Numerous studies have demonstrated the acute and chronic benefits of Hormone Replacement Therapy (HRT), including the relief of menopausal symptoms such as hot flushes and insomnia, as well as possible reductions in the risk of osteoporosis. However, a significant number of women never seek treatment, or will refuse or discontinue the use of HRT due to the risks, medical contraindications, or a general reluctance to use ‘unnatural’ exogenous equine (horse) hormones. The concern about HRT and breast cancer appears justified, as a significant increase in breast cancer, coronary heart disease, and stroke has been demonstrated among long-term estrogen users. Thus, many women are actively seeking alternative approaches, including botanical dietary supplements such as Black Cohosh, to manage their menopausal symptoms1.
THE HISTORY OF BLACK COHOSH
Black Cohosh is a coarse, woodland herb with large compound leaves, and a thick, knotted, rhizome (root) system. The plant is native to North America, with a distribution from southern Canada to Georgia. There are numerous vernacular names for this plant, including black snakeroot, black root, bugbane, rattle root, rattle top, rattle squawroot, snake root, and rattleweed. Historically, Black Cohosh rhizomes were routinely used as a medicine by the Native American Indians (Penobscot, Winnebago, and Dakota), for the treatment of coughs, colds, constipation, fatigue, and rheumatism, as well as to increase breast milk production. In 1832, a tincture of Black Cohosh rhizome was used for the treatment of pain and inflammation associated with endometriosis, rheumatism, neuralgia, and dysmenorrhea. In addition, a fluid extract of Black Cohosh was listed in the US National Formulary for over 100 years from 1840 until 1946. Currently, Black Cohosh products are marketed in the US as herbal remedies for the treatment of menopausal symptoms1.
MEDICAL USES OF BLACK COHOSH
Black Cohosh is one of the most widely researched herbs for the treatment of a range of female hormonal conditions - especially menopause. A 12-week randomized, double-blind, placebo-controlled trial compared the efficacy of Remifemin® (a Black Cohosh extract) with that of standard HRT or placebo for the treatment of hot flushes and vaginal dryness, both symptoms commonly associated with menopause. Eighty women, between the ages of 45 and 58 years, were treated with either 48–140mg of the dried herb, standard HRT, or placebo. At the end of the 12-week treatment period, all groups showed improvements. However, a significant decrease in hot flushes was observed in the group treated with Black Cohosh. Also reported was a significant decrease in anxiety and a significant improvement in vaginal dryness, indicating a possible estrogenic effect. Only minor adverse events were reported including headache, weight gain, slight breast tenderness, and leg heaviness in the group treated with the extract2.
Black Cohosh benefits Cirrhosis of the Liver sufferers
In another controlled comparison trial involving 60 women between the ages of 45 and 60 years, the efficacy of the Remifemin® extract was compared to that of HRT or diazepam (an anti-anxiety drug) for the treatment of menopausal symptoms. The outcomes measured included hot flushes, night sweating, nervousness, headache, and heart palpitations. Proliferation of the vaginal lining was also assessed. The patients were treated with either 80 drops of a 60% ethanol extract of Remifemin® (Black Cohosh) standard HRT, or diazepam 2mg for a period of 12 weeks. All three forms of therapy improved the symptoms of menopause. Treatment with the Remifemin® extract was reported to produce the best improvements in all measures3.
Black Cohosh benefits women with drug-induced Menopause
In a more recent clinical trial, the effect of Black Cohosh was assessed in young premenopausal breast cancer survivors with hot flushes due to Tamoxifen (an oestrogen blocking drug used for breast cancer treatment). The study involved 136 breast cancer survivors aged 35–52 years. After treatment with segmental or total mastectomy, radiation therapy, and adjuvant chemotherapy, participants were randomly assigned to receive treatment with oral Tamoxifen 20 mg/day or Tamoxifen 20 mg/day plus Black Cohosh. Duration of treatment was 5 years for Tamoxifen, and 12 months for Black Cohosh. Compared with the Tamoxifen only group, the group given the Tamoxifen and Black Cohosh had a reduction in the number and severity of hot flushes after treatment with Black Cohosh. Almost half the patients of the Black Cohosh group were free of hot flushes, while severe hot flushes were reported in 73.9% in the Tamoxifen only group. The study concluded that combined administration of Tamoxifen plus Black Cohosh for a period of 12 months reduced the number and severity of hot flushes in women with Tamoxifen-induced menopausal symptoms4.
