Black Cohosh: An Effective Natural Remedy for Menopausal Symtpoms

Black cohosh, Black bugbane or Black snakeroot; syn. Actaea racemosa and Cimicifuga racemosa is a member of the family Ranunculaceae, native to eastern North America from the extreme south of Ontario south to central Georgia, and west to Missouri and Arkansas.


It is a glabrous herbaceous perennial plant, growing 0.75-2.5 m tall. The basal leaves are up to 1 m long and broad, tripinnately compound, the leaflets with a coarsely toothed margin. The flowers are produced in late spring and early summer on a tall stem in racemes up to 50 cm long; they have no petals or sepals, only a tight cluster of 55-110 white stamens 5-10 mm long surrounding the white stigma. The flowers have a distinctly sweet smell. The fruit is a dry follicle 5-10 mm long containing several seeds.

Although Blue Cohosh (Caulophyllum thalictroides) is similarly named, it is actually a plant in a separate genus.

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Black cohosh has been included in herbal compounds or dietary supplements marketed to women as remedies for the symptoms of premenstrual tension, menopause and other gynecological problems. However, a recent study published in Annals of Medicine (December 19, 2006)casts serious doubt on its efficacy. The researchers actually found black cohosh slightly less effective than a placebo and concluded that the herb “shows little potential as an important therapy for relief of vasomotor symptoms.” However, that study used a product that contained 5 mgs of the active component a day whereas the current daily recommended dose of the long-used standard Remifemin contains 2 mgs. The American Botanical Council discusses that study.

It was thought that black cohosh contained estrogen-like chemicals, but recent research suggests that it works by binding to serotonin receptors. Native Americans used black cohosh to treat gynecological disorders and other disorders as well, including sore throats, kidney problems, and even depression.

Black cohosh has been used as an abortifacient.

History and Claims
This herbal goes by many names. These include: Black Cohosh, Cimicifuga Racemosa, Squaw Root, Rattle Snake Root and Black Snake Root. It does NOT go by the name Snake Root, this is an unrelated herbal–Aristolochia Serpentaria. If a woman chooses to use it, she will most likely buy it under its brand name of Remifemin. This comes in drops or tablets.

Black Cohosh has been used by Native Americans, Europeans, and Chinese for centuries.

Native Americans used it for a wide variety of female problems. They used it to restore normal menstrual function, to return a woman to her pre-pregnancy state after birth, and for menopause. It has been described as “hormone-like” and a mild euphoric by some. It has scientific evidence to support its effect on improving blood pressure. In addition, it has many claims that were not investigated for the purposes of this article. These claims include: its use as an astringent, an anti-diarrheal, a water pill, and a cough suppressant/expectorant. It is also believed to improve heart rate, increase sweating, and be an antidote to rattlesnake poison.

Garden use:
Cimicifuga racemosa grows in dependably moist, fairly heavy soil. It bears tall tapering racemes of white midsummer flowers on wiry black-purple stems, whose mildly unpleasant, medicinal smell at close range gives it the common name ‘Bugbane’. The drying seed heads stay handsome in the garden for many weeks. Its burgundy, deeply cut leaves add interest to American gardens, wherever summer heat and drought do not make it die back, which make it a popular garden perennial.
Chemistry and Pharmacology of Black Cohosh (Cimicifuga Racemosa or Reminfemin):
It is classified as a phytoestrogen. It is from the plant family N.O. Ranunculaceae. The active components of the natural form include: acetin, cimicifugioside, acetylacteal, 27-deoxyactin, cimigenol, deoxyacetylateal. The processed forms also include isoterulic and salicylic acid (the main ingredient is aspirin).

It is not known exactly how it works. But studies on animals and women have shown that its various components act on the hormonal system in at various levels. Some do bind to estrogen receptors in the body. It causes LH, but not FSH suppression. (Estrogens cause both to be suppresed, when they both rise they are signs of menopause) . Some studies have found it to cause an increase in vaginal epithelium that is superior to estrogen replacment.

The Scientific Evidence For Black Cohosh (Cimicifuga Racemosa or Reminfemin) For Menopausal Symptom Relief:
Most of the studies done used the Remifemin version of the herb. Many of the studies were done by the manufacturer of Remifemin.

Studies compared Black Cohosh to Estrogen Replacement (for physical and psychological symptoms) and valium (for psychological only), and to women not taking anything. In more than one study, black cohosh has been found to improve a myriad of physical and mood symptoms in the menopausal women who took it. Women who took it did as well as those who took estrogen or valium, and better than those who took nothing.

Black Cohosh was not found to cause any of the side effects commonly associated with hormone replacement. While it is reported that nausea and vomiting can be due to overdose, no evidence of discontinuation due to side effects was found. Over 93% of women in one study reported no side effects.

Black Cohosh is not associated with increased breast cancer rates, nor dysfunctional uterine bleeding. It is not habit-forming. It does not interact with other medications. It is considered non-toxic.
Side effects:
Black cohosh should not be used during pregnancy or lactation. There is a case report of neurological complications in a postterm baby after labor induction with a mixture of black cohosh and blue cohosh (Caullophylum thalictroides) during a home birth. Other cases of adverse outcomes experienced by neonates born to women who reportedly used blue cohosh to induce labor have been published in peer-reviewed journals.

Black cohosh produces endometrial stimulation. Since black cohosh increases blood flow to the pelvic area, its use is not recommended during menses as it may increase or prolong bleeding. Because of the possible estrogenic action, it should be used with caution after six months. Additionally, black cohosh contains tannin, which inhibits iron absorption. This, considered with possible effects of enhancing menstrual bleeding, gives good cause to monitor iron stores when taking black cohosh.

No studies have been published on long-term safety in humans. However concerns arise that, in humans, because of its estrogen-like effects, long-term use may promote metastasis of estrogen-sensitive cancer tissue via stimulation of cells in the endometrium or breast. Black cohosh increased metastasis of cancer to the lungs (but did not cause an increased incidence of breast cancer) in an experiment done on mice (which was never published and the lung tumors were never biopsied, just observed.)

The liver damage reported in a few individuals using black cohosh has been severe, but large numbers of women have taken the herb for years without reporting adverse health effects. See the NIH link above for thorough discussion of the liver issue. While studies of black cohosh have not proven that the herb causes liver damage, Australia has added a warning to the label of all products containing black cohosh, stating that it may cause harm to the liver of some individuals and should not be used without medical supervision.

Aside from pregnancy complications, increased menstrual bleeding, anemia, and rare but serious hepatic dysfunction, reported direct side-effects also include dizziness, diarrhea, nausea, and occasional gastric discomfort. Additional possible side effects include headaches, seizures, vomiting, sweating, constipation, low blood pressure, slow heartbeats, weight gain, and loss of bone mass (leading to osteoporosis).

Using Black Cohosh (Cimicifuga Racemosa or Reminfemin) For Menopausal Symptom Relief:
As mentioned Remifemin is the processed and packaged version and the one most studied. It comes in liquid (take 40 drops, two times a day) or tablets (take 2 tablets twice a day). Other regimens include: the fluid extract U.S.P — 15 to 30 drops, the fluid extract B.P. — 5 to 30 drops, tincture U.S.P. — 1 drachm, tincture B.P. — 15 to 60 drops, Cimicifugin — 1 to 6 grains, and powdered extract, U.S.P. — 4 grains.

Results have been found in as little as four weeks of use, but six to eight was more common. Twelve weeks is the point were a woman might discontinue the herb if it hasn’t worked by that time. While there is no documentation of adverse effects with long-term use, this practice has not been closely studied. Therefore, some have suggested a 6 month limit on its usage.

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