Abstract
The objective of this study was to evaluate the efficacy of fluoxetine and black cohosh in the treatment of women with postmenopausal symptoms. A total of 120 healthy women with menopausal symptoms were recruited to this prospective study with a follow-up period of 6 mo. They were randomly assigned to 1 of 2 groups and were treated with fluoxetine or black cohosh. After entry into the study, patients were examined at the first, second, third, and sixth months of the treatment period. The women kept diaries in which they reported the daily number and intensity of hot flushes and night sweats. In addition, at the beginning and end of the third month, they completed questionnaires consisting of a modified Kupperman Index, Beck’s Depression Scale, and a RAND-36 Quality-of-Life Questionnaire. Statistically significant differences were noted in the Kupperman Index and Beck’s Depression Scale at the end of the third month in both groups compared with baseline values. In the black cohosh group, the Kupperman Index decreased significantly compared with that in the fluoxetine group by the end of the third month. On the other hand, in the fluoxetine group, Beck’s Depression Scale decreased significantly compared with that in the black cohosh group. Monthly scores for hot flushes and night sweats decreased significantly in both groups; however, black cohosh reduced monthly scores for hot flushes and night sweats to a greater extent than did fluoxetine. At the end of the sixth month of treatment, black cohosh reduced the hot flush score by 85%, compared with a 62% result for fluoxetine. By the sixth month of the study, 40 women had discontinued the study—20 (33%) in the fluoxetine group and 20 (33%) in the black cohosh group. Compared with fluoxetine, black cohosh is more effective for treating hot flushes and night sweats. On the other hand, fluoxetine is more effective in improvements shown on Beck’s Depression Scale.
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References
van derMooren MJ, Kenemans P. Postmenopausal hormone therapy: impact on menopauserelated symptoms, chronic disease and quality of life.Drugs. 2004; 64: 821–836.
Anderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial.JAMA. 2004; 291: 1701–1712.
Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the women’s health initiative randomized controlled trial.JAMA. 2002; 288: 321–333.
Vittinghoff E, Shlipak MG, Varosy PD, et al. Risk factors and secondary prevention in women with heart disease: the Heart and Estrogen/Progestin Replacement Study.Ann Intern Med. 2003; 138: 81–89.
Beral V. Breast cancer and hormone-replacement therapy in the million women study.Lancet. 2003; 362: 419–427.
Austin PC, Mamdani MM, Tu K, Jaakkimainen L. Prescriptions for estrogen replacement therapy in Ontario before and after publication of the women’s health initiative study.JAMA. 2003; 289: 3241–3242.
Simon JA, Mack CJ. Counseling patients who elect to discontinue hormone therapy.Int J Fertil Womens Med. 2003; 48: 111–116; discussion 137–138.
Lobo RA, McCormick W, Singer F, Roy S. Depo-medroxyprogesterone acetate compared with conjugated estrogens for the treatment of postmenopausal women.Obstet Gynecol. 1984; 63: 1–5.
Andersen O, Engebretsen T, Solberg VM, Orbo A. Alpha-methyldopa for climacteric hot flushes: a double-blind, randomized, cross-over study.Acta Obstet Gynecol Scand. 1986; 65: 405–409.
Loprinzi CL, Pisansky TM, Fonseca R, et al. Pilot evaluation of venlafaxine hydrochloride for the therapy of hot flashes in cancer survivors.J Clin Oncol. 1998; 16: 2377–2381.
Stearns V, Beebe KL, Iyengar M, Dube E. Paroxetine controlled release in the treatment of menopausal hot flashes: a randomized controlled trial.JAMA. 2003; 289: 2827–2834.
Loprinzi CL, Sloan JA, Perez EA, et al. Phase III evaluation of fluoxetine for treatment of hot flashes.J Clin Oncol. 2002; 20: 1578–1583.
Loprinzi CL, Kugler JW, Sloan JA, et al. Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial.Lancet. 2000; 356: 2059–2063.
