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Vaginal, endometrial, and reproductive hormone findings: randomized, placebo-controlled trial of black cohosh, multibotanical herbs, and dietary soy for vasomotor symptoms: the Herbal Alternatives for Menopause (HALT) Study

Reed, Susan D. MD, MPH1,2,4; Newton, Katherine M. PhD1; LaCroix, Andrea Z. PhD1,4; Grothaus, Louis C. MS1; Grieco, Verena S. MD3; Ehrlich, Kelly MA1

doi: 10.1097/gme.0b013e318057787f

Objective: To evaluate vaginal, endometrial, and reproductive hormone effects of three herbal regimens compared with placebo and hormone therapy (HT).

Design: This was a 1-year, randomized, double-blind, placebo-controlled trial of 351 women, ages 45 to 55, with two or more vasomotor symptoms per day. Women were randomly assigned to (1) black cohosh, (2) a multibotanical containing black cohosh, (3) the same multibotanical plus dietary soy counseling, (4) HT, or (5) placebo. Women were ineligible if they had used HT in the previous 3 months or menopausal herbal therapies in the previous month. Data on vaginal cytology and dryness were collected (at baseline and 3 and 12 mo). Daily menstrual diaries were maintained by 313 women with a uterus, and abnormal bleeding was evaluated. Serum estradiol, follicle-stimulating hormone, luteinizing hormone, and steroid hormone-binding globulin were assessed (baseline and 12 mo) among 133 postmenopausal women. Gynecologic outcomes of the five groups were compared.

Results: The five groups did not vary in baseline vaginal cytology profiles, vaginal dryness, menstrual cyclicity, or hormone profiles. The HT group had a lower percentage of parabasal cells and vaginal dryness than the placebo group at 3 and 12 months (P < 0.05). Abnormal bleeding occurred in 53 of 313 (16.9%) women. There were no differences in frequency of abnormal bleeding between any of the herbal and placebo groups, whereas women in the HT group had a greater risk than those in the placebo group (P < 0.001). Among postmenopausal women, HT significantly decreased follicle-stimulating hormone and increased estradiol; none of the herbal interventions showed significant effects on any outcomes at any time point.

Conclusion: Black cohosh, used alone or as part of a multibotanical product with or without soy dietary changes, had no effects on vaginal epithelium, endometrium, or reproductive hormones.

Black cohosh used alone, or as part of a multibotanical product with and without soy diet changes, had no effects on vaginal epithelium or dryness, menstrual cyclicity, abnormal bleeding patterns, endometrial pathology, or reproductive hormones.

From the 1Group Health Center for Health Studies, Seattle, WA; Departments of 2Obstetrics and Gynecology and 3Pathology, University of Washington School of Medicine, Seattle, WA; and 4Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, WA.

Received December 21, 2006; revised and accepted February 28, 2007.

Funding/support: This project was funded by the National Institute on Aging and the National Center for Complementary and Alternative Medicine (grant R01AG17057, Alternative Therapies for Menopause: A Randomized Trial) and an administrative supplement from the National Institute on Aging (Alternative Therapies for Menopause-A Randomized Trial: Herbal Alternatives Quality Control Supplement).

Financial disclosure: None reported.

Address correspondence to: Susan D. Reed, MD, MPH, Department of Obstetrics and Gynecology, Harborview Medical Center, 325 9th Avenue, Box 359865, Seattle, WA. E-mail:

©2008The North American Menopause Society