This potent extract is standardized to contain 2.5% total triterpene glycosides, the active measurable component in Black Cohosh.

Our capsules contain as much Black Cohosh as the leading brands, however, our formula also includes Chasteberry Fruit Powder and Dong Quai Root Powder to increase its effectiveness in the female system.* Compare for purity!


Shown to Help With:*

Menopausal Symptoms

Quite a few clinical studies confirm that the use of black cohosh is effective for improving menopausal symptoms, although some have found no improvement. Early German studies found black cohosh improved physical and psychological menopausal symptoms, including anxiety, hot flashes, night sweats, and vaginal dryness.

In a clinical study of 120 women with menopausal symptoms, black cohosh was more effective in relieving hot flashes and night sweats than the antidepressant fluoxetine.

Given the results of most clinical studies, many experts conclude that black cohosh may be a safe and effective alternative for women who cannot or will not take hormone replacement therapy (HRT) for menopause. A 2010 review by researchers found that black cohosh provided a 26% reduction in hot flashes and night sweats (also known as vasomotor symptoms).

However, experts do not agree on the effectiveness and safety of using black cohosh to relieve symptoms of menopause. The American College of Obstetricians and Gynecologists (ACOG) reports that many of the early studies were poorly designed and did not evaluate the safety and effectiveness of black cohosh beyond 6 months of use. A 2009 study reported that black cohosh did not relieve hot flashes any more than placebo did. Still, the ACOG recognizes the value of black cohosh for menopausal symptoms.

Until further studies are conducted, some doctors recommend only short-term (less than 6 months) use of this herb for the relief of hot flashes.


Hot Flashes Related to Breast Cancer Treatments

Breast cancer medications such as tamoxifen can cause hot flashes. While many breast cancer patients may take black cohosh to reduce the number and intensity of hot flashes, two well-designed studies concluded that the herb is no more effective than a placebo. In addition, Yale researchers report that herbal medicines such as black cohosh may interfere with common breast cancer treatments, such as radiation and cancer therapy drugs.

There has been some concern that black cohosh may contain plant-based estrogens, or phytoestrogens, which can stimulate the growth of breast tumors. However, a case-control clinical study of 949 breast cancer cases and 1,524 controls found that black cohosh use had significant protective effects against breast cancer development. More research is needed. Patients with a history of breast cancer, risk factors for breast cancer, or who are actively engaged in breast cancer treatment, should talk to their doctor before taking black cohosh.


Arthritis

Preliminary studies suggest that black cohosh may help reduce inflammation associated with osteoarthritis and rheumatoid arthritis. In a review of scientific studies, researchers concluded that a combination of black cohosh, willow bark ( Salix spp.), sarsaparilla ( Smilax spp.), guaiacum (Guaiacum officinale) resin, and poplar bark ( Populus tremuloides) may help relieve symptoms of osteoarthritis. However, there is not enough human research to make a clear recommendation about the use of black cohosh alone for arthritis.


Osteoporosis

Laboratory studies have found that plant-based estrogens (called phytoestrogens) in black cohosh may inhibit bone loss, such as seen with osteoporosis. More research is needed.

Source: University of Maryland Medical Center

Pharmacology

The primary active constituent of the black cohosh root is believed to be the terpene glycoside fraction, including actein and cimifugoside. The rhizome also contains other potentially biologically active substances, including alkaloids, flavonoids, and tannins. The therapeutic activity of black cohosh was originally believed to derive from an activation of estrogen receptors; however, more recent studies 2,3 show that although some constituents of the extract bind to at least one subtype of estrogen receptors, this binding produces very little if any, estrogenic effect, and may selectively block some of these effects.

One early study 4 reported that treatment with black cohosh produced a decrease in luteinizing hormone (LH) levels consistent with an estrogenic effect; however, more recent studies 5,6 have shown no effect on levels of LH, follicle-stimulating hormone (FSH), or prolactin. It remains unclear whether black cohosh exerts its effect via estrogen receptors or through another mechanism.


