Black CohoshCimicifuga racemosa
Black cohosh is a tall perennial herb originally found in the northeastern United States. Native Americans used it primarily for women's health problems, but also as a treatment for arthritis, fatigue, and snakebite. European colonists rapidly adopted the herb for similar uses. In the late nineteenth century, black cohosh was the principal ingredient in the wildly popular Lydia E. Pinkham's Vegetable Compound for menstrual cramps.
Black cohosh’s main use today is for the treatment of menopausal symptoms
In the past, black cohosh was believed to be a phytoestrogen, a plant-based substance that has actions similar to estrogen. However, as we describe below, growing evidence indicates that black cohosh does not have general estrogen-like actions. Rather, it may act like estrogen only in certain places: the brain (reducing hot flashes), bone (potentially fighting osteoporosis), and vagina (reducing vaginal dryness).
Black cohosh has also been tried for reducing hot flashes in women who have undergone surgery for
Finally, black cohosh is sometimes recommended as a kind of general women’s herb, said to be effective for a variety of menstrual issues, such as
The body of evidence regarding black cohosh for menopausal symptoms remains incomplete and inconsistent. 53,54
The best study was a 12-week,
Promising results were also seen in a 3-month, double-blind study of 120 menopausal women.
Previous smaller studies have found improvements not only in hot flashes but also in other symptoms of menopause. For example, in a double-blind, placebo-controlled study, 97 menopausal women received black cohosh, estrogen, or placebo for 3 months.
One study, too small to have reliable results from a statistical point of view, found black cohosh equally effective as 0.6 mg daily of conjugated estrogens.
A study reported in 2006 found that black cohosh has weak estrogen-like effects on vaginal cells and possible positive effects on bone (specifically, stimulating new bone formation).
An earlier study also found multiple benefits with black cohosh, but its results are difficult to trust. This trial followed 80 women for 12 weeks and compared the effects of black cohosh, estrogen, and placebo.
Several other studies are also often cited as evidence that black cohosh is useful for various symptoms of menopause, but in reality they prove nothing at all.
A substantial (244-participant) double-blind study published in 2007 compared black cohosh against the synthetic hormone tibolone, and found them equally effective for treating menopausal symptoms.
One interesting double-blind study evaluated a combination therapy containing black cohosh and
In contrast, several other studies failed to find benefit. For example, in a 12-month, double-blind, placebo-controlled study of 350 women, participants were given either black cohosh, a multibotanical containing 10 herbs, the multibotanical plus soy, standard hormone replacement therapy, or placebo.
The bottom line: Black cohosh may be modestly effective for reducing hot flashes and other symptoms of menopause, but doubts remain.
Some interesting information has developed regarding how black cohosh may work. In the past, the herb was described as a phytoestrogen, a plant-based chemical with estrogen-like effects. However, subsequent evidence indicates that black cohosh is not a general phytoestrogen, but may act like estrogen in only a few parts of the body: the brain (reducing hot flashes) and bone (potentially helping to prevent or treat osteoporosis), and, perhaps to some extent, in the vagina.
Because of it estrogenic properties, researchers investigated whether black cohosh might be helpful in women who were having difficulty conceiving. Women with unexplained
Breast Cancer Survivors
Women who have had treatment for breast cancer frequently experience hot flashes, often but not always due to the use of the estrogen-antagonist medications like
The most commonly used dosage of black cohosh is 1 or 2, 20-mg tablets twice daily of a standardized extract, manufactured to contain 1 mg of 27-deoxyactein per tablet.
Note: An analysis of 11 available black cohosh products found that 3 of them contained an Asian herb related to black cohosh rather than the proper herb. 39
Make sure not to confuse black cohosh with the toxic herb
Black cohosh seldom produces any side effects other than occasional mild gastrointestinal distress. One rigorous study looked for possible deleterious effects on cholesterol levels, blood sugar, and blood coagulability, and did not find any. 46
Unlike estrogen, black cohosh does not stimulate breast-cancer cells growing in a test tube.
There are a growing number of case reports in which it appeared that use of a black cohosh led to severe liver injury.
Safety in young children or those with severe liver or kidney disease is not known.
