HELP WITH HOT FLASHES

Black Cohosh
Additional information
HORMONES
HOT FLASHES
XENOESTROGENS

What will help with hot flashes? I have liver cysts and do not want to take HRT.

Veniafaxine (Effexor)

Effexor is a new treatment for hot flashes, an alternative to hormonal based treatments. It useful for women with breast cancer who cannot take hormones. Effexor is useful for us with cystic livers. Cystic livers have hormone receptors that stimulate their growth. A clinical trial at the Mayo Clinic found that Effexor substantially reduced hot flashes in 62 percent of women. MPA was another leg of the trial. However MPA might slightly increase breast cancer risk. With a lessening of hormone replacement therapy there has been a 7% decline in breast cancer.

BLACK COHOSH is another alternative herbal treatment called remifemin. Effexor is a better alternative. December 18, 2006 Study SEATTLE -- Black cohosh alone or with other botanical therapies was no better than placebo at relieving hot flashes or other vasomotor symptoms associated with menopause, found the Herbal Alternatives for Menopause (HALT) trial.

Other studies with women with estrogen binding breast cancers, have reported that remifemin or black cohosh produced a reduction in hot flashes without causing a growth in breast cancer tumors.

"This alternative black cohosh could possibly work," says author Judy Bolton, a professor at the University of Illinois at Chicago. In her tests with rats, black cohosh did not interact with estrogen receptors. Instead, it targeted the part of the brain that regulates body temperature: serotonin receptors. Antidepressants--which are believed to reduce to hot flashes--also influence this system.
Bolton warns that the study, published in the Journal of Agricultural and Food Chemistry, is preliminary and should not be overstated. A one-year clinical trial is now underway to show if the herb actually reduces the number and intensity of hot flashes in women.
"We have a long way to go to determine if this is applicable to people at all," she says.

I decided to review the literature on black cohosh and post it here for all to evaluate. I have decided to avoid black cohosh.

AN OVERVIEW OF THE MEDICAL RESEARCH:

2800 individuals used black cohosh. 5.4% had side effects not directly related to the black cohosh. Clinical trials with black cohosh have shown it does not increase breast cancer tumors, however with 200 female mice prone to develop breast cancer, it did. A small trial in humans with breast cancer showed it did not causes a recurrence and 57% had relief from hot flashes. There was one case reported of autoimmune hepatitis., This is the only case ever of autoimmune hepatitis. This was linked to black cohosh.

I wrote a doctor in Hawaii who was doing studies and had written an article on Black Cohosh. His name is Dr. Bruce Kessel. He said there are two fairly large clinical trials going on currently. One is running in the Seattle Washington area and one is running in New York, all within the USA. He did not know how Black Cohosh might effect liver cysts.

Throughout Europe this has long been used for relief of hot flashes. It is said to work upon reducing certain surges in hormones which triggers the hot flash and directly acts upon the temperature regulating center of the brain. So here are the articles.

Cancer Invest. 2004;22(4):515-21.Pilot evaluation of black cohosh for the treatment of hot flashes in women.
Pockaj BA, Loprinzi CL, Sloan JA, Novotny PJ, Barton DL, Hagenmaier A, Zhang H, Lambert GH, Reeser KA, Wisbey JA.
Department of Surgery, Mayo Clinic, Scottsdale, Arizona 85259, USA. pockaj.barbara@mayo.edu
BACKGROUND: Hot flashes cause significant morbidity in postmenopausal women, including women with breast cancer. We undertook a pilot study to estimate the effectiveness of black cohosh to reduce hot flashes. METHODS: Women who reported significant hot flashes (> or = 14 per week) were enrolled. Black cohosh was given in the form of the commercial product Remifemin. The first week was a no-treatment baseline period, and therapy was given for the subsequent 4 weeks. Hot flash data were collected by daily questionnaires during baseline and treatment weeks. Adverse effects were recorded. RESULTS: Twenty-one women completed the study. Their mean age was 56 years (range, 38-80). Thirteen patients had a history of breast cancer. Six patients were taking tamoxifen or raloxifene. Patients reported an average of 8.3 hot flashes per day during the baseline week. The reduction in mean daily hot flash frequency was 50% (95% CI, 34%-65%), while weekly hot flash scores were reduced 56% (95% CI, 40%-71%) at completion of the study. Overall, patients reported less trouble with sleeping, less fatigue, and less abnormal sweating. No patients stopped therapy because of adverse effects. CONCLUSIONS: Black cohosh appeared to reduce hot flashes and had a low toxicity. The efficacy found in this trial seems to be more than would be expected by a placebo effect (20%-30% hot flash reduction in previous trials). These results suggest that further evaluation of this black cohosh preparation with a phase III randomized trial is indicated.

