Herbs for Menopause: Black Cohosh Known As Cimicifuga Racemosa

Black cohosh is a member of the buttercup family and has been used for centuries by Native Americans to treat menopausal symptoms such as hot flashes, mood changes, night sweats and vaginal dryness. It grows wild in eastern Canada and the US and can get anywhere from 4-8 feet tall with tall, feathery white flowers.

Black cohosh does not appear to act as a phytoestrogen—extracts used in supplements contain only one phytoestrogen, formononetin. Formononetin is an isoflavone and is found in red clover and many different legumes. It has been studied for its anti-cancer effects and in studies to treat Alzheimer’s disease. 1 2 3

Most studies indicate that estrogen receptors do not play a role in how black cohosh relieves menopausal symptoms.

A panel of European experts called Commission E has approved black cohosh for a number of uses including premenstrual discomfort such as weight gain, water retention, mood fluctuations and breast tenderness, and for perimenopausal symptoms, including hot flashes. It has been widely used in Germany for over 50 years to relieve menopausal symptoms.

The North American Menopause Society (NAMS) has recommended black cohosh as one of the first steps in treating perimenopausal and menopausal symptoms, particularly for the relief of mild hot flashes.

Black cohosh’s long traditional use give us some idea that it is quite safe—and studies lasting up to a year of treatment with black cohosh indicate that it is safe in non-pregnant and non-breastfeeding women.

You may have heard (or were told) that black cohosh causes liver damage. Natural Standard, one of the main databases tracking herbs and supplements reported that 30 adverse effects reports were analyzed and scored to determine whether black cohosh was likely to be the cause of these adverse effects. They found that black cohosh was the “possible” cause. So, to be safe, if you have any liver disorder or develop abdominal pain, dark urine or yellowing skin or eyes, discontinue using black cohosh and contact your healthcare provider.

Black cohosh appears to bind to a non-estrogen receptor (the human mu-opiate receptor, hMOR)) and it is because of this interaction that it is effective in relieving symptoms. It also appears to act through receptors for certain brain chemicals, serotonin and dopamine, at least in lab rats. 4 It also acts as an anti-inflammatory agent, acts to stabilize blood lipids (and increase HDL, the “good” cholesterol) and acts as an anti-oxidant, protecting DNA from damage. In one study, a supplement containing black cohosh (Reumalex, sold over-the-counter in Britain) relieved chronic rheumatic arthritis pain. 5

Studies using black cohosh to relieve menopausal symptoms have been mixed—some have reported positive effects 6 7 8 9 10 while others have reported little or no effect—positive OR negative. 11 12

Perhaps a bit oddly, there have been only a few studies where the number of hot flashes before, during and after using black cohosh are even reported. In one of the best designed studies where black cohosh was compared to estrogen treatment, the daily hot flashes decreased from 5.2 to 3.2 (in the estrogen group), 4.9 to 0.7 (in the black cohosh group) and 5.1 to 3.1 (in the placebo group). These women took two 2mg tablets of Remifemin™ twice a day. 13

Side effects are relatively rare and relatively mild—they include stomach discomfort, headache, or rash. If you know you are allergic to buttercups, you shouldn’t use black cohosh. Even the reported liver damage is very rare—much rarer, for example, than those reported for medication errors. 14 15 16

There do not appear to be any significant drug interactions with black cohosh, but always speak to all your healthcare professionals and let all of them know the medications and supplements you are taking.

What about dosing?

The recommendations vary, but a total of 100-200 mg of dried black cohosh root can be taken as divided doses during the day. If you are taking black cohosh in a supplement that has other herbs, follow the guidelines given by the manufacturer. You can also get black cohosh root and make your own tea—in this case, steep about 1 teaspoonful of powdered root for each cup of tea. You can re-use the powder for a total of 2 cups. The general recommendation is to drink 1 cup three times a day—but, as always, speak to a knowledgeable healthcare professional first.

Also, you shouldn’t think that you will be using black cohosh for the rest of your life—these herbs are meant to re-balance your system and get you through some of the more difficult times during menopause. At some point, you will be post-menopausal and will likely not need these herbs!

Notes:

  1. Auyeung, K.K. and J.K. Ko, Novel herbal flavonoids promote apoptosis but differentially induce cell cycle arrest in human colon cancer cell. Investigational New Drugs, 2010. 28(1): p. 1-13.
  2. Beck, V., U. Rohr, and A. Jungbauer, Phytoestrogens derived from red clover: an alternative to estrogen replacement therapy? The Journal Of Steroid Biochemistry And Molecular Biology, 2005. 94(5): p. 499-518.
  3. Occhiuto, F., et al., The isoflavones mixture from Trifolium pratense L. protects HCN 1-A neurons from oxidative stress. Phytother Res. , 2009. 23(2): p. 192-6.
  4. Burdette, J., et al., Black cohosh acts as a mixed competitive ligand and partial agonist of the serotonin receptor. J Agric Food Chem. , 2003. 51(19): p. 5661-70.
  5. Mills, S., et al., Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: a double-blind study. Br J Rheumatol., 1996. 35(9): p. 874-8.
  6. Osmers, R., et al., Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. . Obstet.Gynecol 2005. 105(5 Pt 1): p. 1074-1083.
  7. Bai, W.P., et al., [Efficacy and safety of remifemin compared to tibolone for controlling of perimenopausal symptoms]. Zhonghua Fu Chan Ke.Za Zhi. , 2009. 44(8): p. 597-600.
  8. Oktem, M., et al., Black cohosh and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized trial. . Adv Ther, 2007. 24(2): p. 448-461.
  9. Bai, W.P., et al., [Efficacy and safety of remifemin compared to tibolone for controlling of perimenopausal symptoms]. Zhonghua Fu Chan Ke.Za Zhi. , 2009. 44(8): p. 597-600.
  10. Oktem, M., et al., Black cohosh and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized trial. . Adv Ther, 2007. 24(2): p. 448-461.
  11. Pockaj, B.A. and a. et., Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1. . J Clin Oncol. , 2006. 24(18): p. 2836-2841.
  12. Bebenek, M., et al., Effect of exercise and Cimicifuga racemosa (CR BNO 1055) on bone mineral density, 10-year coronary heart disease risk, and menopausal complaints: the randomized controlled Training and Cimicifuga racemosa Erlangen (TRACE) study. . Menopause. , 2010. 17(4): p. 791-800.
  13. Warnecke, G., Influencing of menopausal complaints with a phytodrug: successful therapy with Cimicifuga monoextract (in German). Medizinische Welt, 1985. 36: p. 871-874.
  14. Benkirane, R.R., et al., Incidence of adverse drug events and medication errors in intensive care units: a prospective multicenter study [corrected] [published erratum appears in J PATIENT SAF 2010 Mar;6(1):57]. Journal of Patient Safety, 2009. 5(1): p. 16-22.
  15. Calabrese, A.D., et al., Medication administration errors in adult patients in the ICU. Intensive Care Medicine, 2001. 27(10): p. 1592-1598.
  16. Celebi, N., et al., Problem-based training for medical students reduces common prescription errors: a randomised controlled trial. Medical Education, 2009. 43(10): p. 1010-1018.

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