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Flash Point



I'm 51 and have been going through menopause for the past year now. I get all the symptoms--palpitations, sweating, hot flashes--but I don't feel I need to medicate myself for them. Of course it's not enjoyable, but I know menopause is just part of getting older. I see all my friends jumping from one herbal pill to another, or doing hormone replacement, and I think: Why can't we just return to a simpler time when natural processes were accepted as part of life, without trying to fix everything with a pill?


It's definitely a trade-off. Advances in medicine have saved countless lives and relieved incredible suffering, but the price we pay is awfully high: relentless drug commercials. Exactly how many softly focused, preternaturally glowing actors launching equally adorable children into the air, or merrily riding their bicycles through a leaf-littered city park can a person take in the name of medical innovation? Sure, I suppose one could argue the merits of pharmaceutical comfort for painful afflictions, but personally I'd be willing to trade every Lunesta and Nexium commercial for a few glorious re-runnings of Jello 1-2-3.

Your comment, however, is a welcome interruption. It opens the door to a discussion of an herbal supplement that I've wanted to talk about, black cohosh. For years, women have used preparations of the roots and stems of the wild plant to moderate the hot flashes and other discomforts of menopause. Also known as bugbane (presumably because the stench of its flowers wards off insects), this authentically Native American remedy is now sold as tea, capsules and extracts. Thankfully, no pharmaceutical giant has begun producing TV ads, but discussions of the herb abound in women's magazines. I haven't read them, of course, because perfume samples have a bugbane effect on me.

Until recently, the symptoms associated with menopause had been most commonly treated using hormone replacement therapy (HRT). The rapid heartbeat, sweating and flushing are the result of a natural reduction of hormones, such as estrogen, occurring as a woman's reproductive system slows to a stop. The low doses of hormones in HRT generally relieved the complaints, and had also been seen to provide safe protection against age-associated bone loss. That is until 2002, when the findings of the Women's Health Initiative Study were released. Among the results was surprisingly clear evidence that hormone replacement actually increases the risk of breast cancer, heart disease and stroke. The use of HRT dried up faster than interest in Kevin Federline, and sales of black cohosh rose significantly.

If the bad news from that study didn't frustrate women enough, new research published last month could drive them toward a Xanax. In the journal Annals of Internal Medicine, the Herbal Alternative for Menopause Study (a double-blind, placebo controlled project following 350 menopausal women over 12 months) showed that either alone or in combination with other botanicals, black cohosh did not prevent hot flashes any better than a placebo. So, why do so many women and their doctors swear the herb works? One explanation can result in symptom relief in many people. Or, perhaps, it is due to the interesting additional finding of the Herbal Alternatives study: regardless of treatment, menopausal symptoms improved, consistently (by about a third), over the course of a year.

If ineffectiveness isn't enough to discourage black cohosh use, there is now evidence of a health risk. Worldwide, about 50 cases of liver failure or autoimmune hepatitis have been linked to it--with as little as one month of use. These cases are definitely rare, given the number of people using the supplement, but have been quite serious, with some even requiring liver transplantation. In fact, both Australia and the United Kingdom now require warning labels on black cohosh products sold within their borders.

So, if hormone replacement is out, and black cohosh is ineffective and dangerous, what's left for women whose symptoms make them feel like Rosie O'Donnell stuck in an elevator with Donald Trump? Some new studies have suggested that acupuncture may relieve the hot flashes, racing heart, and other change-of-life manifestations. In addition, one can learn from the experience of thousands of women who have gone before. They advise avoiding spicy food, caffeine and alcohol. Also, sleeping in a room cooler than usual and dressing in easily shed layers are reported to help. My only added recommendation is to stop watching network television; at least in my case, one more Claritin ad will cause a flash hot enough to melt the remote.

Dr. Ed Rabin is a chiropractor practicing at Life Chiropractic Center in Boise. Send free sample packs and health-related questions to theantidote@edrabin.com (on the Web at www.edrabin.com).

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