Black Cohosh vs The Menopause
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Black Cohosh, By Any Other Name…
Black cohosh is a flowering plant whose extracts are popularly used to relieve menopausal (and postmenopausal) symptoms.
Note on terms: we’ll use “black cohosh” in this article, but if you see the botanical names in studies, the reason it sometimes appears as Actaea racemosa and sometimes as Cimicfuga racemosa, is because it got changed and changed back on account of some disagreements between botanists. It’s the same plant, in any case!
Read: Reclassification of Actaea to include Cimicifuga and Souliea (Ranunculaceae)
Does it work?
In few words: it works for physical symptoms, but not emotional ones, based on this large (n=2,310) meta-analysis of studies:
❝Black cohosh extracts were associated with significant improvements in overall menopausal symptoms (Hedges’ g = 0.575, 95% CI = 0.283 to 0.867, P < 0.001), as well as in hot flashes (Hedges’ g = 0.315, 95% CIs = 0.107 to 0.524, P = 0.003), and somatic symptoms (Hedges’ g = 0.418, 95% CI = 0.165 to 0.670, P = 0.001), compared with placebo.
However, black cohosh did not significantly improve anxiety (Hedges’ g = 0.194, 95% CI = -0.296 to 0.684, P = 0.438) or depressive symptoms (Hedges’ g = 0.406, 95% CI = -0.121 to 0.932, P = 0.131)❞
~ Dr. Ryochi Sadahiro et al., 2023
Source: Black cohosh extracts in women with menopausal symptoms: an updated pairwise meta-analysis
Here’s an even larger (n=43,759) one that found similarly, and also noted on safety:
❝Treatment with iCR/iCR+HP was well tolerated with few minor adverse events, with a frequency comparable to placebo. The clinical data did not reveal any evidence of hepatotoxicity.
Hormone levels remained unchanged and estrogen-sensitive tissues (e.g. breast, endometrium) were unaffected by iCR treatment.
As benefits clearly outweigh risks, iCR/iCR+HP should be recommended as an evidence-based treatment option for natural climacteric symptoms.
With its good safety profile in general and at estrogen-sensitive organs, iCR as a non-hormonal herbal therapy can also be used in patients with hormone-dependent diseases who suffer from iatrogenic climacteric symptoms.❞
~ Dr. Castelo-Branco et al., 2020
(iCR = isopropanolic Cimicifuga racemosa)
So, is this estrogenic or not?
This is the question many scientists were asking, about 20 or so years ago. There are many papers from around 2000–2005, but here’s a good one that’s quite representative:
❝These new data dispute the estrogenic theory and demonstrate that extracts of black cohosh do not bind to the estrogen receptor in vitro, up-regulate estrogen-dependent genes, or stimulate the growth of estrogen-dependent tumors❞
Source: Is Black Cohosh Estrogenic?
(the abstract is a little vague, but if you click on the PDF icon, you can read the full paper, which is a lot clearer and more detailed)
The short answer: no, black cohosh is not estrogenic
Is it safe?
As ever, check with your doctor as everyone’s situation can vary, but broadly speaking, yes, it has a very good safety profile—including for breast cancer patients, at that. See for example:
- Black cohosh efficacy and safety for menopausal symptoms: the Spanish Menopause Society statement
- Black cohosh (Cimicifuga racemosa): safety and efficacy for cancer patients
- The safety of black cohosh (Actaea racemosa, Cimicifuga racemosa)
Where can I get some?
We don’t sell it, but here for your convenience is an example product on Amazon
Enjoy!
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Time Smart – by Dr. Ashley Whillans
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First, what this is not: it’s not a productivity book.
What is rather: a book of better wellbeing.
There is a little overlap, insofar as getting “time smart” in the ways that Dr. Whillans recommends will give you more ability to also be more productive—if that’s what you want.
She talks us through time traps and the “time poverty epidemic”, as well as steps to finding time and funding time. Perhaps most critical idea-wise is the chapter on building a “time-affluence habit”, making decisions that prioritize your time-freedom where you can—which in turn will allow you to build yet more. Kind of like compound interest really, but for time.
The writing style is a conversational tone, but peppered with bullet-point lists and charts and the like from time to time, and often with citations to back up claims. It makes for a very readable book, and yet one that’s also inspiring of the confidence that it’s more than just one person’s opinion.
Bottom line: if you sometimes feel like you could do everything you want to if you could just find the time, this book can help you get there.
