Black Cohosh

Black cohosh (Cimicifuga racemosa) is a native American perennial growing to 8 feet in height. It has irregular leaflets with jagged edges and long pedunculated drooping racemes of white flowers. The extract from the rhizome and root has been widely used for centuries by native Americans, and in Europe since 1956.

Basic Uses

• Menopausal symptoms: hot flashes, mood changes, and vaginal atrophy.
• “Surgical menopause” - post oophorectomy.
• Menopause in patients for whom hormone replacement therapy is contraindicated due to hormone-sensitive malignancy or high risk thereof.
• Premenstrual syndrome.

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Clinical Applications

Black Cohosh and Menopause

• It has demonstrated safety and efficacy for menopause.
• "Safe, effective alternative to estrogen replacement therapy for those patients in whom estrogen replacement therapy is either refused or contraindicated." (7)
• Alleviates hot flashes, profuse sweating, sleep disturbances, depressive moods, heart palpitations, vertigo, and headaches in menopausal women.
• Reduces emotional symptoms of menopause: depression, irritability, mood swings, etc.
• Black cohosh extract does not stimulate the growth of estrogen-dependent breast cancer cells and augments the efficacy of the drug tamoxifen in preventing breast cancer recurrence.
• Lowers the modified Kupperman-Index of vaginal mucosal atrophy, to an extent equivalent to estrogen replacement, by increasing the number of stratified squamous epithelial cells lining the mucosal tissue.

Premenstrual syndrome

• Occupation of estrogen receptors by constituents of Cimicifuga serves to blockade receptors from activation by endogenous estrogens, reducing the physiological effects of an elevated estrogen-progesterone ratio.

Breast cancer prevention

• Inhibits serum-stimulated growth in both T-47D and MCF-7 breast cancer cells in vitro.
• Occupation of estrogen receptors by far less potent phyto-estrogens reduces physiological influence by endogenous estrogens, thereby decreasing risk of estrogen-dependent malignancies.

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How Does Black Cohosh Work?

• Pharmacological effects are caused by at least three different synergistically acting compounds manifesting three types of endocrine activity:
  • Constituents which are not ligands for the estrogen receptor but suppress luteinizing hormone (LH) release after chronic treatment.
  • Constituents binding to the estrogen receptor and also suppressing LH release.
  • Compounds which are ligands for the estrogen receptor but without an effect of LH release.
• Inhibits binding of LH to hypothalamic receptors.
• Black cohosh extract has demonstrated no influence on the secretion of follicle-stimulating hormone (FSH) or prolactin.
• Plant phyto-estrogens have approximately 2% of the potency Estrogenic activity of fukinolic acid was shown by increased proliferation of an estrogen dependent MCF-7 cell system with reference to estradiol. This effect manifests clinically in the reversal of post-menopausal vaginal atrophy by improving the quality of vaginal squamous epithelium.
• Occupation of estrogen receptors with plant constituents that are far less potent than endogenous hormones reduces the physiological effects of endogenous estrogens.

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Recommended Dosage of Black Cohosh

The recommended dosage of black cohosh is:

• Cimicifuga racemosa (Black Cohosh Extract) (standardized to contain 2.5% total triterpenes) -- 80 mg: one or two capsules daily or as directed by your healthcare professional.
• 250 mg: one capsules once daily or as directed by your healthcare professional.
• Dosage should be adjusted to your individual needs. Determine the minimum dosage that will control symptoms.

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Black Cohosh Side Effects

• Well tolerated by patients and has an excellent history of consistent patient compliance and satisfaction.
• Can be safely used in complementary combination with other natural approaches to menopause.
• No health hazards or side effects have been identified at recommended doses.
• Very high doses (12 grams of extract daily) have been associated with vomiting, headache, dizziness, limb pains, and hypotension.

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Black Cohosh Studies

1. Dixon-Shanies D and Shaikh N, Growth inhibition of human breast cancer cells by herbs and phytoestrogens. Oncol Rep 1999 Nov-Dec;6(6):1383-7.
2. Duker EM, et al, Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats. Planta Med 1991 Oct;57(5):420-4.
3. Gruenwald J, et al, eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Co., 1998.
4. Hardy ML, Herbs of special interest to women. J Am Pharm Assoc (Wash) 2000 Mar-Apr;40(2):234-42; quiz 327-9.
5. Kruse SO, et al, Fukiic and piscidic acid esters from the rhizome of Cimicifuga racemosa and the in vitro estrogenic activity of fukinolic acid. Planta Med 1999 Dec;65(8):763-4.
6. Lehmann-Willenbrock E and Riedel HH, Clinical and endocrinologic studies of the treatment of ovarian insufficiency manifestations following hysterectomy with intact adnexa. Zentralbl Gynakol 1988;110(10):611-8.
7. Lieberman S, A review of the effectiveness of Cimicifuga racemosa (black cohosh) for the symptoms of menopause. J Womens Health 1998 Jun;7(5):525-9.
8. Liske E, Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders. Adv Ther 1998 Jan-Feb;15(1):45-53.