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  • Black cohosh (Actaea racemosa L)
  • Menopause
  • syn. Cimicifuga racemosa
    • Date: December 06, 2001HC# 101211-207

    Re:Black Cohosh Monograph Reviews Recent Research

    McKenna. Black Cohosh: Efficacy, Safety, and Use In Clinical and Preclinical Applications Alternative Therapies. May/June 2001; Vol 7, No. 3:93-100.

    This monograph from the forthcoming book The Natural Dietary Supplement Desktop Reference provides extensive background and therapeutic information on black cohosh (Actaea racemosa L., syn – Cimicifuga racemosa) and related species. Black cohosh, also known as bugbane, cimicifuga, and rattle weed, is native to eastern North America, and has historically been used by Native Americans for a variety of conditions unique to women. An ingredient in Lydia Pinkham’s Vegetable Compound early in the 20th century, black cohosh was also used for such varied conditions as arthritis, snakebite, whooping cough, and malaria as well as female conditions such as menstrual pain and amenorrhea, and was also widely used perinatally. A related Actaea species known as shengma in traditional Chinese medicine is used for various disorders. Contemporary uses of black cohosh are primarily for treatment of menopausal symptoms, such as hot flashes, anxiety, and depression, as well as premenstrual syndrome and dysmenorrhea according to the monograph of the German Commission E.

    Preclinical studies of endocrine and hormonal effects of black cohosh have produced varied results, possibly due to the recent findings of the existence of two types of estrogen receptors. Studies have demonstrated reduced levels of luteinizing hormone, whereas Schaper and Brümmer GmbH (Salzgitter, Germany), the makers of the black cohosh preparation Remifemin , deny any systemic estrogen agonistic activity at the current recommended dose, which is one-half of the original recommended dose. According to some preclinical studies, patients at high risk for breast cancer may safely take extracts of black cohosh, and the breast cancer drug Tamoxifen and black cohosh may act synergistically to prevent estrogen-dependent proliferation of breast cancer cells. Preliminary evidence shows that black cohosh has a uterine stimulant effect, antimicrobial activity to Staphylococcus aureus, analgesic and antipyretic (fever lowering) effects, and may have a role in maintaining bone density.

    A number of clinical studies of menopausal women using Remifemin as a standardized source of black cohosh collectively showed improvements in somatic and psychological complaints as measured by the Kupperman Menopause Index, the Self-Assessment Depression Scale, the Menopausal Index, and the Clinical Global Impression Scale when compared to placebo, no treatment, or estrogen injection. One study comparing estrogen, diazepam, and Remifemin showed similar vaginal cytologic responses in patients receiving estrogen and Remifemin, and similar positive psychological effects from all three treatments. However, newer studies show that the Remifemin influence on vaginal cytology cannot be verified. No serious side effects or toxicological complications were observed in any of the studies.

    The manufacturers of Remifemin have classified its action as a substance which may act differently on different target organs due to the different types of estrogen receptors, referring to its antagonistic effect on the hormone estradiol, which is associated with an increased risk of breast, ovarian, and endometrial cancers. The German Commission E and other research findings indicate that use of Remifemin in patients with a history of breast cancer is not contraindicated. On the other hand, The American Herbal Products Association’s Botanical Safety Handbook classifies black cohosh as a class 2b herbal medicine, indicating that it should not be used in pregnancy unless otherwise directed by an expert qualified in its use. No adverse effects on lactation or nursing children have been noted, but gastrointestinal discomfort in the nursing child is [theoretically] possible, being an occasional adverse effect in adults.

    The current dosage recommendations from the makers of Remifemin are one 20-mg tablet twice daily, or 40 drops of Remifemin liquid extract per day. No drug interactions have been identified, and occasional gastric discomfort is the only reported side effect when used at recommended dosages. Large doses may cause vertigo, nausea, vomiting, headache, and impaired circulation and eyesight. Use of standardized extracts of black cohosh along with estrogen replacement therapy have shown minimal side effects, and a recent postmarketing surveillance study suggests a positive synergistic effect in the reduction of menopausal psychological symptoms for a standardized combination of black cohosh and St. John’s Wort (Hypericum perforatum; herbal combination Remifemin plus).

    — Diane Graves, MPH, RD

    Editor’s note:] The original journal article states that the title of the forthcoming book is The Natural Dietary Supplement Deskton Reference. However, that is now incorrect and the corrected title is Botanical Medicines: The Desk Reference to Major Herbal Supplements.

    In addition, the original article lists the lactation credential as ICBLB. It should read IBCLC (International Board Certified Lactation Consultant).