Black cohosh and red clover are widely promoted as helping to ease menopausal and aging-related symptoms, but a rigorously performed study has found they are no better than placebo for treating hot flashes and night sweats.

That doesn't mean that they won't be helpful for some women, Dr. Stacie E. Geller, a professor of obstetrics and gynecology at the University of Illinois, Chicago, the study's lead author, told Reuters Health.

But, she added, while the herbal extracts they tested were completely safe when taken daily for a year, the same isn't necessarily the case with products available over the counter. Unfortunately in this country and many others, there's not enough rigorousness around the development, standardization and monitoring of these products, Geller said. We developed our own product, so that's why we knew it was safe and pure.

About 75 percent of women will experience some hot flashes and night sweats as they enter menopause, Geller noted. There is a small group of women who have pretty severe hot flashes for a long period of time, she added. It can be incredibly disruptive.

The one treatment that's nearly always helpful is hormone replacement therapy (HRT), which is considered to be safe for short-term use in some women. Several studies have found that black cohosh can help to reduce hot flashes and night sweats, and also to improve mood, but most of this research was funded by companies that make the supplements, Geller and her team note in the journal Menopause. There's also some evidence that red clover could have modest benefits for women experiencing hot flashes and night sweats, while improving mental function as well.

Geller and her team randomly assigned 89 menopausal women to take either HRT, black cohosh, red clover, or placebo for a year. The women were experiencing anywhere from 52 to 71 hot flashes or night sweats every week.

After a year, each group reported improvements. Symptoms were reduced by 34 percent in women taking black cohosh, by 57 percent in women taking red clover; by 63 percent in women taking placebo, and by 94 percent in women on HRT, which was the only therapy significantly better than placebo.

HRT has also been tied to reductions in verbal memory among menopausal women, so Geller and her colleagues tested memory and other mental functions in 66 of the women. Black cohosh and red clover had no effect on any aspect of mental function, but there was some evidence that HRT had detrimental effects on verbal memory.

For women who are really suffering from menopausal symptoms and need help, HRT can be a safe option for some, Geller noted. I always encourage women to think about taking the smallest dose possible for the shortest period of time, she said.

For women who won't or can't take hormones, she added, she will suggest black cohosh, with the caveat that they treat it just as they would a prescription drug, consulting with their physician before starting to take it and seeking out a high-quality product. It may or may not work, but it's worth a try, she said. The literature clearly reports that some women get better on it.

SOURCE: Menopause, November/December 2009.

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