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.
Shutterstock
How 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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Is Cutting Calories The Key To Healthy Long Life?
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Caloric Restriction with Optimal Nutrition
Yesterday, we asked you “What is your opinion of caloric restriction as a health practice?” and got the above-depicted, below-described spread of responses:
- 48% said “It is a robust, scientifically proven way to live longer and healthier”
- 23% said “It may help us to live longer, but at the cost of enjoying it fully”
- 17% said “It’s a dangerous fad that makes people weak, tired, sick, and unhealthy”
- 12% said “Counting calories is irrelevant to good health; the body compensates”
So… What does the science say?
A note on terms, first
“Caloric restriction” (henceforth: CR), as a term, sees scientific use to mean anything from a 25% reduction to a 50% reduction, compared to metabolic base rate.
This can also be expressed the other way around, “dropping to 60% of the metabolic base rate” (i.e., a 40% reduction).
Here we don’t have the space to go into much depth, so our policy will be: if research papers consider it CR, then so will we.
A quick spoiler, first
The above statements about CR are all to at least some degree True in one way or another.
However, there are very important distinctions, so let’s press on…
CR is a robust, scientifically proven way to live longer and healthier: True or False?
True! This has been well-studied and well-documented. There’s more science for this than we could possibly list here, but here’s a good starting point:
❝Calorie restriction (CR), a nutritional intervention of reduced energy intake but with adequate nutrition, has been shown to extend healthspan and lifespan in rodent and primate models.
Accumulating data from observational and randomized clinical trials indicate that CR in humans results in some of the same metabolic and molecular adaptations that have been shown to improve health and retard the accumulation of molecular damage in animal models of longevity.
In particular, moderate CR in humans ameliorates multiple metabolic and hormonal factors that are implicated in the pathogenesis of type 2 diabetes, cardiovascular diseases, and cancer, the leading causes of morbidity, disability and mortality❞
Source: Ageing Research Reviews | Calorie restriction in humans: an update
See also: Caloric restriction in humans reveals immunometabolic regulators of health span
We could devote a whole article (or a whole book, really) to this, but the super-short version is that it lowers the metabolic “tax” on the body and allows the body to function better for longer.
CR may help us to live longer, but at the cost of enjoying it fully: True or False?
True or False, contingently, depending on what’s important to you. And that depends on psychology as much as physiology, but it’s worth noting that there is often a selection bias in the research papers; people ill-suited to CR drop out of the studies and are not counted in the final data.
Also, relevant for a lot of our readers, most (human-based) studies recruit people over 18 and under 60. So while it is reasonable to assume the same benefits will be carried over that age, there is not nearly as much data for it.
Studies into CR and Health-Related Quality of Life (HRQoL) have been promising, and/but have caveats:
❝In non-obese adults, CR had some positive effects and no negative effects on HRQoL.❞
❝We do not know what degree of CR is needed to achieve improvements in HRQoL, but we do know it requires an extraordinary amount of support.
Therefore, the incentive to offer this intervention to a low-risk, normal or overweight individual is lacking and likely not sustainable in practice.❞
CR a dangerous fad that makes people weak, tired, sick, and unhealthy: True or False?
True if it is undertaken improperly, and/or without sufficient support. Many people will try CR and forget that the idea is to reduce metabolic load while still getting good nutrition, and focus solely on the calorie-counting.
So for example, if a person “saves” their calories for the day to have a night out in a bar where they drink their calories as alcohol, then this is going to be abysmal for their health.
That’s an extreme example, but lesser versions are seen a lot. If you save your calories for a pizza instead of a night of alcoholic drinks, then it’s not quite so woeful, but for example the nutrition-to-calorie ratio of pizza is typically not great. Multiply that by doing it as often as not, and yes, someone’s health is going to be in ruins quite soon.
Counting calories is irrelevant to good health; the body compensates: True or False?
True if by “good health” you mean weight loss—which is rarely, if ever, what we mean by “good health” here at 10almonds (unless we clarify such), but it’s a very common association and indeed, for some people it’s a health goal. You cannot sustainably and healthily lose weight by CR alone, especially if you’re not getting optimal nutrition.
Your body will notice that you are starving, and try to save you by storing as much fat as it can, amongst other measures that will similarly backfire (cortisol running high, energy running low, etc).
For short term weight loss though, yes, it’ll work. At a cost. That we don’t recommend.