Click here to check out Time Smart, and live your most satisfying life!
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What Teas To Drink Before Bed (By Science!)
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Which Sleepy Tea?
Herbal “tea” preparations (henceforth we will write it without the quotation marks, although these are not true teas) are popular for winding down at the end of a long day ready for a relaxing sleep.
Today we’ll look at the science for them! We’ll be brief for each, because we’ve selected five and have only so much room, but here goes:
Camomile
Simply put, it works and has plenty of good science for it. Here’s just one example:
❝Noteworthy, our meta-analysis showed a significant improvement in sleep quality after chamomile administration❞
Also this writer’s favourite relaxation drink!
(example on Amazon if you want some)
Lavender
We didn’t find robust science for its popularly-claimed sedative properties, but it does appear to be anxiolytic, and anxiety gets in the way of sleep, so while lavender may not be a sedative, it may calm a racing mind all the same, thus facilitating better sleep:
(example on Amazon if you want some)
Magnolia
Animal study for the mechanism:
Human study for “it is observed to help humans sleep better”:
As you can see from the title, its sedative properties weren’t the point of the study, but if you click through to read it, you can see that they found (and recorded) this benefit anyway
(example on Amazon if you want some)
Passionflower
There’s not a lot of evidence for this one, but there is some. Here’s a small study (n=41) that found:
❝Of six sleep-diary measures analysed, sleep quality showed a significantly better rating for passionflower compared with placebo (t(40) = 2.70, p < 0.01). These initial findings suggest that the consumption of a low dose of Passiflora incarnata, in the form of tea, yields short-term subjective sleep benefits for healthy adults with mild fluctuations in sleep quality.❞
So, that’s not exactly a huge body of evidence, but it is promising.
(example on Amazon if you want some)
Valerian
We’ll be honest, the science for this one is sloppy. It’s very rare to find Valerian tested by itself (or sold by itself; we had to dig a bit to find one for the Amazon link below), and that skews the results of science and renders any conclusions questionable.
And the studies that were done? Dubious methods, and inconclusive results:
Nevertheless, if you want to try it for yourself, you can do a case study (i.e., n=1 sample) if not a randomized controlled trial, and let us know how it goes 🙂
(example on Amazon if you want some)
Summary
- Valerian we really don’t have the science to say anything about it
- Passionflower has some nascent science for it, but not much
- Lavender is probably not soporific, but it is anxiolytic
- Magnolia almost certainly helps, but isn’t nearly so well-backed as…
- Camomile comes out on top, easily—by both sheer weight of evidence, and by clear conclusive uncontroversial results.
Enjoy!
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What is Ryeqo, the recently approved medicine for endometriosis?
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For women diagnosed with endometriosis it is often a long sentence of chronic pain and cramping that impacts their daily life. It is a condition that is both difficult to diagnose and treat, with many women needing either surgery or regular medication.
A medicine called Ryeqo has just been approved for marketing specifically for endometriosis, although it was already available in Australia to treat a different condition.
Women who want the drug will need to consult their local doctor and, as it is not yet on the Pharmaceutical Benefits Scheme, they will need to pay the full cost of the script.
What does Ryeqo do?
Endometriosis affects 14% of women of reproductive age. While we don’t have a full understanding of the cause, the evidence suggests it’s due to body tissue that is similar to the lining of the uterus (called the endometrium) growing outside the uterus. This causes pain and inflammation, which reduces quality of life and can also affect fertility.
Ryeqo is a tablet containing three different active ingredients: relugolix, estradiol and norethisterone.
Relugolix is a drug that blocks a particular peptide from releasing other hormones. It is also used in the treatment of prostate cancer. Estradiol is a naturally occurring oestrogen hormone in women that helps regulate the menstrual cycle and is used in menopausal hormone therapy. Norethisterone is a synthetic hormone commonly used in birth control medications and to delay menstruation and help with heavy menstrual bleeding.
All three components work together to regulate the levels of oestrogen and progesterone in the body that contribute to endometriosis, alleviating its symptoms.
Relugolix reduces the overall levels of oestrogen and progesterone in the body. The estradiol compensates for the loss of oestrogen because low oestrogen levels can cause hot flushes (also called hot flashes) and bone density loss. And norethisterone blocks the effects of estradiol on the uterus (where too much tissue growth is unwanted).
Is it really new?
The maker of Ryeqo claims it is the first new drug for endometriosis in Australia in 13 years.
