Black Cohosh (Cimicifuga racemosa [L.] Nutt.)

by MedlinePlus

Blackcohosh is popular as an alternative to hormonal therapy in the treatment of menopausal (climacteric) symptoms such as hot flashes, mood disturbances, diaphoresis, palpitations, and vaginal dryness. Several controlled trials and case series have reported black cohosh to improve menopausal symptoms for up to six months. Although these initial studies are suggestive, they have been few in number and have universally suffered from methodological weaknesses.

The mechanism of action of black cohosh remains unclear, and the effects on estrogen receptors or hormonal levels (if any) have not been fully elucidated. Recent publications suggest that there may be no direct effects on estrogen receptors, although this is an area of active controversy (1-8). Safety and efficacy data beyond six months are not available, although recent reports suggest safety of short-term use, including in women experiencing menopausal symptoms for whom estrogen replacement therapy is contraindicated (9;10). Nonetheless, due to a lack of long-term follow-up, caution is advisable until better-quality safety data are available. Use of black cohosh in high-risk populations (such as in women with a history of breast cancer) should be under the supervision of a licensed healthcare professional.

Synonyms

23-epi-26-deoxyactein, Actaea macrotys, Actaea racemosa L., actee a grappes, Amerikanisches wanzenkraut, baneberry, BCE, black cohosh roots black snakeroot, botrophis serpentaria, bugwort, cohosh bugbane, cimicifuga, Cimicifugae racemosae rhizoma, cimicifugawurzelstock cimicifugoside M, cimiracemoside A , cimiracemoside B, cimiracemoside C, cimiracemoside D, cimiracemoside E, cimiracemoside F, cimiracemoside G, cimiracemoside H , CR, CR extract, ethanolic aqueous extract, herbe au punaise, hydroxytyrosol, ICR, isoferulic, isopropanolic black cohosh extract, macrotys, Macrotys actaeoides, phenylpropanoids (cimiracemate A, cimiracemate B) Ranunculaceae, rhizome of black cohosh, rich weed, rattle root, rattle snakeroot, rattle top, rattle weed, rhizoma actaeae richweed, schwarze schlangenwurzel, solvlys, squaw root, Thalictrodes racemosa , Traubensilberkerze, Wanzwnkraut.

Note: Do not confuse black cohosh with blue cohosh ( Caulophyllum thalictroides ), which contains chemicals that may damage the heart and raise blood pressure. Do not confuse black cohosh ( Cimicifuga racemosa ) with cimicifuga foetida , bugbane, fairy candles, or sheng ma; these are species from the same family ( Ranunculaceae ) with different effects.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidence

Menopausal symptoms

Black cohosh is a popular alternative to prescription hormonal therapy for treatment of menopausal symptoms such as migraine headaches, sleep disturbances, hot flashes, mood problems, perspiration, heart palpitations, and vaginal dryness. Initial human research suggests that black cohosh may improve some of these symptoms for up to six months. However, most studies are not well designed and results are not conclusive. Many studies have used a specially designed questionnaire that does not consider some of the important symptoms of menopause such as vaginal dryness, but does measure other symptoms which are not commonly associated with menopause, such as tingling sensations and dizziness. Well-designed studies are needed using black cohosh for longer than six months.

Joint pain

There is not enough human research to make a clear recommendation about the use of black cohosh for painful joints in rheumatoid arthritis or osteoarthritis.

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

AIDS, anti-inflammatory, antioxidant, anxiety, aphrodisiac, appetite stimulant, asthma, back pain, breast disease, breast pain/inflammation (mastitis), bone diseases, bronchitis, cancer, cervical dysplasia (abnormal pap smear), chemotherapy induced premature menopause, child birth (labor induction), cough remedy, decreased blood platelets, depression, diarrhea, dizziness, dyspareunia, edema, endometriosis, fever, gall bladder disorders, headache, heart disease/palpitations, high blood pressure, hormone replacement therapy, infertility, inflammation, insect repellent, itchiness, kidney inflammation, liver disease, malaria, menopausal symptoms in breast cancer patients, menstrual dysfunction, menstrual period problems, miscarriage, muscle pain, muscle spasms, nerve pain, ovarian cysts, pain, pancreatitis, perspiration, pertussis (whooping cough), polycystic breast disease, polycystic ovarian syndrome, perimenopausal symptoms, premenstrual syndrome (PMS), reduction of hot flashes in prostate cancer, ringing in the ears, sleep disorders, snakebites, sore throat, tamoxifen-related hot flashes, urogenital atrophy, uterine diseases and bleeding, vaginal discharge, yellow fever.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Standardization

Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. It is not always known if the chemicals being measured are the "active" ingredients. The dose of black cohosh is often based on the amount of the chemical 27-deoxyactein. The German product, Remifemin®, used in most human studies, contains an alcoholic extract of black cohosh standardized to contain 1 milligram of 27-deoxyactein in each 20 milligram tablet. The manufacturing process and dosing recommendations for Remifemin® have changed over the past 20 years, and doses used in different studies are not always the same. A standardized liquid formulation of Remifemin® has also been used in some studies.

Adults (18 years and older)

Tablets: For menopausal symptoms, studies have used 20 milligram or 40 milligram Remifemin® tablets (containing 1 or 2 milligrams of 27-deoxyactein) twice daily or 40 drops of a liquid extract. Some clinical studies have used 20 milligrams taken twice daily.

Dried rhizome (root): The British Herbal Compendium recommends 40 to 200 milligrams of dried rhizome daily in divided doses, although traditional doses have been as high as 1 gram three times daily.

Tincture/Liquid: The British Herbal Compendium recommends 0.4 to 2 milliliters of a (1:10) 60% ethanol tincture daily.

Children (younger than 18 years)

There is not enough scientific information to recommend black cohosh in children.

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