Contraindications of Black Cohosh
Black Cohosh is generally regarded as a very safe herb however it should be avoided during pregnancy unless professionally prescribed. Although the adverse effect profile and tolerability of this herb are excellent, long-term safety studies are lacking. Check with your health care practitioner before taking this herb long term.
Drug Interactions with Black Cohosh
Although Black Cohosh, like any herbal medicine, can conflict with medications, no significant herb/drug interactions with Black Cohosh have been reported. However, we do advise that before using this herb or any other herbal preparation, to consult your health care professional for your individual requirements.
Therapeutic/safe dosages of Black Cohosh
The usual dosage of crude, dried Black Cohosh root (used as an infusion) is 3,000 - 6,000 mg per day.
The usual dosage of 1:1 fluid extract of Black Cohosh is 12 ml per day.
The usual dosage of 4:1 powdered Black Cohosh in capsules/tablets is 750 - 1,500 mg per day.
The main active component of Black Cohosh is 27-deoxyacteine for menopause. The usual dosage of Black Cohosh products that have been standardized to contain 1 mg of 27-deoxyacteine per 530 - 550 mg capsule is 2,120 - 2,200 mg per day (which should supply 4 mg of 27-deoxyacteine per day). This is an ideal starting dosage however, dosages doubling that have been used in clinical trials with safety and good efficacy.
Other herbs that can be used with Black Cohosh
As with many herbal preparations, herbs are often combined to make a formula. This formula usually contains herbs with a similar action thus improving the effectiveness over a single herbal preparation. Herbs that are commonly found with Black Cohosh include:
• Chase Berry. Some studies have shown that Chaste Berry stimulates the actual secretion of luteinising hormone (a hormone that stimulates Progesterone production) from the pituitary gland. This may lead to higher Progesterone levels at menopause, which can reduce the severity of menopausal symptoms.
• Tribulus. Tribulus may alleviate hot flushes, insomnia, anxiety, excessive perspiration, irritability, depression, reduced sexual desire and apathy occurring as a result of female Menopause. Combined with Black Cohosh, Tribulus is especially beneficial if the sufferer has a reduced libido during menopause.
• False Unicorn. False Unicorn may be useful for the treatment of symptoms such as hot flushes, reduced vaginal mucous, and poor pelvic tone resulting from female menopause. False Unicorn is an excellent agent for women who commonly experience vaginal drying as a symptom of menopause.
Black Cohosh is a highly prized herb and has been used for thousands of years for the treatment of women’s hormonal complaints, arthritis and liver disorders as well as coughs, colds, constipation and general fatigue. More recently is has been found to be especially beneficial for the treatment of menopausal symptoms. Clinical trials now support these uses and there is weighty scientific data that supports the medicinal uses of this herb. While Black Cohosh is generally regarded as safe, interactions between this herb and medical drugs are possible. If you are on medication of any kind, please check with your health care professional before taking any herbs.
1. Mahady, G., Black cohosh (Actaea/Cimicifuga racemosa): review of the clinical data for safety and efficacy in menopausal symptoms. Treat Endocrinol, 2005. 4(3): p. 177-184.
The information contained on this website is for educational purposes only. It is not provided to diagnose, prescribe or treat any condition of the body. The information on this website should not be used as a substitute for medical counselling with a health professional.
2. Stoll, W., Phytopharmakon beeinflußt atrophisches vaginalepithel doppelblindversuch Cimicifuga vs. ostrogenpraparat. Therapeutikon, 1987. 1: p. 7-15.
3. Warnecke, G., Influencing menopausal symptoms with a phytotherapeutic agent. Med Welt, 1985. 36: p. 871-4.
4. Munoz GH, P.S., Cimicifuga racemosa for the treatment of hot flushes in women surviving breast cancer. Maturitas, 2003. 44 (Suppl. 1): p. S59-65.
5. Laekeman G, D.C.S., De Meyer K. K.U.Leuven., St. Mary's Thistle: an overview. J Pharm Belg., 2003. 58(1): p. 28-31.