Black Cohosh for Menopausal Treatment

NTR 450
4/18/13
Group #1
Amy Fisher
Nia Jarrett
Deniz Nebi
Christina Taalla
Shannon Truong

Black Cohosh Treatment for Menopausal Women

Section 1
We decided to select a nutrition problem that every middle age woman goes
through: menopause. Menopause is defined by the Mayo clinic as the permanent
termination of menstruation and fertility in women aged between 40 and 50 (Mayo Clinic
Staff). With menopause comes symptoms such as unwanted hot flashes, night sweats, and
mood swings. Although the end of menstruation can be an exciting relief, the symptoms
that are included with menopause can cause great distress to women. It seems to be a
bigger problem with women who battle Cancer as the symptoms last longer. There have
been extremes where patients would have hot flashes even six to ten years after their final
period (Anderson, et. al). This age frame not only focuses on menopause but often
midlife crisis. A midlife crisis can lead to doing anything possible to feel young again
and that can involve dressing, eating, or acting younger. This can also include searching
for remedies to make menopause a smoother transition.
Section 2
Women treat menopause by several different methods including hormonal
treatments, antidepressants, CAM (complimentary and alternative medicine), and
lifestyle changes. CAM tends to use more natural products such as black cohosh. After
reviewing a meta analysis, black cohosh seems to be effective in treating menopausal
symptoms. In this analysis, they reviewed 9 literature articles from PubMed, Embase, and
Cochrane Library that included black cohosh treatment for menopause. The results were
two trials did not show any difference in the symptoms however, the rest of the studies
presented some sort of improvement. Five of the successful studies had black cohosh

mixed with other herbs like dong quai and the rest had black cohosh by itself. It was
concluded that black cohosh was efficient in treating menopausal symptoms
(Shams, et. al).
A randomized trial was conducted in 2006 to further research the treatment of
menopause with black cohosh and a mixture of other components like multibotanicals,
soy, hormone therapy, and a placebo. This was a one-year double blind, placebocontrolled trial with 351 women participants from the ages 45 to 55 that had two or more
symptoms a day. The black cohosh mixture was predicted to suppress vasomotor
symptoms associated with menopause. It was found that black cohosh on its own or
together with other botanicals has little potential to relieve vasomotor symptoms
(Newton, et. al).
The first article was a Meta analysis that drew from three different articles
summarizing that black cohosh was effective, whereas the second article in 2006 is just
one study. Because the first and second article contradicts each other, it shows that more
research needs to be done to fully understand the effectiveness of black cohosh. However
due to the more recent Meta analysis, our program believes that black cohosh can be an
effective source to mediate vasomotor symptoms. To be noted as well, most studies did
measure lifestyle factors such as exercise and dietary habits.
Section 3
Our proposed solution to women experiencing unfortunate menopausal symptoms
is to advise patients to use black cohosh for treatment of vasomotor symptoms. The data
is limited on the dosage of black cohosh that would be effective warrants further research
to suggest an appropriate daily dosage. However, the University of Maryland Medical
Center suggests 20 mg can be taken twice every day to treat hot flashes, mood swings,

and other symptoms (Ehrlich, S.D.). The evidence also discloses that black cohosh is safe
but can have possible adverse effects, so inform patients of this when developing a
treatment plan, and maintain a close vigilance on signs and symptoms of negative
interactions. While black cohosh has been associated with liver damage or liver failure,
the dosage has always been inconclusive. In most cases where either occurred, the
subjects were taking additional herbal supplements or medications (Mahady G.B., et, al).
In addition to supplementation of black cohosh, our proposed intervention will include a
healthy diet, following the recommendations of the Mediterranean diet and at least 30
minutes of physical activity every day.
Section 4
S This solution will be geared towards women aged 40-55 which are the most common
years to experience menopause. The solution will consist of giving women 20 mg black
cohosh pills to take twice a day until the menopause is complete. If they notice any
decrease in hot flashes, irritability, fatigue, and night sweats
M The goal is that the solution realizes a decrease of at least 50% of the symptoms in at
least 75% of menopausal women. The solution will be measured to ensure it is meeting
the expectation of declining vasomotor symptoms in menopausal women by measuring
symptoms on a weekly basis for each candidate. There will be a scale from 1-10
indicating the intensity of symptoms on a daily basis, to be compared with a baseline
measurement.
A The research tells one that the desired outcomes are achievable, as long as the women
take the allotted amount of black cohosh on a daily basis. This does not require any big
effort, or much time commitment.

R This is whether the black cohosh is effective or not, and how it will change the quality
of life of menopausal women. The solution proposed should be undertaken because black
cohosh can aid in relieving undesired symptoms, affecting womens daily routines - both
day and night.
T The solution will be assessed on a monthly basis to see the progress in womens
symptoms, and address any issues on an individual basis. Some women may need an
increase in medication dosage; some may also require integration of exercise and
nutrition education to help the effectiveness of black cohosh supplementation.

References

Anderson D.J., Yates P., Mccarthy A., Lang C.P., Hargraves M., Mccarthy N. Younger
and older womens concerns about menopause after breast cancer. European Journal of
Cancer Care. 2011;20:785-794
Mayo Clinic Staff. Menopause. Mayo Clinic. 2013. Available at:
http://www.mayoclinic.com/health/menopause/DS00119 Accessed April 14, 2013.
Shams T., Setia M.S., Hemmings R., McCusker J., Sewitch M., Ciampi A. Efficacy of
black cohosh-containing preparations on menopausal symptoms:a meta analysis. Altern
Ther Health Med. 2010;16(1):36-44.
Newton K.M., Reed S.D., LaCroix A.Z., Grothaus L.C., Ehrlich K., Guiltinan J.
Treatment of Vasomotor Symptoms of Menopause with Black Cohosh, Multibotanicals,
Soy, Hormone Therapy, or Placebo. Ann Intern Med. 2006; 145:869-879.
Ehrlich S.D. Menopause. University of Maryland Medical Center. 2011. Available at:
http://www.umm.edu/altmed/articles/menopause-000107.htm. Accessed April 16, 2013.
Mahady GB, Low Dog T, Barrett ML et al. United States Pharmacopeia review of the
black cohosh case reports of hepatotoxicity. Menopause: The Journal of The North
American Menopause Society. 2008. 15(4); 628-638.