If you are taking cisplatin , black cohosh might reduce its effectiveness.
2. Liske E, Hanggi W, Henneicke-Von Zepelin HH, et al. Physiological investigation of a unique extract of black cohosh ( Cimicifugae racemosae rhizoma ): a 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med. 2002;11:163-174.
8. Lehmann-Willenbrock E, Riedel HH. Clinical and endocrinologic studies of the treatment of ovarian insufficiency manifestations following hysterectomy with intact adnexa [in German; English abstract]. Zentralbl Gynakol. 1988;110:611-618.
13. Wuttke W, Jarry H, Heiden I, et al. Selective estrogen receptor modulator (SERM) activity of the Cimicifuga racemosa extract BNO 1055: pharmacology and mechanisms of action [abstract]. Phytomedicine. 2000;7(suppl 2):12.
16. Nesselhut T, Schellhase C, Dietrich R, et al. Investigation into the growth-inhibitive efficacy of phytopharmacopia with estrogen-like influences on mammary gland carcinoma cells [translated from German]. Arch Gynecol Obstet. 1993;254:817-818.
18. Freudenstein J, Dasenbrock C, Nisslein T. Lack of promotion of estrogen dependent mammary gland tumors in vivo by an isopropanolic black cohosh extract [abstract]. Phytomedicine. 2000;7(suppl 2):13.
25. Wuttke W, Seidlova-Wuttke D, Gorkow C. The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers. Maturitas. 2003;44(suppl 1):S67-S77.
29. Beck V, Unterrieder E, Krenn L, et al. Comparison of hormonal activity (estrogen, androgen and progestin) of standardized plant extracts for large scale use in hormone replacement therapy. J Steroid Biochem Mol Biol. 2003;84:259-268.
32. Wuttke W, Gorkow C, Seidlova-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study. Menopause. 2006;13:185-196.
36. Verhoeven MO, van der Mooren MJ, van de Weijer PH, et al. Effect of a combination of isoflavones and Actaea racemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind study. Menopause. 2005;12:412-20.
38. Wuttke W, Gorkow C, Seidlova-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study. Menopause. 2006;13:185-96.
39. Jiang B, Kronenberg F, Nuntanakorn P, et al. Evaluation of the botanical authenticity and phytochemical profile of black cohosh products by high-performance liquid chromatography with selected ion monitoring liquid chromatography-mass spectrometry. J Agric Food Chem. 2006;54:3242-3253.
42. Hostanska K, Nisslein T, Freudenstein J, et al. Cimicifuga racemosa extract inhibits proliferation of estrogen receptor-positive and negative human breast carcinoma cell lines by induction of apoptosis. Breast Cancer Res Treat. 2004;84:151-60.
43. Pockaj BA, Gallagher JG, Loprinzi CL, et al. 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;24:2836-2841.
45. Wuttke W, Raus K, Gorkow C. Efficacy and tolerability of the Black cohosh (Actaea racemosa) ethanolic extract BNO 1055 on climacteric complaints: A double-blind, placebo- and conjugated estrogens-controlled study. Maturitas. 2006 Aug 21. [Epub ahead of print]
49. Bai W, Henneicke-von Zepelin HH, Wang S, et al. Efficacy and tolerability of a medicinal product containing an isopropanolic black cohosh extract in Chinese women with menopausal symptoms: A randomized, double blind, parallel-controlled study versus tibolone. Maturitas. 2007 Jun 21. [Epub ahead of print]
50. Swanson SG, Drosman S, Helmond FA, et al. Tibolone for the treatment of moderate to severe vasomotor symptoms and genital atrophy in postmenopausal women: a multicenter, randomized, double-blind, placebo-controlled study. Menopause. 2006;13:917-925.
51. Reed SD, Newton KM, Lacroix AZ, et al. Vaginal, endometrial, and reproductive hormone findings: randomized, placebo-controlled trial of black cohosh, multibotanical herbs, and dietary soy for vasomotor symptoms: the Herbal Alternatives for Menopause (HALT) Study. Menopause. 2007 Jul 6. [Epub ahead of print]
Last reviewed April 2009 by EBSCO CAM Review Board
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