But individually, all three active ingredients in Ryeqo have been in use since 2019 or earlier.
Ryeqo has been available in Australia since 2022, but until now was not specifically indicated for endometriosis. It was originally approved for the treatment of uterine fibroids, which share some common symptoms with endometriosis and have related causes.
In addition to Ryeqo, current medical guidance lists other drugs that are suitable for endometriosis and some reformulations of these have also only been recently approved.
The oral medicine Dienogest was approved in 2021, and there have been a number of injectable drugs for endometriosis recently approved, such as Sayana Press which was approved in a smaller dose form for self-injection in 2023.
You can’t take the contraceptive pill with Ryeqo but the endometriosis drug could replace it.
ShutterstockHow to take it and what not to do
Ryeqo is a once-a-day tablet. You can take it with, or without food, but it should be taken about the same time each day.
It is recommended you start taking Ryeqo within the first five days after the start of your next period. If you start at another time during your period, you may experience initial irregular or heavier bleeding.
Because it contains both synthetic and natural hormones, you can’t use the contraceptive pill and Ryeqo together. However, because Ryeqo does contain norethisterone it can be used as your contraception, although it will take at least one month of use to be effective. So, if you are on Ryeqo, you should use a non-hormonal contraceptive – such as condoms – for a month when starting the medicine.
Ryeqo may be incompatible with other medicines. It might not be suitable for you if you take medicines for epilepsy, HIV and AIDS, hepatitis C, fungal or bacterial infections, high blood pressure, irregular heartbeat, angina (chest pain), or organ rejection. You should also not take Ryeqo if you have a liver tumour or liver disease.
The possible side effects of Ryeqo are similar to those of oral contraceptives. Blood clots are a risk with any medicine that contains an oestrogen or a progestogen, which Ryeqo does. Other potential side effects include bone loss, a reduction in menstrual blood loss or loss of your period.
It’s costly for now
Ryeqo can now be prescribed in Australia, so you should discuss whether Ryeqo is right for you with the doctor you usually consult for your endometriosis.
While the maker has made a submission to the Pharmaceutical Benefits Advisory Committee, it is not yet subsidised by the Australian government. This means that rather than paying the normal PBS price of up to A$31.60, it has been reported it may cost as much as $135 for a one-month supply. The committee will make a decision on whether to subsidise Ryeqo at its meeting next month.
Correction: this article has been updated to clarify the recent approval of specific formulations of drugs for endometriosis.
Nial Wheate, Associate Professor of the School of Pharmacy, University of Sydney and Jasmine Lee, Pharmacist and PhD Candidate, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How Intermittent Fasting Reduces Heart Attack Risk (Directly, Not Via Weight Control!)
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We’ve written before about the benefits of intermittent fasting, such as:
- Intermittent Fasting: What’s The Truth?
- 16/8 Intermittent Fasting For Beginners
- Before You Eat Breakfast: 3 Surprising Facts About Intermittent Fasting
Intermittent fasting is mostly enjoyed for its metabolic benefits, such as How To Prevent And Reverse Type 2 Diabetes.
We also covered a very related topic, with intermittent fasting once again being on the suggestions list:
Improve Your Insulin Sensitivity! ← this is actually more important even that blood sugar control itself, important as that latter is!
So, how does it work to reduce heart attack risk?
While intermittent fasting can be used as a weight loss tool (it also doesn’t have to be—it depends on what you eat and what you’re doing in terms of exercise, amongst other factors), this isn’t about that.
Although it is also worth mentioning that intermittent fasting does reduce the risks associated with diabetes, hypercholesterolemia, cancer, Alzheimer’s, and more, as well as generally improving cardiovascular health by reducing blood pressure, cholesterol, and insulin resistance, amongst other metrics.
However, this is about platelet aggregation. Or in whole: platelet activation, aggregation, and thrombosis.
A team of scientists, Dr. Shimo Dai et al., investigated the effects of alternate-day intermittent fasting on platelets and thrombosis, in two quite different, but both important, demographics:
- Humans with coronary artery disease
- Mice with the ApoE gene (the Alzheimer’s risk gene)
Why the mice? Because they wanted to check the level of cerebral ischemia-reperfusion injury (the damage that occurs after a stroke), and no ethics board will let scientists slice up human participants brains at will.
In both cases, the intermittent fasting group enjoyed protective effects that the control group (ad libitum eating) did not.
