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Although it has been used to assist in childbirth, black cohosh is not recommended in pregnancy.

PRACTICE POINTS/PATIENT COUNSELLING

• Several clinical trials have tested black cohosh in menopause and generally found it to bean effective symptom reliever.

• It appears that 4-12 weeks' continuous treatment are required for adequate menopausal symptom relief.

• Black cohosh Is also used In the treatment of premenstrual syndrome and dysmenorrhea and Is Commission E-approved for these uses; however, controlled studies are not available to confirm efficacy.

• There is some evidence suggesting black cohosh exerts selective oestrogen receptor modulator activity, serotonergic activity and possibly dopaminergic activity.

• Black cohosh should be only used under professional supervision for treatment of oestrogen-dependent tumours or during pregnancy.

• Black cohosh is well tolerated; however, rare case reports of idiosyncratic hepatic reactions have been described.

ANSWERS TO PATIENTS' FREQUENTLY ASKED QUESTIONS

What will this herb do for me?

Black cohosh has been well tested and shown to be an effective treatment for menopausal symptoms in most women, especially those with mild to moderate symptoms. It may also be useful in the treatment of premenstrual syndrome and prevention of period cramping. When will it start to work?

Studies suggest that benefits are seen within 4-12 weeks' for the treatment of menopausal symptoms.

Are there any safety issues?

Black cohosh should only be used under professional supervision for treatment of oestrogen-dependent tumours or during pregnancy.

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