❝By itself, decreasing calorie intake will have a limited short-term influence.❞
Source: Reducing Calorie Intake May Not Help You Lose Body Weight
See also…
❝Caloric restriction is a commonly recommended weight-loss method, yet it may result in short-term weight loss and subsequent weight regain, known as “weight cycling”, which has recently been shown to be associated with both poor sleep and worse cardiovascular health❞
Source: Dieting Behavior Characterized by Caloric Restriction
In summary…
Caloric restriction is a well-studied area of health science. We know:
- Practised well, it can extend not only lifespan, but also healthspan
- Practised well, it can improve mood, energy, sexual function, and the other things people fear losing
- Practised badly, it can be ruinous to the health—it is critical to practise caloric restriction with optimal nutrition.
- Practised badly, it can lead to unhealthy weight loss and weight regain
One final note…
If you’ve tried CR and hated it, and you practised it well (e.g., with optimal nutrition), then we recommend just not doing it.
You could also try intermittent fasting instead, for similar potential benefits. If that doesn’t work out either, then don’t do that either!
Sometimes, we’re just weird. It can often be because of a genetic or epigenetic quirk. There are usually workarounds, and/but not everything that’s right for most people will be right for all of us.
Take care!
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What is a virtual emergency department? And when should you ‘visit’ one?
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For many Australians the emergency department (ED) is the physical and emblematic front door to accessing urgent health-care services.
But health-care services are evolving rapidly to meet the population’s changing needs. In recent years, we’ve seen growing use of telephone, video, and online health services, including the national healthdirect helpline, 13YARN (a crisis support service for First Nations people), state-funded lines like 13 HEALTH, and bulk-billed telehealth services, which have helped millions of Australians to access health care on demand and from home.
The ED is similarly expanding into new telehealth models to improve access to emergency medical care. Virtual EDs allow people to access the expertise of a hospital ED through their phone, computer or tablet.
All Australian states and the Northern Territory have some form of virtual ED at least in development, although not all of these services are available to the general public at this stage.
So what is a virtual ED, and when is it appropriate to consider using one?
Shutterstock/Nils Versemann How does a virtual ED work?
A virtual ED is set up to mirror the way you would enter the physical ED front door. First you provide some basic information to administration staff, then you are triaged by a nurse (this means they categorise the level of urgency of your case), then you see the ED doctor. Generally, this all takes place in a single video call.
In some instances, virtual ED clinicians may consult with other specialists such as neurologists, cardiologists or trauma experts to make clinical decisions.
A virtual ED is not suitable for managing medical emergencies which would require immediate resuscitation, or potentially serious chest pains, difficulty breathing or severe injuries.
A virtual ED is best suited to conditions that require immediate attention but are not life-threatening. These could include wounds, sprains, respiratory illnesses, allergic reactions, rashes, bites, pain, infections, minor burns, children with fevers, gastroenteritis, vertigo, high blood pressure, and many more.
People with these sorts of conditions and concerns may not be able to get in to see a GP straight away and may feel they need emergency advice, care or treatment.
When attending the ED, they can be subject to long wait times and delayed specialist attention because more serious cases are naturally prioritised. Attending a virtual ED may mean they’re seen by a doctor more quickly, and can begin any relevant treatment sooner.
From the perspective of the health-care system, virtual EDs are about redirecting unnecessary presentations away from physical EDs, helping them be ready to respond to emergencies. The virtual ED will not hesitate in directing callers to come into the physical ED if staff believe it is an emergency.
The doctor in the virtual ED may also direct the patient to a GP or other health professional, for example if their condition can’t be assessed visually, or if they need physical treatment.
The results so far
Virtual EDs have developed significantly over the past three years, predominantly driven by the COVID pandemic. We are now starting to slowly see assessments of these services.
A recent evaluation my colleagues and I did of Queensland’s Metro North Virtual ED found roughly 30% of calls were directed to the physical ED. This suggests 70% of the time, cases could be managed effectively by the virtual ED.
Preliminary data from a Victorian virtual ED indicates it curbed a similar rate of avoidable ED presentations – 72% of patients were successfully managed by the virtual ED alone. A study on the cost-effectiveness of another Victorian virtual ED suggested it has the potential to generate savings in health-care costs if it prevents physical ED visits.
Only 1.2% of people assessed in Queensland’s Metro North Virtual ED required unexpected hospital admission within 48 hours of being “discharged” from the virtual ED. None of these cases were life-threatening. This indicates the virtual ED is very safe.
The service experienced an average growth rate of 65% each month over a two-year evaluation period, highlighting increasing demand and confidence in the service. Surveys suggested clinicians also view the virtual ED positively.
The right advice could tell you whether you need to visit hospital in person or not. 1st footage/Shutterstock What now?
