Menopause is characterized by the cessation of menstrual cycles in women and marks the end of a woman’s natural ability to have children. Contrary to what you might think, menopause is not a disease or a disorder. It’s a natural part of aging for all women, and while it is by no means fatal, it can come with certain uncomfortable symptoms. These symptoms can occur right before menopause as well, during the transition phase known as perimenopause.1 Vasomotor symptoms such as hot flashes and night sweats are among the most common symptoms of perimenopause and menopause. Let’s take a closer look at menopause, hot flashes, and how black cohosh may help to reduce hot flashes.
A Closer Look at Menopause
The average age of menopause is 51. Menopause is caused by changes in the way ovaries respond to hormonal signals from the pituitary gland. During this time, levels of estrogen and progesterone begin to decline. These hormones regulate menstrual cycles and have wide-ranging effects on mood, skin health, and bone density.
Perimenopause, the menopausal transition phase, signals the period when your body is close to menopause. This phase usually begins about two to four years before a woman’s last menstrual period. You officially reach menopause a year after your last period, a result of completely depleted ovarian oocytes and generally reduced function of the ovaries. Postmenopause usually follows menopause and lasts the rest of a woman’s lifetime.
During perimenopause, you can experience a wide range of symptoms as your body adjusts to fluctuating hormones. Some of the most common symptoms include:
- Period changes – Periods may become irregular with heavier or lighter flows and spotting between cycles.
- Bladder and vaginal issues – You may have difficulty holding your urine, and the genital area may become thinner and drier, making it harder to defend against infections.
- Body changes – Hormonal imbalances can contribute to weakened bones and depleted bone tissue, which may result in osteoporosis, a condition characterized by porous bones. Menopause also causes a loss in muscle mass, thinner skin, and increased body fat.
- Reduced sex drive – A decrease in androgen levels can reduce your sex drive, while vaginal dryness can make even attempts at sex painful.
- Hot flashes – Hot flashes are characterized by a sudden rush of heat that isn’t caused by an external heat source. Hot flashes can last a few seconds to whole minutes.2
Although most people know they have menopause based on their own history and symptoms, you can ask your doctor to perform lab tests to properly diagnose menopause, especially if you are worried or unsure. Menopause isn’t the only condition that can cause you to stop menstruating. Tests usually involve measuring estrogen and follicle stimulating hormone levels. Low estrogen levels and increased follicle stimulating hormone are both consistent signs of menopause. However, birth control pills and hormonal therapy can invalidate these tests. Your doctor can also perform other examinations, like checking your thyroid gland and prolactin levels, to make sure that a separate condition isn’t contributing to fluctuations in your menstrual cycle.
What are Hot Flashes?
Hot flashes are one of the best-known symptoms of perimenopause, affecting about 75 percent of all women going through perimenopause in the United States. Hot flashes usually increase during the transitional phase, peak in the first two years of postmenopause, and gradually decline. Most women will have hot flashes for six months to two years, but every woman’s experience of hot flashes can be unique. In some women, hot flashes have been known to last for more than 10 years. Some older women who are well into postmenopause have also been known to experience occasional hot flashes.3
Hot Flashes Symptoms
What does a hot flash feel like? Hot flashes involve episodes of warmth or heat in the face and upper body. Sometimes they come suddenly, while other times you may be able to feel it coming. Hot flashes can involve:
- Tingling in your fingers
- An increase in your heart rate
- Sudden warmth in your skin leading to redness or flushing
- Sweating as your body tries to cool itself down
- Heart palpitations
More than anything, severe hot flashes can affect your quality of life, reducing your energy levels, ability to focus, and general social functions while increasing symptoms of depression. All of this can take a toll on your overall motivation.
How Long Do Hot Flashes Last?
The length of an individual hot flash can vary. Some will last mere seconds, but longer hot flashes can last longer than 10 minutes. You can generally expect hot flashes to last a few minutes on average. The frequency of hot flashes can also vary from person to person. Some may experience several hot flashes within one hour, while others may have a few a week. This can also change based on what stage of menopause you’re going through.
Hot flashes at night can also give way to night sweats, which is characterized by excessive sweating at night. The discomfort of night sweats can result in sleep problems.4
What Causes Hot Flashes?
