may be caused by:
8. |
Bottom Line Health
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| I'm cautious about black cohosh, red clover and other plant remedies that have estrogen-like properties. Research has not demonstrated clearly that they help, and some can have harmful side effects if not properly monitored. However, some women do report good results when they use these remedies. Check with your doctor first. If you don't notice a clear change in symptoms after two to three weeks of trying a new remedy, ask your doctor about trying something else.
What men can do: Buy a dual-control electric blanket so that both of you will be comfortable. Make her a cup of herbal tea. |
Tori Hudson, N.D.
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| It should include vitamin B6; magnesium; gamma linolenic acid from borage, evening primrose, or black currant oil; chaste tree (vitex); vitamin E; Saint John's wort; and possibly some traditional herbs for PMS, including dandelion leaf, dong quai, black cohosh, and wild yam. (See the Resources section for formulation sources.)
• Take a multiple vitamin/mineral supplement, 1 to 6 capsules per day.
• Take 1,000-1,200 mg of calcium per day. |
| In one of the largest studies, 629 women with menopausal complaints received a liquid standardized extract of black cohosh at 40 drops twice per day for six to eight weeks. As early as four weeks after beginning the therapy, a clear improvement in the menopausal ailments was seen in approximately 80 percent of the women. After six to eight weeks, complete disappearance of symptoms occurred in approximately 50 percent. |
| Currently, there is some thought that black cohosh may act as a mild serotonin reuptake inhibitor, which would make it an appealing option for PMS.83
Other plants are used because of their benefit with specific symptoms; for example, kava extract for anxiety, dandelion leaf for water weight gain, valerian for sleep problems, and lemon balm for herpes eruptions. You will often find one or more of these herbs in combination herbal and nutritional products that have been specifically formulated for PMS symptom relief. |
Gary Null and Amy McDonald
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 Indian snakeroot also has anti-hypertensive qualities. black cohosh, an American herb, helps lower blood pressure.
We've said this before, but let's restate the warnings: It is not at all advisable to take all these substances at the same time. Instead, take one or two of these for a month, as professionally directed. Record the results. Then, under continued guidance, repeat or increase the dosage, or move on to different substances. Do not self-medicate. These supplements are not meant as medicines. |
Michael Friedman, ND
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 The mechanism of action appears to be similar to other phytoestrogens, as pharmacological studies have shown a weak estrogen binding activity in vitro. black cohosh extracts have been shown to suppress LH levels and cause peripheral vasodilation in humans. black cohosh is also known to be anti-inflammatory, hypotensive, mildly sedating, and spasmolytic.
Estrogenic and Progesterogenic Herbs: Many other botanicals have estrogenic or progesterogenic effects. For this reason combination products are commonly seen containing a mix of estrogenic and progesterogenic herbs. |
Jonathan V. Wright, M.D. and Alan R. Gaby, M.D.
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 Black cohosh is particularly well studied for helping with the psychological symptoms of menopause—those 'nerve' symptoms you mentioned. Remember, though, that modern science has just recently started serious research on herbal or botanical remedies. And where do scientific researchers get their ideas about which herbs to research for which conditions? From so-called 'folk' or 'ethnic' medicine—in effect from the experiments of thousands of generations of grandmothers! Don't let your sister get to you. |
Heather Boon, BScPhm, PhD and Michael Smith, BPharm, MRPharmS, ND
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 Research has shown that substances found in black cohosh have 'hormone-like' properties that influence the endocrine system. A growing amount of research, including clinical trials, show that some black cohosh products may be of help in alleviating the symptoms of menopause (hot flashes, anxiety, mild depression), premenstrual syndrome, dysmenorrhea, and uterine spasm.
Relevant Research
Preventative and Therapeutic Uses
CONSTITUENTS612
ž tpjterpenoids: a complex mixture including actein, cimigoside, 12-acetylactein, cimifugoside, 27-deoxyacetylacteol.
ž flavonoids: fomiononctin. |
Jonathan V. Wright, M.D. and Alan R. Gaby, M.D.
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| I also got some Dong quai, along with a combination 'women's herbal' with black cohosh that the clerk told me about, and those really helped for over a year. My periods acted like they were coming back—they got a little heavier, the hot flashes disappeared, and all the 'nerve' symptoms got better. But now I haven't had any menstrual bleeding for about 6 months, and all the symptoms are back. My sister, she's 7 years older, is just laughing at me. She doesn't believe in vitamins or herbs or anything. |
Jonny Bowden, Ph.D., C.N.S.
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 The position that menopause is a transition into a powerful and life-affirming stage of life is elucidated brilliantly, poetically, and movingly by my friend Christiane Northrup, M.D., in her excellent book The Wisdom of Menopause. Other wonderful books—notably Shari Lieberman's Get Off the Menopause Roller Coaster!—are also out there to help women navigate this transition in the healthiest and happiest of ways. |
John Heinerman
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 Because black cohosh is able to reduce hypertension somewhat and exert a slight sedative action on the nerves, it may be good for such women. Recommended dosage is about 2 capsules twice daily. black cohosh is available from health food stores.
A Medical Testimony for Lung Disorders
In the Bulletin of The Lloyd Library of Botany, Pharmacy and Materia Medica Number 30 (Cincinnati: 1931; P-271) is a testimony given by an early physician of eclectic medicine in 1823 regarding black cohosh. Dr. J.S. Gardner recommended this herb in tea form (2 cups daily) for all lung problems. |
Alan R. Gaby, M.D., Jonathan V. Wright, M.D., Forrest Batz, Pharm.D. Rick Chester, RPh., N.D., DipLAc. George Constantine, R.Ph., Ph.D. Linnea D. Thompson, Pharm.D., N.D.