We need further research into patient outcomes and satisfaction, as well as the demographics of those using virtual EDs, and how these measures compare to the physical ED across different triage categories.
There are also challenges associated with virtual EDs, including around technology (connection and skills among patients and health professionals), training (for health professionals) and the importance of maintaining security and privacy.
Nonetheless, these services have the potential to reduce congestion in physical EDs, and offer greater convenience for patients.
Eligibility differs between different programs, so if you want to use a virtual ED, you may need to check you are eligible in your jurisdiction. Most virtual EDs can be accessed online, and some have direct phone numbers.
Jaimon Kelly, Senior Research Fellow in Telehealth delivered health services, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Healthiest-Three-Nut Butter
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We’re often telling you to “diversify your nuts”, so here’s a great way to get in three at once with no added sugar, palm oil, or preservatives, and only the salt you choose to put in. We’ve picked three of the healthiest nuts around, but if you happen to be allergic, don’t worry, we’ve got you covered too.
You will need
- 1 cup almonds (if allergic, substitute a seed, e.g. chia, and make it ½ cup)
- 1 cup walnuts (if allergic, substitute a seed, e.g. pumpkin, and make it ½ cup)
- 1 cup pistachios (if allergic, substitute a seed, e.g. poppy, and make it ½ cup)
- 1 tbsp almond oil (if allergic, substitute extra virgin olive oil) (if you prefer sweet nut butter, substitute 1 tbsp maple syrup; the role here is to emulsify the nuts, and this will do the same job)
- Optional: ¼ tsp MSG or ½ tsp low-sodium salt
Method
(we suggest you read everything at least once before doing anything)
1a) If using nuts, heat your oven to 350℉ / 180℃. Place the nuts on a baking tray lined with baking paper, and bake/roast for about 10 minutes, but keep an eye on it to ensure the nuts don’t burn, and jiggle them if necessary to ensure they toast evenly. Once done, allow to cool.
1b) If using seeds, you can either omit that step, or do the same for 5 minutes if you want to, but really it’s not necessary.
2) Blend all ingredients (nuts/seeds, oil, MSG/salt) in a high-speed blender. Note: this will take about 10 minutes in total, and we recommend you do it in 30-second bursts so as to not overheat the motor. You also may need to periodically scrape the mixture down the side of the blender, to ensure a smooth consistency.
3) Transfer to a clean jar, and enjoy at your leisure:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Why You Should Diversify Your Nuts!
- Sesame Seeds vs Poppy Seeds – Which is Healthier?
- If You’re Not Taking Chia, You’re Missing Out
- Sea Salt vs MSG – Which is Healthier?
Take care!
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Watch Out For Lipedema
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Lipedema occurs mostly in women, mostly in times of hormonal change, with increasing risk as time goes by (so for example, puberty yields a lower risk than pregnancy, which yields a lower risk than menopause).
Its name literally means “fat swelling”, and can easily be mistaken for obesity or, in its earlier stages, just pain old cellulite.
Cellulite, by the way, is completely harmless and is also not, per se, an indicator of bad health. But if you have it and don’t like it, you can reduce it:
Obesity is more of a complex matter, and one that we’ve covered here:
Lipedema is actively harmful
Lipedema can become a big problem, because lifestyle change does not reduce lipedema fat, the fat is painful, can lead to obesity if one was not already obese, causes gait and joint abnormalities, causes fatigue, can lead to lymphedema (beyond the scope of today’s article—perhaps another time!) and very much psychosocial distress.
Like many conditions that mostly affect women, the science is… Well, here’s a recent example review that was conducted and published:
Fun fact: in Romanian there is an expression “one eye is laughing; the other is crying”, and it seems appropriate here.
Spot the signs
Because it’s most readily mistaken for cellulite in first presentation, let’s look at the differences between them:
- Cellulite is characterized by dimpled, bumpy, or even skin; lipedema is the same but with swelling too.
- Cellulite is a connective tissue condition; lipedema is too (at least in part), but also involves the abnormal accumulation and deposition of fat cells, rather than just pulling some down a bit.
- Cellulite has no additional symptoms; lipedema soon also brings swollen limbs, joint pain, and/or skin that’s “spongy” and easily bruised.
What to do about it
First, get it checked out by a doctor.
If the doctor says it is just cellulite or obesity, ask them what difference(s) they are basing that on, and ask that they confirm in writing having dismissed your concerns (having this will be handy later if it turns out to be lipedema after all).
If it is lipedema, you will want to catch it early; there is no known cure, but advanced symptoms are a lot easier to keep at bay than they are to reverse once they’ve shown up.