Research has demonstrated that hot flashes are correlated with spikes in luteinizing hormone (LH). 10 LH is released in response to low estrogen and progesterone levels. Certain foods and actions may trigger hot flashes, though you may not have the same triggers as others. Some common triggers for hot flashes include:
- Drinking alcohol
- Consuming caffeine
- Stress and anxiety
- Spicy foods
- Smoking or being around secondhand smoke
Hot Flash Relief with Black Cohosh
Black cohosh, scientifically known as Actaea racemosa and Cimicifuga racemosa, is a member of the buttercup family native to North America. The perennial plant has a long history of use by Native Americans, who used it to treat everything from pneumonia to musculoskeletal pains. Today, black cohosh is most commonly used to help reduce menopausal symptoms (including hot flashes) and support overall hormonal balance. Black cohosh supplements are prepared from the plant’s roots and rhizomes and sold in the form of powder, liquid extracts, and pills containing the dried extract form.5
Research finding black cohosh to be helpful for menopause symptoms has been performed using Remifemin, a specific brand of black cohosh supplements. However, research utilizing generic black cohosh found it to be as helpful or less helpful than placebo.11, 12 In one meta-analysis of nine randomized controlled trials with over 1,400 total participants, results showed that preparations containing some amount of black cohosh improved hot flash (vasomotor) symptoms by 26 percent compared to placebos in seven trials. In five trials, black cohosh used in conjunction with other products improved hot flash symptoms by 41 percent.6
Because black cohosh may be effective in reducing menopause symptoms, we have decided to include it in DrFormulas™ Menopause Support which also combines black cohosh with soy isoflavones, licorice, red clover, false unicorn, and other phytoestrogenic ingredients to further support hormonal balance.
How Does Black Cohosh Work?
Hormone replacement therapy (HRT) is commonly used to treat menopausal symptoms. HRT involves supplying the body with estrogens and progesterone that are normally produced when a woman menstruates. The exact mechanisms of action for black cohosh and how it could work for hot flashes and other menopausal symptoms is unclear, especially when it has no phytoestrogenic activity.13
In a recent study from 2017, rats who had their ovaries surgically removed were given estradiol valerate and black cohosh. Results of the study found that both black cohosh and estradiol valerate enhanced norepinephrine produced in the locus coeruleus. Norepinephrine plays a role in regulation of body temperature, meaning that it may help manage hot flashes. The results also suggest that estradiol valerate and black cohosh may help to regulate the synthesis, degradation, and reuptake of norepinephrine through estrogen receptors.7
Black Cohosh Dosage
As black cohosh is not regulated by the FDA, exact dosage recommendations can vary. The British Herbal Compendium recommends doses of 40 to 200 milligrams of herb’s dried form spread over the course of a day. In liquid form, studies suggest that doses of 0.4 to 2 milliliters in a 60 percent ethanol mixture may offer the desired effects. For teas, powders, and other less easily absorbed forms of black cohosh, doses of 1 to 2 grams three times a day were found to be effective.8
Black Cohosh Side Effects
Black cohosh is generally safe to use, though some groups and health authorities do not recommend using black cohosh for longer than one year. If you have had breast cancer consult your doctor before using black cohosh. There are several reports of liver injury with black cohosh but it was found that these patients consumed alcoholic drinks on a daily basis. Alcohol consumption is known to cause liver damage.14, 15
Natural Remedies for Hot Flashes
While you may have trouble completely stopping your hot flashes, you may be able to manage your hot flashes with some simple changes to your lifestyle.
- Dress in layers so that you can adjust your clothes if you experience a sudden hot flash.
- Avoid foods that can trigger your hot flashes or make them worse (including alcohol, caffeine, and spicy foods).
- Try to quit smoking, which can exacerbate menopausal symptoms and harm your general health.
- Consider practicing yoga, meditation, or other mind-body techniques, which can help to calm your mind, reduce stress (a trigger for hot flashes), and better manage the discomfort of a hot flash episode.
- Try to maintain a healthy weight. Obesity and overweightness have been shown to contribute to more severe and more frequent hot flash episodes.9
No two women are alike, which also means that one treatment that works for one person may not work for another. If everyday methods for managing your hot flashes and other menopausal symptoms seem to be ineffective, talk to your doctor for other potential medications or methods of managing your symptoms.