Uses and Efficacy

Currently, the primary use of black cohosh extract is for the alleviation of menopausal symptoms. The American College of Obstetrics and Gynecology guidelines on the use of botanicals for the management of menopausal symptoms support this use for up to six months, especially in treating the symptoms of sleep and mood disturbance, and hot flashes. 7 [Evidence level C, consensus/expert guidelines] At least eight studies of black cohosh therapy for menopausal symptoms, involving approximately 2,000 women, have been published, most of them in German. 3 Many of these studies used an estrogen product in the control group, and most of the trials used standardized outcome measures such as the Kupperman Menopause Index and the Hamilton Anxiety Scale. Almost all of these studies demonstrate efficacy in patients taking black cohosh extract similar to that of estrogen in the treatment of neurovegetative menopausal symptoms. Unfortunately, most of these studies are open trials and lack blinding and long-term follow-up, making it difficult to draw definitive conclusions from their results.*

As with other herbal medicines believed to have potential estrogenic effects, there has been a concern about the safety of black cohosh in women with a personal history or strong family history of breast cancer. Although further research is needed, at least one tissue-culture study 2 showed no stimulation of estrogen receptor-positive breast cancer cell lines by black cohosh extract. This study 2 found that black cohosh extract increased the inhibitory effect of tamoxifen (Nolvadex) on the breast cancer cell lines. Because this question has not yet been resolved, physicians should discuss the issue with their patients who are at risk for breast cancer and are considering taking black cohosh. In a study that included 69 patients and examined black cohosh as a treatment for hot flushes in women with breast cancer, it was found to be no more effective than placebo, regardless of whether the hot flushes were induced by tamoxifen or by natural menopause. 6 [Evidence level A, randomized controlled trial]*

Black cohosh also has been used to treat dysmenorrhea and is recommended for this indication by the German Commission E, 8 which establishes guidelines for the proper use of herbs in Germany. However, this recommendation is based on case reports, and there are no randomized clinical trials supporting the use of black cohosh for this indication.


Final Comment

Although the clinical trials on black cohosh are of insufficient quality to support definitive statements, this herbal medicine does appear to be effective in the short-term treatment of menopausal symptoms. The mechanism of action is unclear, and early reports of an estrogenic effect have not been proved in recent studies. Some patients will assume that, because black cohosh provides some of the same benefits as hormone therapy in terms of symptom control, the additional salutary effects of hormone therapy can be achieved with the use of black cohosh. Physicians should be quite clear in explaining to their patients that although black cohosh may be useful in treating some menopausal symptoms, there is currently no evidence regarding any protective effect of black cohosh against the development of osteoporosis.

An additional concern exists about the safety of this herb in long-term use, particularly the possibility that it can cause long-term unopposed estrogenic stimulation of the endometrium, thus raising the risk of the development of endometrial cancer. Although studies have not shown any effect on vaginal cytology, the effect of black cohosh extract on the endometrium has not been adequately studied. Some physicians recommend that women using black cohosh on a long-term basis be given progesterone as well. Table 1 discusses the efficacy, safety, tolerability, and cost of black cohosh.

The author indicates that he does not have any conflicts of interest. Sources of funding: none reported.

The Author

BENJAMIN KLIGLER, M.D., M.P.H., is an assistant professor in the Department of Family Medicine at Albert Einstein College of Medicine, New York, N.Y., and teaches in the Beth Israel Residency Program in Urban Family Practice, New York. Dr. Kligler also serves as co-director of the fellowship program in integrative medicine at the Continuum Center for Health and Healing in New York . He received his medical and public health degrees from Boston University School of Medicine and completed a family practice residency at Montefiore Medical Center , Bronx , N.Y.

Address correspondence to Benjamin Kligler, M.D., M.P.H., Beth Israel Center for Health and Healing, 245 Fifth Avenue, New York, NY 10016 (e-mail: [email protected] ). Reprints are not available from the author.

Overview

More than two centuries ago, Native Americans discovered that the root of the black cohosh plant ( Actaea racemosa, formerly known as Cimicifuga racemosa) helped relieve menstrual cramps and symptoms of menopause, such as hot flashes, irritability, mood swings, and sleep disturbances. Today, people use black cohosh for these same reasons. In fact, the herb has been widely used for more than 40 years in Europe and is approved in Germany for premenstrual discomfort, painful menstruation, and menopausal symptoms.

Black Cohosh Root, shown to help with hot flashes, night sweats, headaches, breast soreness, fatigue, mood swings, heart palpitations, cramps, swelling, menopause discomfort.

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