By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

HOT FLASH -- THE JURY'S STILL OUT ON THE SAFETY OF BLACK COHASH

Question: My wife has several friends who are taking black cohash to reduce the symptoms of menopause -- particularly hot flashes. All these women say that it works, but one of them has been bothered by headaches since she started taking this herbal product. I’m wondering if black cohash is really safe, in case my wife decides to take it.

Answer: First let me give you a little background on this herb. The sale of black cohash, also spelled cohosh, in the United States is not controlled by the Food and Drug Administration because it is classified as a dietary supplement rather than a drug. Currently, as your wife’s friends have said, its most popular use is for controlling hot flashes and menopausal symptoms. Over the past several hundred years, though, it’s been used as a medicinal herb to treat a wide variety of human ailments.

North American Indians used black cohash for malaise, gynecological problems, kidney disorders, mild joint pain and sore throats. They also used it to enhance milk production in lactating females. In the 1800s it was a popular home remedy for fever and joint pain. It was also used at that time as a diuretic and to bring on menstruation.

The contemporary use of black cohash -- often sold under the name of Remifemin -- is primarily as a treatment for hot flashes and other menopausal symptoms. Although the few studies that have been done are encouraging, the National Center for Complementary Medicine (NCCAM) says that it can’t yet recommend the use of this herb in treating menopausal symptoms. On the other hand, in 2001 the American College of Obstetricians and Gynecologists -- primarily based on the experiences of its members with their patients -- approved a statement that said that black cohash may be helpful for short term use (less than six months) in the treatment of women with menopausal symptoms.

The mechanism of action of black cohash is not known, and many studies have produced contradictory results. It is believed to have estrogen-like activity. Because black cohash in this country is sold as a dietary supplement without FDA assurances of quality, there is no guarantee that the product you buy is pure and contains the amount of the herb that’s stated on the label.

There have been some side effects reported with the use of black cohash. Headaches, as you mentioned, as well as stomach discomfort and weight problems were the most commonly reported. It might be a good idea for your wife’s friend who was suffering from headaches to stop taking the black cohash and see if the headaches go away.

I strongly recommend that women who are pregnant or who have had breast cancer not take this herb. We need to know a lot more about its biochemistry before we can be sure it is safe for these women.

Personally, I would recommend against any woman using this drug to control hot flashes until the results are in from rigorous ongoing studies currently being funded by NCCAM. But, if your wife does choose to use it, she should let her doctor know. It’s a common misconception that herbal preparations aren’t drugs. They are. That’s why it’s important to include herbs like black cohash anytime a doctor, dentist or other health-care practitioner asks what drugs you are taking. Herbs can and do interact with other over-the-counter drugs and prescription medications.

"Family Medicine" is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. You can also email Dr. Simpson at simpsonm@ohio.edu. Past columns are available online at http://www.FamilyMedicineNews.org.