Loprinzi L, Barton DL, Sloan JA, et al. Pilot evaluation of gabapentin for treating hot flashes.Mayo Clin Proc. 2002; 77: 1159–1163.
Albertazzi P, Bottazzi M, Purdie DW. Gabapentin for the management of hot flushes: a case series.Menopause. 2003; 10: 214–217.
Guttuso T Jr, Kurlan R, McDermott MP, Kieburtz K. Gabapentin’s effects on hot flashes in postmenopausal women: a randomized controlled trial.Obstet Gynecol. 2003; 101: 337–345.
Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials.Ann Intern Med. 2002; 137: 805–813.
Burke GL, Legault C, Anthony M, et al. Soy protein and isoflavone effects on vasomotor symptoms in periand postmenopausal women: the soy estrogen alternative study.Menopause. 2003; 10: 147–153.
Penotti M, Fabio E, Modena AB, Rinaldi M, Omodei U, Vigano P. Effect of soy-derived isoflavones on hot flushes, endometrial thickness, and the pulsatility index of the uterine and cerebral arteries.Fertil Steril. 2003; 79: 1112–1117.
Hernandez Munoz G, Pluchino S.Cimicifuga racemosa for the treatment of hot flushes in women surviving breast cancer.Maturitas. 2003; 44(suppl 1): S59-S65.
Huntley A, Ernst E. A systematic review of the safety of black cohosh.Menopause. 2003; 10: 58–64.
Baber RJ, Templeman C, Morton T, Kelly GE, West L. Randomized placebo-controlled trial of an isoflavone supplement and menopausal symptoms in women.Climacteric. 1999; 2: 85–92.
Knight DC, Howes JB, Eden JA. The effect of Promensil, an isoflavone extract, on menopausal symptoms.Climacteric. 1999; 2: 79–84.
Tice JA, Ettinger B, Ensrud K, Wallace R, Blackwell T, Cummings SR. Phytoestrogen supplements for the treatment of hot flashes: the Isoflavone Clover Extract (ICE) Study: a randomized controlled trial.JAMA. 2003; 290: 207–214.
Hirata JD, Swiersz LM, Zell B, Small R, Ettinger B. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial.Fertil Steril. 1997; 68: 981–986.
Wiklund IK, Mattsson LA, Lindgren R, Limoni C. Effects of a standardized ginseng extract on quality of life and physiological parameters in symptomatic postmenopausal women: a doubleblind, placebo-controlled trial. Swedish Alternative Medicine Group.Int J Clin Pharmacol Res. 1999; 19: 89–99.
Barton DL, Loprinzi CL, Quella SK, et al. Prospective evaluation of vitamin E for hot flashes in breast cancer survivors.J Clin Oncol. 1998; 16: 495–500.
Chenoy R, Hussain S, Tayob Y, O’Brien PM, Moss MY, Morse PF. Effect of oral gamolenic acid from evening primrose oil on menopausal flushing.BMJ. 1994; 308: 501–503.
Komesaroff PA, Black CV, Cable V, Sudhir K. Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women.Climacteric. 2001; 4: 144–150.
McKenna DJ, Jones K, Humphrey S, Hughes K. Black cohosh: efficacy, safety, and use in clinical and preclinical applications.Altern Ther Health Med. 2001; 7: 93–100.
Lieberman S. A review of the effectiveness ofCimicifuga racemosa (black cohosh) for the symptoms of menopause.J Womens Health. 1998; 7: 525–529.
Liske E. Therapeutic efficacy and safety ofCimicifuga racemosa for gynecologic disorders.Adv Ther. 1998; 15: 45–53.
Wuttke W, Seidlova-Wuttke D, Gorkow C. The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers.Maturitas. 2003; 44(suppl 1): S67-S77.
Nappi RE, Malavasi B, Brundu B, Facchinetti F. Efficacy ofCimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol.Gynecol Endocrinol. 2005; 20: 30–35.
Archer JS. NAMS/Solvay Resident Essay Award: relationship between estrogen, serotonin, and depression.Menopause. 1999; 6: 71–78.
