Most herbal remedies for menopausal symptoms give under-whelming results – in fact, most research shows they are no better than placebo. There is always a placebo effect in these trials so any claims at improvements must show a reduction in symptoms well below possible “suggestion or Hawthorne” effects.
At last one such study has appeared (Uebelhack et al Obstet Gynecol 2006;107:247-55) from Germany using black cohosh plus St John’s wort. Black cohosh extract in the dosage of 1mg triterpene glycoside, the active ingredient, is said to relieve symptoms of hot flushes, night sweats and sleep disturbances without exerting oestrogenic effects. St John’s wort has proved effective in the treatment of depression and mood disorders at a dose of 0.25 mg hypericine, so the combination of the two herbs was tested against placebo in the hope of relieving menopausal physiological and psychological symptoms without the side effects of oestrogens or selective serotonin reuptake inhibitors.
Over a 16 week trial period, the women’s menopause rating scores were reduced by 50% in the active ingredient group and by 20% in the placebo group. In the depression rating scale treatment resulted in a 40% reduction in symptoms with a 12% placebo effect. The authors claim the relatively low placebo effect was due to a single investigator being employed who did not accentuate the psychotherapeutic approach.
The side effects were minimal and it appears that the combination of a fixed dose of black cohosh and St John’s wort has a place in the management of climacteric complaints with a pronounced psychological component.