The safety of black cohosh (Actaea racemosa, Cimicifuga racemosa).
Huntley A.
Universities of Exeter and Plymouth, Complementary Medicine, Peninsula Medical School, 25 Victoria Park Road, Exeter, EX2 4NT, UK. alyson.huntley@pms.ac.uk
Black cohosh (Actaea racemosa/Cimicifuga racemosa) is a North American perennial plant that has been used for traditional medicinal purposes by the native Indian population. Its modern day application is the treatment of menopausal symptoms. Unlike conventional non-herbal medications, herbal preparations have not been systematically evaluated for their safety. However, the evidence from in vitro, animal and clinical studies all suggest that black cohosh is a safe herbal therapy for menopausal women if taken for a limited period. More research is needed to evaluate the safety of this herb over longer periods of time, and also to further investigate its mechanism of action.

Menopause. 2004 Sep-Oct;11(5):575-7.Autoimmune hepatitis associated with the use of black cohosh: a case study.
Cohen SM, O'Connor AM, Hart J, Merel NH, Te HS.
University of Chicago, Division of Gastroenterology, Liver Study Unit, Chicago, IL, USA. skimdsmc@aol.com
Herbal remedies generate more than 1.8 billion dollars in annual sales in the United States. Herbal products have been associated with a wide spectrum of hepatic toxicities. With the recent Women's Health Initiative Study demonstrating increased risk of breast cancer and cardiovascular events associated with hormone therapy, many women may resort to herbal remedies for persistent menopause symptoms. We report a case of autoimmune hepatitis likely triggered by the use of black cohosh (Actaea racemosa), an agent marketed to treat menopause symptoms. Given this case report, we recommend close monitoring of women using this herbal preparation.

Int J Oncol. 2003 Nov;23(5):1407-12.
Black cohosh, a menopausal remedy, does not have estrogenic activity and does not promote breast cancer cell growth.
Lupu R, Mehmi I, Atlas E, Tsai MS, Pisha E, Oketch-Rabah HA, Nuntanakorn P, Kennelly EJ, Kronenberg F.
Evanston Northwestern Healthcare Research Institute, Northwestern Medical School, Department of Medicine, Evanston, IL 60201, USA. r-lupu@northwestern.edu
Black cohosh is an increasingly popular alternative to estrogen replacement therapy for the relief of menopausal symptoms, primarily hot flushes. However, an important consideration for long-term therapy is potential toxicity and carcinogenicity. Therefore, we undertook a study to assess the estrogenic activity of black cohosh to examine its safety for those with, or at high risk of developing, breast cancer. Several assays were utilized as listed: RNA protection assays, which ascertain the regulation of the expression of E2-responsive genes; estrogen-responsive-element (ERE)-luciferase, which determines modulation of the ER function by transactivation of the ERE; the Ishikawa cell system, which has an E2-regulated endogenous alkaline phosphatase; and colony formation of ER-expressing breast cancer cells, which indicates possible progression of early stage breast cancer into a more aggressive state. Black cohosh extracts did not demonstrate estrogenic activity in any of these assay systems. This is an encouraging step in the assessment of the safety of black cohosh for treatment of menopausal hot flushes.

Breast Cancer Res Treat. 2004 Mar;84(2):151-60.
Cimicifuga racemosa extract inhibits proliferation of estrogen receptor-positive and negative human breast carcinoma cell lines by induction of apoptosis.
Hostanska K, Nisslein T, Freudenstein J, Reichling J, Saller R.
Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland. katarinahostanska@access.unizh.ch

Hormone replacement therapy is contraindicated in women with breast cancer. Extracts from the rhizomes of Cimicifuga racemosa, have gained acceptance as a natural alternative for the treatment of menopausal symptoms. In the present study we investigated the antiproliferative activity of C. racemosa extracts (isopropanolic and ethanolic) on the estrogen receptor positive MCF-7 and estrogen receptor negative MDA-MB231 breast cancer cells by WST-1 assay. Down regulation of the proliferative activity and cell killing by isopropanolic and ethanolic extracts occurred in a clear dose-dependent response with a 50% growth inhibitory concentration of 54.1 +/- 11.4 and 80.6 +/- 17.7 micro g/ml in MCF-7 cells and of 29.5 +/- 3.0 and 58.6 +/- 12.6 microg/ml in MDA-MB231 cells, respectively. Further, the mode of cell death was identified as apoptosis by microscopic inspection and confirmed by light scatter characteristics and by detection of Annexin V adherence to phosphatidylserine by flow cytometry. In addition, the involvement of activated caspases was supported by the cleavage of cytokeratin 18 detected with M30 antibody. Increases in the level of M30-antigen of about 4-fold and 2-fold over untreated controls were observed in C. racemosa -treated MCF-7 and MDA-MB231 cells. These results indicate that C. racemosa extract exerts no proliferative activity, but kills the estrogen receptor positive MCF-7 as well as estrogen receptor negative MDA-MB231 cells by activation of caspases and induction of apoptosis.

Endocrinol Metab Clin North Am. 2004 Dec;33(4):717-39.
The role of complementary and alternative medicine in management of menopausal symptoms.
Kessel B, Kronenberg F. Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA. bkessel@queens.org
There is a great need for alternatives to hormone therapy for use by symptomatic menopausal women. Alternatives to estrogen can en-compass lifestyle change, complementary and alternative medicine (CAM), and prescription nonhormonal therapies. The use of CAM therapies for menopausal symptoms is widespread and has been increasing. In recent years, there has been an increase in the quantity and quality of research related to CAM therapy use for menopausal symptoms. A highly effective and safe CAM therapy for menopausal symptoms would be valuable but has remained elusive to date. This article reviews randomized controlled trials examining the efficacy of CAM therapies for menopausal symptoms.

Menopause. 2003 Jul-Aug;10(4):299-313.
Critical evaluation of the safety of Cimicifuga racemosa in menopause symptom relief.
Dog TL, Powell KL, Weisman SM.
1Integrative Medicine Education Associates, Corrales, NM, and 2Innovative Science Solutions, LLC, Morristown, NJ 87048, USA. lowdogmd@aol.com
OBJECTIVE: This comprehensive review examines the safety of Cimicifuga racemosa for the treatment of menopause symptoms, particularly in populations in which conventional menopause treatment regimens, including estrogen replacement, are contraindicated. DESIGN: An extensive database of information on Cimicifuga, which included all published literature pertaining to preclinical and clinical safety of various forms of Cimicifuga, the FDA and World Health Organization adverse-event reporting systems, monographs, compendia, internal unpublished data from a major manufacturer, foreign literature, and historical anecdotal reports, was reviewed, and findings pertaining to the safety of Cimicifuga use for menopause treatment were reported. RESULTS: Uncontrolled reports, postmarketing surveillance, and human clinical trials of more than 2,800 patients demonstrate a low incidence of adverse events (5.4%). Of the reported adverse events, 97% were minor and did not result in discontinuation of therapy, and the only severe events were not attributed to Cimicifuga treatment. CONCLUSIONS: Although the effects of Cimicifuga may be dependent on the specific extract preparation, this review clearly supports the safety of specific Cimicifuga extracts, particularly isopropanolic preparations, for use in women experiencing menopausal symptoms and as a safe alternative for women in whom estrogen therapy is contraindicated.

Maturitas. 2003 Mar 14;44 Suppl 1:S59-65.
Cimicifuga racemosa for the treatment of hot flushes in women surviving breast cancer.
Hernandez Munoz G, Pluchino S.
Centro Clinico de Maternidad Leopoldo Aguerrevere, Av. Rio Manapire, Parque Humboldt, Prados del Este, Caracas, Venezuela. drgeher@cantv.net
OBJECTIVES: To examine the effect of Cimicifuga racemosa (CR BNO 1055) on hot flushes caused by tamoxifen adjuvant therapy in young premenopausal breast cancer survivors. This treatment presents an off-label use of CR BNO 1055. METHODS: Between May 1999 and December 2001, we accrued 136 breast cancer survivors aged 35-52 years. After treatment with segmental or total mastectomy, radiation therapy and adjuvant chemotherapy, participants were in open-label randomly assigned (1-2) to receive tamoxifen 20 mg per day orally (usual-care group; n=46) or tamoxifen (same dose and posology) plus CR BNO 1055 (Menofem/Klimadynon, corresponding to 20 mg of herbal drug; intervention group n=90). Duration of treatment was 5 years for tamoxifen, according to international standards for adjuvant therapies, and 12 months for CR BNO 1055. Follow-up included clinical assessment every 2 months; the primary endpoint was to record the number and intensity of hot flushes. RESULTS: Comparing patients assigned to usual-care group with those assigned to intervention group, the number and severity of hot flushes were reduced after intervention. Almost half of the patients of the intervention group were free of hot flushes, while severe hot flushes were reported by 24.4% of patients of intervention group and 73.9% of the usual-care group (P<0.01). CONCLUSIONS: Hot flushes were the most frequent adverse reaction to tamoxifen adjuvant therapy in breast cancer survivors. The combined administration of tamoxifen plus CR BNO 1055 for a period of 12 months allowed satisfactory reduction in the number and severity of hot flushes.

Maturitas. 2003 Mar 14;44 Suppl 1:S67-77.
The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers.
Wuttke W, Seidlova-Wuttke D, Gorkow C.
Department of Clinical and Experimental Endocrinology, University of Gottingen, Robert-Koch-Strasse 40, 37075 Gottingen, Germany. ufkendo@med.uni-goettingen.de
OBJECTIVES: In the present study, therapeutic effects of the Cimicifuga racemosa preparation CR BNO 1055 (Klimadynon/Menofem) on climacteric complaints, bone metabolism and endometrium will be compared with those of conjugated estrogens (CE) and placebo. The question whether CR BNO 1055 contains substances with selective estrogen receptor modulator (SERM) activity will be investigated. METHODS: Sixty-two evaluable postmenopausal women were included in the double-blind, randomized, multicentre study, and treated either with CR BNO 1055 (daily dose corresponding to 40 mg herbal drug), 0.6 mg CE, or matching placebo, for 3 months. Menopausal symptoms were assessed by the menopause rating scale (MRS) and a diary. Levels of CrossLaps (marker of bone degradation) were determined by ELECSYS system and bone-specific alkaline phosphatase (marker of bone formation) by an enzymatic assay. Endometrial thickness was measured via transvaginal ultrasound; vaginal cytology was also studied. The primary efficacy criterion was the change from baseline to end point in the MRS. Change from baseline was analyzed for the secondary variables too. CONCLUSIONS: CR BNO 1055 proved to be equipotent to CE and superior to placebo in reducing climacteric complaints. Under both verum preparations, beneficial effects on bone metabolism have been observed in the serum. CR BNO 1055 had no effect on endometrial thickness, which was significantly increased by CE. Vaginal superficial cells were increased under CE and CR BNO 1055 treatment. CONCLUSIONS: The results concerning climacteric complaints and on bone metabolism indicate an equipotent effect of CR BNO 1055 in comparison to 0.6 mg CE per day. It is proposed that CR BNO 1055 contains substances with SERM activity, i.e. with desired effects in the brain/hypothalamus, in the bone and in the vagina, but without exerting uterotrophic effects.

Eur J Endocrinol. 2003 Oct;149(4):351-62
Evidence for selective estrogen receptor modulator activity in a black cohosh (Cimicifuga racemosa) extract: comparison with estradiol-17beta.
Seidlova-Wuttke D, Hesse O, Jarry H, Christoffel V, Spengler B, Becker T, Wuttke W.
Department of Clinical and Experimental Endocrinology, University of Gottingen, Robert-Koch-Strasse 40, D-37075 Gottingen, Germany.
OBJECTIVE: Some phytoestrogens are believed to have selective estrogen receptor modulator (SERM) activity with no action in the uterus but beneficial effects in the hypothalamo/pituitary unit and in the bone and are presently the focus of clinical interest. In the present experiments, the effects of the clinically used Cimicifuga racemosa (CR) extract BNO 1055 in the uterus, in the bone and on serum luteinizing hormone (LH) were compared with the effects of estradiol-17beta (E(2)) under acute and chronic conditions in ovariectomized rats. METHODS: Ovariectomized rats were treated either acutely (6 h) or chronically (3 Months) with E(2) or the CR extract. Gene expression of some estrogen-regulated genes in the metaphysis of the tibia and the uterus was determined. Furthermore, bone mineral density was measured by quantitative computer tomography. RESULTS: When given acutely, both E(2) and the CR extract inhibited LH secretion and slightly stimulated gene expression of IGF-I, collagen-1alpha1, osteoprotegerin and osteocalcin (all osteoblast products), and of tartrate-resistant acid phosphatase (TRAP, an osteoclast product) in the metaphysis of the femur. While E(2) stimulated uterine weight and expression of progesterone receptor (PR), the complement protein (C3) and IGF-I genes, and inhibited gene expression of the estrogen receptor beta (ERbeta) in the uterus, no such effect was observed under acute CR treatment. After chronic application with pelleted food over 3 Months E(2) had profound effects in the uterus on weight and gene expression (ERbeta, PR, C3 and IGF-I) which were not seen in the CR-treated animals. Within 3 Months after ovariectomy, control rats had lost more than 50% of the metaphyseal bone mass of the tibia, an effect prevented by E(2) and partially by CR supplementation. CONCLUSIONS: These data confirm the concept that the CR extract BNO 1055 contains as yet unidentified substances with SERM properties which act in the hypothalamo/pituitary unit and in the bone but not in the uterus.

For increasing libido, I have found fresh raspberries and saffron to be helpful. A saffron lemon cake with raspberry coulis, makes an interesting dessert. Careful if you are pregnant; raspberries are to be avoided during the first trimester, due to their muscle relaxation effects. For more recipes click here.

last updated Wed March 5, 2008 7:18 PM