Shanafelt TD, Barton DL, Adjei AA, Loprinzi CL. Pathophysiology and treatment of hot flashes.Mayo Clin Proc. 2002; 77: 1207–1218.
Suvanto-Luukkonen E, Koivunen R, Sundstrom H, et al. Citalopram and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized, 9-month, placebo-controlled, doubleblind study.Menopause. 2005; 12: 18–26.
Kocyigit HAO, Fisek G, Olmez N, Memis A. Validity and reliability of Turkish version of SF-36.J Drug Ther. (Ilaç ve Tedavi Dergisi) 1999; 12: 102–106.
Pockaj BA, Loprinzi CL, Sloan JA, et al. Pilot evaluation of black cohosh for the treatment of hot flashes in women.Cancer Invest. 2004; 22: 515–521.
Jacobson JS, Troxel AB, Evans J, et al. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer.J Clin Oncol. 2001; 19: 2739–2745.
Uebelhack R, Blohmer JU, Graubaum HJ, Busch R, Gruenwald J, Wernecke KD. Black cohosh and St. John’s wort for climacteric complaints: a randomized trial.Obstet Gynecol. 2006; 107: 247–255.
Lontos S, Jones RM, Angus PW, Gow PJ. Acute liver failure associated with the use of herbal preparations containing black cohosh.Med J Aust. 2003; 179: 390–391.
Wuttke W, Jarry H, Becker T, et al. Phytoestrogens: endocrine disrupters or replacement for hormone replacement therapy?Maturitas. 2003; 44(suppl 1): S9-S20.
Seidlova-Wuttke D, Jarry H, Becker T, Christoffel V, Wuttke W. Pharmacology ofCimicifuga racemosa extract BNO 1055 in rats: bone, fat and uterus.Maturitas. 2003; 44(suppl 1): S39-S50.
Jarry H, Metten M, Spengler B, Christoffel V, Wuttke W. In vitro effects of theCimicifuga racemosa extract BNO 1055.Maturitas. 2003; 44(suppl 1): S31-S38.
Winterhoff H, Spengler B, Christoffel V, Butterweck V, Lohning A. Cimicifuga extract BNO 1055: reduction of hot flushes and hints on antidepressant activity.Maturitas. 2003; 44(suppl 1): S51-S58.
Berendsen HH. The role of serotonin in hot flushes.Maturitas. 2000; 36: 155–164.
Evans ML, Pritts E, Vittinghoff E, McClish K, Morgan KS, Jaffe RB. Management of postmenopausal hot flushes with venlafaxine hydrochloride: a randomized, controlled trial.Obstet Gynecol. 2005; 105: 161–166.
Weitzner MA, Moncello J, Jacobsen PB, Minton S. A pilot trial of paroxetine for the treatment of hot flashes and associated symptoms in women with breast cancer.J Pain Symptom Manage. 2002; 23: 337–345.
Barton DL, Loprinzi CL, Novotny P, et al. Pilot evaluation of citalopram for the relief of hot flashes.J Support Oncol. 2003; 1: 47–51.
Wiklund I, Holst J, Karlberg J, et al. A new methodological approach to the evaluation of quality of life in postmenopausal women.Maturitas. 1992; 14: 211–224.
Polo-Kantola P, Erkkola R, Irjala K, Helenius H, Pullinen S, Polo O. Climacteric symptoms and sleep quality.Obstet Gynecol. 1999; 94: 219–224.
MacLennan A, Lester S, Moore V. Oral estrogen replacement therapy versus placebo for hot flushes: a systematic review.Climacteric. 2001; 4: 58–74.
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Oktem, M., Eroglu, D., Karahan, H.B. et al. Black cohosh and fluoxetine in the treatment of postmenopausal symptoms: A prospective, randomized trial. Adv Therapy 24, 448–461 (2007). https://doi.org/10.1007/BF02849914
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DOI: https://doi.org/10.1007/BF02849914