From the Guidelines
Dicyclomine and black cohosh are not recommended as first-line treatments for menopause symptoms, and instead, FDA-approved treatments like hormone therapy, non-hormonal medications such as SSRIs, or other lifestyle modifications should be considered under medical guidance. Dicyclomine is an antispasmodic medication primarily used for irritable bowel syndrome, not for managing hot flashes or other menopausal symptoms. Black cohosh, on the other hand, is a herbal supplement that some women use for menopausal symptoms, particularly hot flashes, but its effectiveness is mixed and it may cause side effects including stomach discomfort, headache, and rash 1.
Menopause Symptom Management
For menopause symptom management, the following options can be considered:
- Hormone therapy, which can be effective in reducing hot flashes and other menopausal symptoms, but its use should be individualized and based on the risk-benefit profile of the patient 2, 3
- Non-hormonal medications such as SSRIs, which can decrease the intensity and severity of vasomotor symptoms 4, 5
- Lifestyle modifications, such as rhythmic breathing, vitamins, exercise, and avoiding spicy foods, caffeine, and alcohol, which can help decrease the intensity and severity of menopausal symptoms 4
- Environmental modifications, such as cool rooms and dressing in layers, which can also be helpful 4
Safety Considerations
Black cohosh should be avoided by women with liver disorders, hormone-sensitive conditions, or those taking blood thinners, due to the risk of liver failure and other adverse effects 1. Additionally, hormone replacement therapy may be contraindicated in certain types of cancer, such as low-grade serous epithelial ovarian cancer, granulosa cell tumors, and advanced endometrioid uterine adenocarcinoma 3.
Individualized Approach
A short-term administration of hormone replacement therapy can be discussed individually for symptomatic survivors, and management needs to be individualized based on the patient's medical history, risk factors, and preferences 3. Follow-up and separate consultation can be proposed to address concerns about sexuality and vaginal health, and referral networks of specialized persons can be established to provide comprehensive care 3.
From the Research
Black Cohosh for Menopause
- Black cohosh has been used for over 100 years in the United States for the treatment of gynecologic complaints, including menopausal symptoms such as hot flashes, profuse sweating, insomnia, and anxiety 6.
- The evidence suggests that black cohosh may be useful for the treatment of menopausal symptoms, with some studies showing significant improvements in overall menopausal symptoms, hot flashes, and somatic symptoms 7, 8.
- However, the efficacy of black cohosh as a treatment for menopausal symptoms is uncertain, and further rigorous trials seem warranted 9.
Dicyclomine and Black Cohosh
- There is no direct evidence in the provided studies regarding the use of dicyclomine and black cohosh for menopause.
- Dicyclomine is not mentioned in any of the studies, and therefore, its effectiveness or safety in combination with black cohosh for menopausal symptoms cannot be determined from the available evidence.
Safety and Efficacy of Black Cohosh
- Black cohosh has been shown to be safe and effective for reducing menopausal symptoms, with a low risk of adverse reactions such as nausea, vomiting, headaches, dizziness, mastalgia, and weight gain 6, 7.
- The current recommended dose of black cohosh is 40-80 mg per day, and at least 4-12 weeks of treatment may be required before any therapeutic benefits may be apparent 6.
- Black cohosh should not be administered to children or during pregnancy and lactation due to potential effects on sex hormones 6.