Herb remedy found ineffective for menopause symptoms

December 19, 2006|By Thomas H. Maugh II | Thomas H. Maugh II,LOS ANGELES TIMES

The widely used herbal remedy black cohosh does nothing to eliminate hot flashes, night sweats and other symptoms of menopause, either alone or in combination with other herbs, federally sponsored researchers reported yesterday.

Thousands of women use the supplement, but a controlled trial reported in The Annals of Internal Medicine showed it is no more effective than a placebo. Only estrogen produced a significant reduction in hot flashes.

"In the doses we used, and the way we used it, it did not work," said Katherine M. Newton of Group Health, a Seattle health system, who led the study. "The findings will certainly be a disappointment to women. It would have been nice to find something that is safe and effective."

The study was sponsored by the National Institute on Aging and the National Center for Complementary and Alternative Medicine, both components of the National Institutes of Health.

Dr. Carol M. Mangione, of UCLA's Geffen School of Medicine, wrote in an editorial accompanying the study that physicians and women will have to look elsewhere for help, and there are few alternatives available.

An estimated 2 million American women turn 50 each year, and about 80 percent of them suffer some menopause symptoms.

Black cohosh - a member of the buttercup family - is available in pill or liquid form and is sold over the counter in many health food stores.

It is among a host of supplements including soy, wild yam, red clover and St. John's wort that have been tried for relief of hot flashes and night sweats, but studies almost universally have found they don't work.

Certain antidepressants have proved effective, and one company, Depomed Inc. of Menlo Park, Calif., plans to seek the Food and Drug Administration's approval to sell an anti-seizure drug, gabapentin, for relief of hot flashes.

A 2002 federal study showed that women who underwent estrogen replacement therapy have an increased risk of breast cancer and heart disease. For many women, black cohosh has become the primary alternative to hormone therapy.

Newton and her colleagues studied 351 women, ages 45 to 55 years. Half were in the midst of menopause and half were post-menopausal. They averaged about six symptoms per day.

The women were divided into five groups. One group got black cohosh. A second group got a multi-botanical of black cohosh and nine other herbs. The third got the multi-botanical and were encouraged to eat more soy foods. The fourth got estrogen, with or without progestin. And the fifth got a placebo.

Women receiving either black cohosh or the multi-botanical had an average reduction of 0.5 symptoms per day compared with those in the placebo group, a statistically insignificant finding.

Women receiving estrogen, in contrast, had a reduction of four symptoms per day. Those consuming soy had more symptoms, for reasons that are not clear.

The good news, Newton said, is that over the course of a year, symptoms in the placebo group were gradually reduced by about 30 percent.

"The really strong message we need to get out is that menopause is a natural event, it is not an illness, and the symptoms are self-limiting," said Newton, an epidemiologist unaffiliated with any supplement or hormone maker.

If the symptoms are too powerful, women should take hormones in the lowest dose possible and for the shortest time possible, she said.

Menopausal women can still make behavioral changes such as dressing in layers, sleeping in a cooler room and avoiding possible triggers such as very hot liquids and alcohol, Newton said. The study also shows that symptoms decreased over the course of the 12-month period and nearly always go away on their own.

"If you can relax your mind appropriately, you can also relax your body," said Barrie Cassileth, an alternative-medicine researcher at Memorial Sloan-Kettering Cancer Center in New York, who was not involved in the study. "If 30 percent of women could lose hot flashes because their mind made them do it, that's fantastic."

The findings come less than a week after researchers reported a sharp decline in U.S. breast cancer cases, a drop that doctors attributed partially to fewer women using hormone therapy to treat menopause symptoms.

Thomas H. Maugh II writes for the Los Angeles Times. The Associated Press contributed to this article.

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