Black Cohosh Does Not Appear to Relieve Hot Flashes in Breast Cancer Survivors

Black Cohosh Does Not Appear to Relieve Hot Flashes in Breast Cancer Survivors, Although Sweating May Be Reduced

According to an article recently published in theJournal of Clinical Oncology, black cohosh fails to improve typical menospause symptoms, except for sweating, in women with a history of breast cancer.

Breast cancer is the second leading cause of cancer death in women in the United States, with approximately 200,000 cases diagnosed each year. Breast cancer survivors often complain of menopausal symptoms after treatment, which may be the result of certain types of hormone therapy (such as tamoxifen), chemotherapy or due to their age. Hot flashes can have a particularly adverse effect on breast cancer survivors’ quality of life, and many breast cancer patients reported using black cohosh to relieve these symptoms.

Black cohosh (Cimicifuga racemosa) is a woodland plant native to the eastern United States and Canada. It is known in folk medicine as a woman’s remedy and has been historically used primarily to treat menstruation and menopause symptoms. The root is used for medicinal purposes and the typical dosage is usually 40 mg twice daily. In 1989, the Kommission E (Germany’s regulatory agency for dietary supplements and herbs) approved black cohosh for PMS, menstrual cramps and symptoms of menopause such as hot flashes. Black cohosh is commonly used to treat menospause symptoms throughout European countries. Researchers have hypothesized that black cohosh may work by mimicking estrogen.

Researchers at Columbia University conducted a clinical trial of 85 breast cancer patients who had completed their primary treatment, some of whom were receiving tamoxifen (59 of 85). Patients were divided into two groups, the treatment group receiving 40 mg of black cohosh daily while the other group received a placebo (inert pill). The patients completed a menopause symptom questionnaire at the start of the study and kept a 4-day hot flash diary prior to starting the study and at one and two months into the study. The menopause symptoms under investigation included hot flashes, heart palpitations, headaches, irritability and sweating. The patients also had their follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels measured at the first and final visits.

Both the treatment and the placebo group reported a similar decline in the number and intensity of hot flashes. There did not appear to be any difference between the placebo and treatment groups, nor between women receiving tamoxifen and those who did not, for other menopause symptoms. The one exception was sweating, which women taking black cohosh reported as significantly less than women receiving placebo. There was no significant difference in the FSH and LH levels between women receiving black cohosh or placebo. This suggests that black cohosh does not affect estrogen hormone levels, which would make it unsafe for women with estrogen-dependent breast cancer. No adverse events appeared related to the use of black cohosh.

The research team concluded that “for breast cancer survivors, our data provide little evidence of either harm or benefit from using black cohosh to control hot flashes, although a reduction in sweating may be important to patients.” Additional research, including a study with a longer follow up and/or a more typical dosage of black cohosh, may produce different results.

Reference: Jacobson JS, Troxel AB, Evans J, et al. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer.

Journal of Clinical Oncology. 2001;19:2739-45.

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