Weight maintenance, skin care (including good hydration), and compression therapy have all been shown to help slow the progression.
If it is allowed to progress unhindered, that’s when a lot more fat accumulation and joint pain is likely to occur. Liposuction and surgery are options, but even they are only a temporary solution, and are obviously not fun things to have to go through.
Prevention is, as ever, much better than
curetreatment ← because there is no known cureOne last thing
Lipedema’s main risk factor is genetic. The bad news is, there’s not much that can be done about that for now, but the good news is, you can at least get the heads-up about whether you are at increased risk or not, and be especially vigilant if you’re in the increased risk group. See also:
One Test, Many Warnings: The Real Benefit Of Genetic Testing
Take care!
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From straight to curly, thick to thin: here’s how hormones and chemotherapy can change your hair
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Head hair comes in many colours, shapes and sizes, and hairstyles are often an expression of personal style or cultural identity.
Many different genes determine our hair texture, thickness and colour. But some people’s hair changes around the time of puberty, pregnancy or after chemotherapy.
So, what can cause hair to become curlier, thicker, thinner or grey?
Curly or straight? How hair follicle shape plays a role
Hair is made of keratin, a strong and insoluble protein. Each hair strand grows from its own hair follicle that extends deep into the skin.
Curly hair forms due to asymmetry of both the hair follicle and the keratin in the hair.
Follicles that produce curly hair are asymmetrical and curved and lie at an angle to the surface of the skin. This kinks the hair as it first grows.
The asymmetry of the hair follicle also causes the keratin to bunch up on one side of the hair strand. This pulls parts of the hair strand closer together into a curl, which maintains the curl as the hair continues to grow.
Follicles that are symmetrical, round and perpendicular to the skin surface produce straight hair.
Each hair strand grows from its own hair follicle.
Mosterpiece/ShutterstockLife changes, hair changes
Our hair undergoes repeated cycles throughout life, with different stages of growth and loss.
Each hair follicle contains stem cells, which multiply and grow into a hair strand.
Head hairs spend most of their time in the growth phase, which can last for several years. This is why head hair can grow so long.
Let’s look at the life of a single hair strand. After the growth phase is a transitional phase of about two weeks, where the hair strand stops growing. This is followed by a resting phase where the hair remains in the follicle for a few months before it naturally falls out.
The hair follicle remains in the skin and the stems cells grow a new hair to repeat the cycle.
Each hair on the scalp is replaced every three to five years.
Each hair on the scalp is replaced every three to five years.
Just Life/ShutterstockHormone changes during and after pregnancy alter the usual hair cycle
Many women notice their hair is thicker during pregnancy.
During pregnancy, high levels of oestrogen, progesterone and prolactin prolong the resting phase of the hair cycle. This means the hair stays in the hair follicle for longer, with less hair loss.
A drop in hormones a few months after delivery causes increased hair loss. This is due to all the hairs that remained in the resting phase during pregnancy falling out in a fairly synchronised way.
Hair can change around puberty, pregnancy or after chemotherapy
This is related to the genetics of hair shape, which is an example of incomplete dominance.
Incomplete dominance is when there is a middle version of a trait. For hair, we have curly hair and straight hair genes. But when someone has one curly hair gene and one straight hair gene, they can have wavy hair.
Hormonal changes that occur around puberty and pregnancy can affect the function of genes. This can cause the curly hair gene of someone with wavy hair to become more active. This can change their hair from wavy to curly.
Researchers have identified that activating specific genes can change hair in pigs from straight to curly.
Chemotherapy has very visible effects on hair. Chemotherapy kills rapidly dividing cells, including hair follicles, which causes hair loss. Chemotherapy can also have genetic effects that influence hair follicle shape. This can cause hair to regrow with a different shape for the first few cycles of hair regrowth.
Your hair can change at different stages of your life.
Igor Ivakhno/ShutterstockHormonal changes as we age also affect our hair
Throughout life, thyroid hormones are essential for production of keratin. Low levels of thyroid hormones can cause dry and brittle hair.
Oestrogen and androgens also regulate hair growth and loss, particularly as we age.
Balding in males is due to higher levels of androgens. In particular, high dihydrotestosterone (sometimes shortened to DHT), which is produced in the body from testosterone, has a role in male pattern baldness.
Some women experience female pattern hair loss. This is caused by a combination of genetic factors plus lower levels of oestrogen and higher androgens after menopause. The hair follicles become smaller and smaller until they no longer produce hairs.
Reduced function of the cells that produce melanin (the pigment that gives our hair colour) is what causes greying.
Theresa Larkin, Associate professor of Medical Sciences, University of Wollongong
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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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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