Black/Blue CohoshMenopauseSt. John's Wort

Trying hard to generate positive research results for black cohosh

There are doctors in Germany who are working overtime to convince us that black cohosh is a valuable treatment for menopausal symptoms.

I’m not buying it. But then, I’m not in menopause.

This latest study monitored more than 6000 women treated by more than 1200 gynecologists in Germany.

  • Treatment options were black cohosh with or without St. John’s wort for treatment of climacteric treatment.
  • Patients were followed for 6 months, optionally 12 months.
  • There was no attempt to blind the doctors or the patients (ie, conceal what treatment the women received).
  • There was no attempt to assign treatment in a random manner.
  • There was no placebo-treated group for comparison.

And the results.

  • The researchers reported that both treatments lead to improvement in symptoms.
  • “The fixed combination of black cohosh plus St. John’s wort was superior to black cohosh alone in alleviating climacteric mood symptoms.”
  • Both treatments were well tolerated with few side effects.

The bottom line?
There’s an inherent bias when doctors are asked to assess the response to treatment they choose for their patients. Also, their patients are placed in a difficult position when they have to judge the effectiveness of their physician’s prescribing. After all, doesn’t it reflect poorly on them if the physician they chose failed to improve their condition after 12 months?

The abstract doesn’t indicate how many of the 6000+ women dropped out of the study. But it appears that at the 6- and 12-month evaluations, only those who completed treatment were included in the analysis of efficacy.

If that’s true, it’s logical to conclude that many of the drop outs were caused by side effects or a failure of treatment. Therefore, a disproportionate number of those who completed the study (and therefore were available for 6 and 12-month assessment) felt better.

The disappointing results with black cohosh in earlier studies and safety considerations can be reviewed by clicking the “Black Cohosh” button at right.

Considering the flawed study design, this study tells us nothing about the value of black cohosh alone or combined with St. John’s wort to treat menopausal symptoms.

6/27/07 22:00 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.