Climacteric symptoms during adjuvant treatment in hormone-responsive breast cancer patients: the underestimated role of Cimicifuga racemosa

Abstract

The treatment of breast cancer is complex, with a wide variety of surgical, radiotherapeutic, chemotherapeutic, biological and endocrine options available. Although these therapies have improved survival rates, adjuvant treatment does have side-effects. The main adverse effects, such as vasomotor symptoms, classically represented by hot flushes and night sweats, are related to anti-hormone therapy, which aims to block the estrogen receptor or destroy estrogen-producing tissue. Options generally include selective estrogen receptor modulators (SERMs), GnRH analogues and aromatase inhibitors, which all cause climacteric symptoms in most breast cancer survivors and have a big impact on their quality of life and treatment compliance. Classically, hormone replacement therapy (HRT) has been the gold standard treatment for menopausal hot flushes. However, this treatment has risks, and should not be the first option in women with breast cancer or at high risk of developing the disease. Many alternatives to HRT such as tibolone, phytoestrogens and antidepressants have been proposed in recent decades, but results have been controversial regarding efficacy and safety, and consequently compliance is poor. Therefore, interventions to improve compliance with adjuvant hormonal therapy are required. Black cohosh or Cimicifuga racemosa isopropanolic extract (Remifemin®) is a herbal medication frequently used for alleviating menopausal symptoms. Several recent studies have shown that patients with mild menopausal symptoms usually experience spontaneous remission after taking black cohosh, while those with moderate to severe symptoms may experience some benefit. No adverse effects or estrogen activity were reported with this compound. This review examined the effectiveness of black cohosh extract for relieving symptoms and improving quality of life in breast cancer survivors and high-risk women with moderate to severe menopausal symptoms.