Specifically, reduced platelet activation, as well as reduced platelet aggregation. Just to be clear:
- Platelet activation = platelets getting deployed
- Platelet aggregation = platelets sticking together
Both are required for thrombosis, which occurs when the platelets, having been activated and aggregated (which is their job, for example to stop bleeding in the case of an injury), block one or more blood vessels.
A healthy level of platelet activation and aggregation rests in the sweet spot wherefrom it can stop bleeding, without stopping blood circulation.
This was found to be associated with increased levels of indole-3-propionic acid (IPA), which is created by certain gut bacteria (C. sporogenes), who proliferate enthusiastically during intermittent fasting.
In few words:
- intermittent fasting triggers the C. sporogenes to proliferate,
- which increases IPA levels,
- which reduces platelet activation and aggregation,
- which reduces the risk of thrombosis,
- and thus reduces the risk of heart attack.
We may hypothesize that this may be a reason to not do intermittent fasting if you have a bleeding disorder, and consult your doctor if you’re on blood thinners.
For everyone else, this is one more thing that makes intermittent fasting a very healthful practice!
You can find the paper itself here:
And here’s a pop-science article that gets more technical than we have, if you’d like a middle-ground in terms of complexity:
Intermittent fasting cuts heart attack risk by preventing dangerous blood clots
Want to try intermittent fasting, but it sounds hard?
Check out this:
Enjoy!
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Next-Level Headache Hacks
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A Muscle With A Lot Of Therapeutic Value
First, a quick anatomy primer, so that the rest makes sense. We’re going to be talking about your sternocleidomastoid (SCM) muscle today.
To find it, there are two easy ways:
- look in a mirror, turn your head to one side and it’ll stick out on the opposite side of your neck
- look at this diagram
(we’re going to talk about it in the singular, but you have one on each side)
This muscle is interesting for very many reasons, but what we’re going to focus on today is that massaging/stretching it (correctly!) can benefit several things that are right next to it and/or behind it, namely:
- The tenth cranial nerve
- The eleventh cranial nerve
- The carotid artery
Why do we care about these?
Well, we would die quickly without the first and last of those. However, more practically, massaging each has benefits:
The tenth cranial nerve
This one is also known by its superhero alter-ego name:
The Vagus Nerve (And How You Can Make Use Of It)
The eleventh cranial nerve
This one’s not nearly so critical to life, but it does facilitate most of the motor functions in that general part of the body—including some mechanics of speech production, and maintaining posture of the shoulders/neck/head (which in turn strongly affects presence/absence of certain kinds of headaches).
The carotid artery
We suspect you know what this one does already; it supplies the brain (and the rest of your head, for that matter) with oxygenated blood.
What is useful to know today, is that it can be massaged, via the SCM, in a way that brings about a gentler version of this “one weird trick” to cure a lot of kinds of headaches:
Curing Headaches At Home With Actual Science
How (And Why) To Massage Your SCM
…to relieve many kinds of headache, migraine, eye-ache, and tension or pain the jaw. It’s not a magical cure all so this comes with no promises, but it can and will help with a lot of things.
In few words: turn your ahead away from the side where it hurts (if both, just pick one and then repeat for the other side), and slightly downwards. When your SCM sticks out a bit on the other side, gently pinch and rub it, working from the bottom to the top.
If you prefer videos, here is a demonstration:
How (And Why) To Stretch Your SCM
The above already includes a little stretch, but you can stretch it in a way that specifically stimulates your vagus nerve (this is good for many things).
In few words: stand (or sit) up straight, and interlace your fingers together. Put your hands on the back of your neck, thumbs-downwards, and (keeping your face forward) look to one side with your eyes only, and hold that until you feel the urge to yawn (it’ll probably take between about 3 seconds and 30 seconds). Then repeat on the other side.
If you prefer videos, this one is a very slight variation of what we just described but works the same way:
Take care!
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Egg Whites vs Whole Eggs – Which is Healthier?
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Our Verdict
When comparing egg whites to whole eggs, we picked the whole eggs.
Why?
Egg whites are mostly protein. Egg yolks are mostly fat, with some protein.
However, fat ≠ bad, and the yolk is also where the choline is stored, which itself (as well as its benefits for your brain) will tend to reduce fat storage in the body.
Furthermore, the yolk contains an assortment of vitamins, minerals, and essential amino acids. After all, the yolk is there specifically to contain everything needed to turn a cluster of cells into a small bird.
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