Sorry, gentlemen, this article is for the ladies.

One of the unspoken side effects of chemo and radiation is early menopause. Cancer patients often get told about the effects on our fertility but doctors don’t always mention the other symptoms, which can sometimes be even more distressing. It’s definitely the elephant in the room. Symptoms like hot flushes, night sweats, insomnia, loss of libido, vaginal atrophy, depression, irritability and mood swings can severely affect your wellbeing and even affect your relationships with your partner and family. Plus the loss of oestrogen can result in loss of bone density, leading to osteoporosis. The problems are even worse for those with hormonal cancers, who are often treated with antihormonal therapies like tamoxifen.

Some women may consider hormone replacement therapy (HRT), but it is generally discouraged by doctors. The problem is that, even if you don’t have a hormonal cancer, your risk of getting other cancers is higher after chemo and radiation because the treatments increase the risk. And increasing oestrogen levels by using HRT adds an additional risk factor. For breast cancer patients, the risk of recurrence is just too high.

Certain extracts of Black cohosh (Cimicifuga racemosa), created using isopropanol as a solvent, have been shown to safely treat menopausal symptoms without increasing the risk of hormonal cancers. The commercial preparations Remifemin® and Remifemin Plus® are the extracts used in all these studies. Preparations of Black cohosh prepared using ethanol and other solvents don’t work in the same way and can potentially cause problems.

Until fairly recently, it was thought that Black cohosh was oestrogenic. But a significant number of studies show that Remifemin® doesn’t change hormone levels, breast density, the growth of breast cells, or the thickness of the endometrium, the lining of the uterus (1, 4). In fact, in human studies, recurrence-free survival of breast cancer survivors treated with Remifemin Plus®, which has higher levels of Black cohosh plus St John’s Wort (Hypericum perforatum), was increased by 4.5 years and they had a lower rate of metastasis (1).

Patients on tamoxifen, who tend to suffer worse menopausal symptoms, particularly benefited from the addition of St John’s Wort to a higher dose of Black cohosh in Remifemin Plus®, with about 70% of them getting benefit from it (2). The 2 herbs together work more effectively and St John’s Wort is especially effective against the psychological symptoms of menopause.

In one study of patients who had surgery for early endometrial cancer, the surgery caused early menopause. Treatment with Remifemin® for 24 weeks significantly reduced their symptoms and increased their bone density as well (2).

Another study looked at patients who had surgery for gynaecological cancers (ovarian, cervical, endometrial, and breast cancers). They had a significant reduction in sweating, hot flushes and depression after receiving Remifemin® for 3 months (2).

This isn’t an instant fix. Studies show that it’s most effective if you take it for at least 3 months (2). You start to get results after 4 weeks but it improves with time, so don’t give up if you don’t get relief straight away.

Unlike regular HRT, Remifemin® has few side effects. It doesn’t significantly affect weight gain, blood pressure, heart rate, kidney or liver function (2). It does increase HDL (‘good’) cholesterol and reduces LDL (‘bad’) cholesterol.

The St John’s wort in Remifemin Plus® is a very low dose. It doesn’t need to be high because of the way it works synergistically with the Black cohosh. The research shows that it doesn’t have the problems with drug interactions that high doses would have (2).

It would be unwise to take these supplements during treatment. There is animal research that suggests that Black cohosh increases the effects of docetaxel and doxorubicin, and reduced the effects of cisplatin, all of which are used to treat breast cancer and other cancers (3). It didn’t affect radiation or 4-hydroperoxycyclophosphamide (4-HC) (3). I suggest that you wait until after your treatment is complete before using it.

As always, I recommend that you consult a natural health practitioner for individual advice and let your oncologist know that you’re using any complementary therapies.

Remifemin® is widely available in chemists and even in some supermarkets.

References

(1)   Ruan X, Mueck A, Beer A, Naser B, Pickartz S. Benefit–risk profile of black cohosh (isopropanolic Cimicifuga racemosa extract) with and without St John’s wort in breast cancer patients. Climacteric. 2019;22(4):339-347. doi:10.1080/13697137.2018.1551346

(2)    Castelo-Branco C, Gambacciani M, Cano A et al. Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms – an update on the evidence. Climacteric. 2020;24(2):109-119. doi:10.1080/13697137.2020.1820477

(3)    Rockwell S, Liu Y, Higgins S. Alteration of the effects of cancer therapy agents on breast cancer cells by the herbal medicine black cohosh. Breast Cancer Res Treat. 2005;90(3):233-239. doi:10.1007/s10549-004-4260-x

(4)    Fritz H, Seely D, McGowan J et al. Black Cohosh and Breast Cancer. Integr Cancer Ther. 2013;13(1):12-29. doi:10.1177/1534735413477191