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Questions and Answers About Black Cohosh and the Menopause and Early Menopause Treatment

Table of Contents: This fact sheet provides an overview of the use of black cohosh for menopausal symptoms.


Main points

Black cohosh is a herbal product for menopause. It is sold as a dietary supplement in the USA. In most cases it is used for hot flashes and other menopause and early menopause symptoms. A number of organizations and medical centers carry out a rigorous scientific investigation to determine whether treatment with black cohosh reduces the frequency and intensity of hot flashes, and other menopause and early menopause symptoms. In the majority of cases the answer to the question whether black cohosh work in case of hot flashes, night sweats, vaginal dryness, etc. is positive.

What's black cohosh root?

Black cohosh roots (a.k.a. Actaea racemosa and Cimicifuga racemosa), is a well-known herb for relieving menopause symptoms. Black cohosh is a perennial plant that is native to North America. It belongs to the buttercup family. It is also often referred to as rattletop, black snakeroot, rattleroot, bugbane, macrotys, bugwort, and rattleweed.

What are the main black cohosh preparations?

Common black cohosh preparations are made from its roots and underground stems (rhizomes). The most popular is Remifemin, though there is a number of other black cohosh products.

What's the historical applications of black cohosh?

Black cohosh was actively used by North American Indians to treat malaise, gynecological disorders, cough, constipation, kidney disorders, malaria, rheumatism, sore throat, colds, hives, and backache. In 19th-century America, black cohosh extremely popular among a group of alternative practitioners who called black cohosh "macrotys" and prescribed it for rheumatism, lung conditions, neurological conditions, and conditions that affected women's reproductive organs. It was also a home remedy used for rheumatism and fever, as a diuretic, and to treat menstrual problems, inflammation of the uterus or ovaries, infertility, and many other deceases and disorders.

What are clinical investigations that have been done on black cohosh and its effect on menopause and early menopause symptoms?

Black cohosh is used for menopause and early menopause symptoms, primarily for hot flashes. Quite a large number of investigations using various designs have been conducted to determine how black cohosh affects menopause and early menopause symptoms. Several studies were placebo controlled, and most assessed symptoms by using the Kupperman index-a scale that combines measures of hot flashes, anxiety, insomnia, depression and fatigue but not vaginal dryness.

What's the effect of black cohosh?

It is still a mystery how black cohosh works. There is the possibility that black cohosh exhibits estrogenic activity but the evidence of that is quite contradictory.
Menopausal women usually have lower levels of estrogen and higher levels of two other hormones-luteinizing hormone (LH) and follicle-stimulating hormone (FSH)-than do women who menstruate. Ten of nine investigations show that black cohosh does not affect LH or FSH. Some active compounds appear to include triterpene glycosides, resins, and caffeic and isoferulic acids. A compound recently identified in black cohosh fukinolic acid was noticed to have estrogenic activity in vitro.
Vitro investigations used to examine the effect of black cohosh also has contradictory results. Black cohosh had no activity in estrogen receptor (ER) binding assays in Ishikawa (endometrial) and S30 (breast cancer) cell lines. Studies have been mixed on whether black cohosh affects vaginal epithelium. One placebo-controlled, double-blind trial of black cohosh showed estrogenic changes in vaginal epithelium of menopausal women, but another study of two Remifemin doses (39 or 127.3 mg/day) found that 6 months of treatment in perimenopausal and menopausal women caused no changes in vaginal cytology. Because of the marked changes in hormone levels in women who have achieved menopause, numerous modifications occur in the structure and activity of vaginal and uterine tissues.
Menopause is commonly associated with a thinning of the endometrium (uterine lining). In fact, no human examination have adequately evaluated the effect of black cohosh on uterine lining.

What's the regulatory status of black cohosh in the USA?

Black cohosh is sold as a dietary supplement. Dietary supplements are considered to be foods, not medications in the USA. Because dietary supplements are not always tested for manufacturing consistency, the composition may vary considerably from lot to lot.

Does black cohosh have side effects?

Black cohosh usually is not used for long periods of time. But still it was investigated that black cohosh cause stomach discomfort and headaches in some cases. Headaches, gastric complaints, heaviness in the legs, and weight problems are also quite rare. Still the importance of long-term studies can't be underestimated.

Does black cohosh have contraindication?

The effect of black cohosh in case of breast cancer has not been rigorously studied. So women suffering from breast cancer would better avoid black cohosh until its medical effect on breast tissue is understood.
The use of black cohosh on pregnant women also has not been carefully investigated yet. Thus, it would be wise of pregnant women not to take black cohosh preparations unless they do so under the supervision of their physicians.

Interrelation of black cohosh with other drugs and medications

Interrelation of black cohosh with other drugs and medications has not been carefully studied yet. But for the present moment black cohosh has not been reported to influence laboratory tests and to interact with any medications.

What are some additional sources of information on black cohosh?

There are a number of medical libraries, which for sure have a great deal of additional about black cohosh and other medicinal herbs for menopause. Some others include Web-based resources such as CAM on PubMed.


If you want to learn more about black cohosh and menopause treatment, make use of the following sources:

  1. American College of Obstetricians and Gynecologists: Use of botanicals for management of menopausal symptoms. ACOG Practice Bulletin 28: 1-11, 2001.
  2. Chen S-N, Li W, Fabricant DS, Santasiero BD, et al.: Isolation, structure elucidation, and absolute configuration of 26-deoxyactein from Cimicifuga racemosa and clarification of nomenclature associated with 27-deoxyactein. Journal of Natural Products 65: 601-605, 2001.
  3. Dixon-Shanies D, Shaikh N: Growth inhibition of human breast cancer cells by herbs and phytoestrogens. Oncology Reports 6: 1383-1387, 1999.
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  5. Duker EM, Kopanski L, Jarry H, Wuttke W: Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats. Planta Medica 57: 420-424, 1991.
  6. Einer-Jensen N, Zhao J, Anderson KP, Kristoffersen K: Cimicifuga and Melbrosia lack oestrogenic effects in mice and rats. Maturitas 25: 149-153, 1996.
  7. Finkle RS, Zarlengo KM: Blue cohosh and perinatal stroke. New England Journal of Medicine 351: 302-303, 2004.
  8. Foster S: Black cohosh: Cimicifuga racemosa: a literature review. HerbalGram 45: 35-49, 1999.
  9. Freudenstein J, Dasenbrock C, Nisslein T: Lack of promotion of estrogen-dependent mammary gland tumors in vivo by an isopropanolic Cimicifuga racemosa extract. