Principal Results of a Randomized Placebo-Controlled Trial of Black Cohosh, Multibotanical Herbs and Dietary Soy for Vasomotor Symptoms: The Herbal Alternatives for Menopause (HALT) Study

Clinical Information

• ACP Medicine

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  From: XI Menopause (© - subscription required) Authors: Reed SD et al.
  "Black cohosh, a possible phytoestrogen, may be effective, but no large controlled trials have been conducted."

• Agency for Healthcare Research and Quality (AHRQ)

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  From: Complementary and alternative therapies for the management of menopause-related symptoms: a systematic evidence review. Arch Intern Med 2006 (© - subscription required) Authors: Nedrow A et al.
  "Although individual trials suggest benefits from certain therapies, data are insufficient to support the effectiveness of any complementary and alternative therapy in this review for the management of menopausal symptoms." Based on: Evidence Report/Technology Assessment: Number 120: Management of Menopause-Related Symptoms (free access)

• MKSAP

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  From: Menopause (© - subscription required)
  "For patients with mild hot flushes, keeping the temperature cool and using paced respiration with or without the use of nonprescription treatments, such as black cohosh or soy protein, may be helpful."

• PIER

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  From: Menopause and Hormone Therapy: Non-drug Therapy (© - subscription required) Authors: Col N et al.
  Black cohosh (Actacea racemosa) may ease menopausal symptoms, but findings vary across studies. While several studies used Remifemin®, the formulation of this product has changed over time. From: Menopause (Complementary/Alternative Medicine) - Possibly effective (subscription required) Authors: Rubino S. Consider black cohosh as a safe alternative therapy that may provide some relief from menopausal vasomotor symptoms.

Patient information

• Office of Dietary Supplements

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  From: Questions and Answers About Black Cohosh and the Symptoms of Menopause (free access)
  "Although preliminary evidence is encouraging, the currently available data are not sufficient to support a recommendation on the use of black cohosh for menopausal symptoms."

• National Center for Complementary and Alternative Medicine (NCCAM)

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  From: Herbs at a glance - Black Cohosh (free access)
  "Study results are mixed on whether black cohosh effectively relieves menopausal symptoms."

• UpToDate

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  From: Alternatives to postmenopausal hormone therapy (free access) Authors: Santen RJ
  "Other phytoestrogens such as ginseng, dong quai, and black cohosh can be purchased at health-food stores. However, these supplements might increase breast cancer risk because they act like estrogen in some tissues of the body. The efficacy of these supplements for hot flashes has not been rigorously proven."

Clinical Information

• ACP Medicine

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  From: XI Menopause (© - subscription required) Authors: Reed SD et al.
  "Estrogen is highly effective for the treatment of vasomotor symptoms... ...Several nonhormonal alternatives for treatment of vasomotor symptoms may have some efficacy. These include venlafaxine, selective serotonin reuptake inhibitors (SSRIs) (e.g., fluoxetine and paroxetine), and gabapentin."

• Agency for Healthcare Research and Quality (AHRQ)

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  From: Nonhormonal therapies for menopausal hot flashes: systematic review and meta-analysis. JAMA 2006 (© - subscription required) Authors: Nelson HD et al.
  "The SSRIs or SNRIs, clonidine, and gabapentin trials provide evidence for efficacy; however, effects are less than for estrogen..." Based on: Evidence Report/Technology Assessment: Number 120: Management of Menopause-Related Symptoms (free access)

• Clinical Evidence

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  From: Menopausal symptoms (© - subscription required)
  About this publication Beneficial Progestogens alone Tibolone Trade off between benefits and harms Oestrogens alone (improved menopausal symptoms but increased risk of breast cancer, endometrial cancer, stroke, and venous thromboembolism after long term use) Oestrogens plus progestogens (improved menopausal symptoms but increased risk of breast cancer, endometrial cancer, stroke, and venous thromboembolism after long term use) Unknown effectiveness Antidepressants Clonidine Phyto-oestrogens Testosterone

• MKSAP

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  From: Menopause (© - subscription required)
  "Estrogen improves menopausal symptoms, including hot flushes, night sweats, vulvar and vaginal atrophy, vaginal dryness, and itching... Regular physical activity decreases vasomotor frequency and severity. Smoking cessation might lower the number of hot flushes, but no clinical trials have specifically studied this issue. Prescription treatments that may be helpful in patients with hot flushes include gabapentin, venlafaxine, and the selective serotonin reuptake inhibitors paroxetine or fluoxetine."

• PIER

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  From: Menopause and Hormone Therapy: Drug Therapy (© - subscription required) Authors: Col N et al.
  Consider HT [hormonal therapy] as appropriate only for women experiencing bothersome menopausal symptoms that are responsive to HT" Consider available nonhormonal drug therapies, such as SSRI or SNRI antidepressants, for control of hot flashes

• UpToDate

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  From: Menopausal hot flashes (© - subscription required) Authors: Capser RJ et al
  For postmenopausal women with moderate-to-severe vasomotor symptoms (and no history of breast cancer or cardiovascular disease), we suggest short-term estrogen therapy as the treatment of choice. For women with moderate-to-severe hot flashes, in whom estrogen is contraindicated, not well tolerated, or for women who have stopped estrogen and are experiencing recurrent symptoms, but wish to avoid resuming estrogen, we suggest therapy with an SNRI, SSRI or gabapentin.

Patient Information

• National Center for Complementary and Alternative Medicine (NCCAM)

  NCCAM	Close
  From: Do CAM Therapies Help Menopausal Symptoms? (free access)
  "There is very little high-quality scientific evidence about the effectiveness and long-term safety of CAM therapies for menopausal symptoms."

• UpToDate

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  From: Postmenopausal hormone therapy (free access) Authors: Martin KA
  "Estrogen or combined estrogen-progestin therapy remains the gold standard for relief of menopausal symptoms, and therefore is a reasonable option for most postmenopausal women, with the exception of those with a history of breast cancer, CHD, a previous blood clot or stroke, or those at high risk for these complications."