The People's Perspective on Medicine

Is St. John’s Wort Safe & Effective For Hot Flashes?

Q. I have been reading about the problems of hormone replacement therapy on your website. Since discontinuing HRT I have been using St. John’s wort and it has relieved many symptoms, including sleeplessness, stress and fits of temper. I don’t know why doctors in the USA don’t suggest it, because it is safe and you don’t feel medicated taking it. Your thoughts?
A. We’re not surprised that you got benefit from St. John’s wort. This herb has been shown to be an effective treatment for symptoms of perimenopause and menopause in a double-blind, placebo-controlled trial.
A recent review in the journal Gynecological Endocrinology (Sept. 2012) concluded that when black cohosh (Cimicifuga racemosa) is combined with St. John’s wort (Hypericum perforatum) the benefits are better than placebo. The combination of black cohosh and St. John’s wort is recommended by many physicians in Europe, especially in Germany, though it has not achieved the same degree of popularity in the U.S.
American physicians like scientific support before they recommended an alternative approach. Here is a link to one study published in the highly respected journal Obstetrics and Gynecology. The authors concluded:
“This fixed combination of black cohosh and St. John’s wort is superior to placebo in alleviating climacteric complaints [menopausal symptoms], including the related psychological component.”
Here is what our visitors have reported:

“I have personally found Black Cohosh to be most effective for hot flushes. Occasionally I stop taking it just to check but the problem is back within a day. I have been taking this for several years now, with no problems.”
Kiwi R.

“Black Cohosh has worked wonderfully well for my night sweats and hot flashes. It truly is amazing. If I stop taking them for about three days the hot flashes start again, although it takes about a week before the night sweats reappear. Having just completed menopause (1 year), I may try to taper off of the Black Cohosh in about 6 months. So far, this regimen has been very effective for me.”
E. M.

“I started using Remifemin (black cohosh, taken twice daily) at least 6 weeks ago. My most troublesome menopause symptom was insomnia. After 4 weeks on Remifemin I noticed I was sleeping better.”

Not everyone gets such results, however. Some women report that black cohosh doesn’t help at all.
“I tried everything as my hot flashes began – acupuncture, tofu, miso, soy milk, Chinese herbs, Remifemin (red clover), black cohosh, etc. All worked for awhile and then nothing worked at all. My hot flashes were debilitating!”
W. H.

The combination of black cohosh and St. John’s wort may be better than either alone. But St. John’s wort does carry risks. For one thing, it can interact with a number of medications and should never be taken without double-checking to avoid dangerous incompatibility problems. Side effects may include nausea, stomachache, dry mouth and loss of appetite. It may also affect vision. We have a FREE Guide to St. John’s wort at this link.
If you would like to learn more about easing menopausal symptoms, you may find Graedons’ Guide to Menopause of value. We discuss in detail a number of natural approaches that may work well for you or someone you know. We also have an extensive chapter about dealing with menopause in our book, Best Choices From The People’s Pharmacy. Hormone replacement therapy or antidepressant medications are NOT the only way to deal with menopausal symptoms.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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I have read reports questioning its effectiveness, but evening primrose oil has worked for me. Three pills daily pretty much kept the hot flashes to a minimum. The only side effect is that you’re spending a lot of money; none of these supplements are cheap! Which, by the way, is proof that those manufacturers are no more ‘moral’ or ‘ethical’ than drug companies; else why would they charge so much money?
Anyway, I’ve read a lot of skeptical reports about Evening Primrose Oil but it has worked well for me.

St Johns Wort is a natural anti-depressant, and I would not recommend this herb for hot flushes. I would only recommend this herb if you’re feeling depressed, are you? If you’re after something natural to take for stress I would recommend 5-HTP, 5-HTP is great and can also be used for better sleep and weight loss. Lemon balm is also a great herb for reducing anxiety and stress.
If you want something to take for hot flushes during the menopause, I would recommend Black Cohosh it’s a very popular herb for ladies suffering from hot flushes during menopause. You can also get this is a liquid and add it to water, if it is you don’t like taking tablets. Also I would recommend you take Evening Primrose Oil capsules along side it, not only does Evening Primrose Oil balance out your hormones, (during the menopause your hormones become unbalanced) but it is great for your skin, hair and nails too. It is also great for relieving discomfort of PMS, menopause, menstruation, endometriosis and fibrocystic/sore breasts. Also Dong Quai is particularly useful in helping to end hot flushes and is great herb to use if you suffer from menstrual cramps, I’ve heard many great things about this herb, it has been used by the Chinese for many years now. Also during the menopause you might not want sex as much as you used to, and this become a problem for some ladies, Dong Quai is a widely used natural aphrodisiac, and could boost your desire for sex.
Some herbs work for some and not for others, you’ll need to try out a few to know what’s right for your own body. I would also advise you to stay away from HRT, always try herbal remedies first, HRT can do more harm than good.
I hope this helps, I’m 27 years old and have not experienced the menopause myself, not yet anyway, but I have been trained to give advice about alternative medicine, I worked at Holland and Barrett for 2 years. Please be careful if you’re on any other medication, be sure to ask your doctors advice before taking anything herbal. People sometimes think that because it’s herbal it’s safe, well it’s not, it can be very dangerous and could cause problems with your prescribed medication. If there is anything else I can help/advise you with, please don’t hesitate to ask.
PEOPLE’S PHARMACY RESPONSE: The combination of St. John’s wort and black cohosh is used for hot flashes in Europe. Both herbs have possible side effects and interactions, however (see our herb library) so be informed before you start taking them.

How many mg of Black Cohosh is recommended for hot flashes?

@Karen, you won’t have to enter your credit card info for the free .PDF, there’s a place you can check off indicating it’s a free item.

I also tried Black Cohosh and got no results. I’m finally past the hot flashes as a daily occurrence, but still occasionally still get them, especially as I take Lysine for the herpes virus mouth sores. Are there any known side effects to taking St. Johns long term?

>I don’t know why doctors in the USA don’t suggest it, because it is safe and you don’t feel medicated taking it.
Because it’s not that safe, and herbal preparations are a messy swamp of unregulated murk. (And I spend a ton o’money on supplements, but on my own recognizance).
I had the WORST sunburn of my life EVERY on St. John’s Wort. I had read that it can make you photosensitive, but I had NO idea of what I was letting myself in for. The sun exposure just wasn’t long enough to get my attention–backyard gardening, not beach tanning–until the red set in. Ouchiola!
Then, when I quit taking the SJW, I had a massive crash. Had I thought about it, many of the SSRIs can cause withdrawal symptoms, but this was a while ago, just about the time the newer drugs were hitting the market, and the idea that they were hard to get off wasn’t in common discussion. Were I to try SJW again today, I’d think twice about quitting cold turkey. But that sunburn…e
I suspect the possible eye damage may be related to the increased sun sensitivity.
Without reading the free pdf from this site because I don’t feel like entering all my credit card info to get a free anything, I seem to recall that the drug interactions are similar to those of grapefruit juice, in that SJW interferes with one of the liver enzymes. Attention-getting, IMO.
I don’t understand why “natural” is equated with “safe.” All the mushrooms are natural, as are most of the recreational opiods. Oh well.

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