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Black Cohosh and Menopausal Symptoms

Authors: Désirée Lie, MD, MSEdFaculty and Disclosures

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The Cases

Case 1

A 50-year-old African American woman with an intact uterus who became menopausal 6 months ago stopped taking estrogen replacement therapy 1 month ago because of concerns about cardiovascular risk. Her hot flashes have returned and occur daily and nightly, reducing her quality of life and ability to work effectively in an office as a manager. She also reports some mood swings and is experiencing vaginal dryness. Her health maintenance is up-to-date with a normal Pap smear and mammogram and normal lipid profile, blood pressure, and body mass index. Her diet is healthy and she normally exercises approximately 2 hours per week, although the recurrence of hot flashes has recently reduced her exercise program. She is sexually active and is concerned that going off hormone replacement therapy (HRT), which has already caused vaginal dryness, will lead to a reduction in libido and other symptoms that may reduce her enjoyment of sexual relations with her husband. She would like to consider alternate nonprescription therapy and heard about black cohosh from her friends, who also told her that it may be helpful in preventing breast cancer. She asks her physician to assess its efficacy for her symptoms and its potential adverse effects and would like a recommendation for the appropriate dosage and duration to use this herbal preparation.

Case 2

A 55-year-old postmenopausal white woman with osteoarthritis of the knees and a history of tension headaches recently completed primary breast cancer treatment and is now taking tamoxifen. She complains of hot flashes associated with this agent. She is currently taking evening primrose oil, paroxetine -- a serotonergic reuptake inhibitor -- for depression, and 1 baby aspirin a day for cardiovascular prophylaxis. She heard that black cohosh may be of help for her arthritis and headaches and reduce the hot flashes associated with tamoxifen. She would like her physician's advice on taking this herb for her various symptoms.

Table of Contents

  1. The Cases
  2. Commentary
  3. Response to Cases