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Safety and effect of Black Cohosh and Red Clover for hot flushes

3 August 2009

A group from Chicago have recently reported the results of a trial comparing Black Cohosh, Red Clover, Hormone Replacement Therapy (HRT) and placebo (inactive tablet) for the treatment of menopausal hot flushes and night sweats (vasomotor symptoms). Menopausal women who were suffering from vasomotor symptoms were randomly allocated to receiving one of the four options for 12 months and were unaware of which option they were taking. Reductions in number of vasomotor symptoms were as follows: black cohosh—34%, red clover—57%, placebo—63%, and HRT—94%, with only the HRT group achieving a reduction which was significantly better than placebo. No concerns about safety were demonstrated.


Many women choose Alternative therapies rather than HRT for treatment of menopausal symptoms. As a doctor, I continue to have difficulty in advising women about the use of alternative therapies, simply because of lack of information about their effectiveness. Although many preparations claim significant benefits, this is not often backed up by scientific evidence. Some will report results of trials showing that women taking the product will experience a reduction in symptoms, but unless the trial has included a group of women taking an inactive tablet and the women are unaware of what they are taking, then the results are unhelpful since, as this recent trial has shown, many women experience a reduction in symptoms when taking placebo anyway. This maybe due to natural reduction in symptoms with time, but also an effect of taking something which the individual believes will work, the “placebo effect”. A product can only be claimed as being effective if its effect is significantly better than placebo, which in this trial, for black cohosh and red clover was not the case.

Previous trials on black cohosh and red clover have shown mixed results, some showing some benefit and others not. As with previous trials, this one is limited by the small number of women in the trial, (89), but does add to the growing feeling that, although unlikely to be harmful, alternative therapies used frequently for menopausal symptoms, are likely to provide minimal benefit, if at all.

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