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 Black cohosh is not a substitute for hormone replacement therapy during menopause (page 311).
Botanical name: Ballota nigra Parts used and where grown
This European mint family (Lamiaceae) plant now grows in North America and on other continents as well. The leaf and flower are used medicinally. This plant should not be confused with white horehound (page 691), which acts differently. |
| This approval appears to be based on historical use as there are no modern clinical trials to support the use of black cohosh for PMS.
Based on anecdotal evidence, yarrow (page 763) tea has been used by European doctors when the main symptom of PMS is spastic pain.58 Combine 2—3 teaspoons of yarrow flowers with one cup of hot water, then cover and steep for 15 minutes. Drink three to five cups per day beginning two days before PMS symptoms usually commence. In addition, 1—3 cups of the tea added to hot or cold water can be used as a sitz bath.
Are there any side effects or interactions? |
| One double-blind trial found that a product containing willow along with black cohosh (page 637), guaiac (Guaiacum officinale, G. sanctum), sarsaparilla (page 742), and aspen {Popu-lus spp.) bark effectively reduced osteoarthritis pain compared to placebo.89 Another trial found that 1,360 mg of willow bark extract per day (delivering 240 mg of salicin) was somewhat effective in treating pain associated with knee and/or hip OA.90
Stinging nettle (page 714) has historically been used for joint pain. |
Michael T. Murray, N.D.
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 Recent scientific investigation has upheld the use of black cohosh in both dysmenorrhea and menopause. Clinical studies show that extracts of black cohosh relieve not only hot flashes, but also depression and vaginal atrophy.5 In addition to exerting vascular effects, black cohosh reduces luteinizing hormone (LH) levels, thus implying a significant estrogenic effect. Remifemin®, a commercial formulation, is the most popular natural alternative to estrogen therapy in Germany. |
Alan R. Gaby, M.D., Jonathan V. Wright, M.D., Forrest Batz, Pharm.D. Rick Chester, RPh., N.D., DipLAc. George Constantine, R.Ph., Ph.D. Linnea D. Thompson, Pharm.D., N.D.
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| Blue cohosh (page 643), although unrelated to black cohosh, has also been used traditionally for easing painful menstrual periods. Blue cohosh, which is generally taken as a tincture, should be limited to no more than 1-2 ml taken three times per day. The average single application of the whole herb is 300-1,000 mg. Blue cohosh is generally used in combination with other herbs. Women of childbearing age using this herb should cease using it as soon as they become pregnant (page 363)—the herb was shown to cause heart problems in an infant born following maternal use of blue cohosh. |
Patrick Holford
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 One recent study gave a combination of panax ginseng, black cohosh, soy, and green tea extracts in the morning and black cohosh, soy, kava, hops, and valerian extracts in the evening. By the end of the second week, the number of hot flashes was reduced by 47 percent.17 By the way, acupuncture and yoga have also both been proven to help.
Synthetic or natural HRT?
The conventional view is that menopausal symptoms are brought about by a lack of estrogen. There is little doubt that the cessation of menstruation is due to declining levels of estrogen, which are needed to trigger ovulation. |
Jonathan V. Wright, M.D. and Alan R. Gaby, M.D.
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| As far as we are aware, black cohosh is the only herb that has been demonstrated by clinical research to relieve menopausal symptoms,14 although the other herbs mentioned have been shown to have estrogen-like effects in animal studies.151617' 18 In a double-blind study, dong quai was no more effective than a placebo at relieving menopausal symptoms.19 However, most herbalists use dong quai in combination with other herbs, rather than by itself, as in that study. On rare occasions, ginseng has caused vaginal bleeding in postmenopausal women, apparently because of its estrogenic activity. |
Alan R. Gaby, M.D., Jonathan V. Wright, M.D., Forrest Batz, Pharm.D. Rick Chester, RPh., N.D., DipLAc. George Constantine, R.Ph., Ph.D. Linnea D. Thompson, Pharm.D., N.D.
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| A review of eight trials concluded black cohosh to be both safe and effecrive.34 Many doctors recommend 20 mg of a highly concentrated extract taken twice per day; 2-4 ml of tincture three times per day may also be used.
A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.35 These herbs include licorice (page 702), alfalfa (page 623), and red clover (page 735). |
Amarjit S. Basra
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 Middle East plants such as turmeric (Curcuma longa) and boswellia (Boswellia serata), from the Far East ginger (Zingiber officinale), and in North America black cohosh (Cicimifuga racemosa) have all traditionally been used to treat inflamed joints. Despite their aspirin content their effect is much slower than orthodox therapies. Devil's claw (Harpagophytum procumbens) is a native of South Africa. It has also traditionally been used and has been found to have analgesic effects, although little anti-inflammatory potential. |
Marshall Editions
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 Dong Quai. These herbs have a variety of compounds that may have effects similar to the body's own progesterone or estrogen, helping to counteract the hormone abnormalities that lead to hirsutism. As with Asian ginseng, above, or any other treatment for hirsutism, treatment should be continued for at least four to six months and should not take the place of conventional medical treatment or diagnosis. |
Amarjit S. Basra
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| A small short-term Australian study has shown benefit, with a 70 percent improvement in menopausal symptoms after three months, and a review of eight human studies found black cohosh to be a safe, effective alternative to estrogen therapy.38 Wild yam (Dioscorea villosa) has been widely promoted as an alternative approach to hormone therapy, yet it does not seem to have any benefit related to phytoestrogen intake. It contains dioscin, a progesterone precursor which the body is unable to convert to progesterone. |
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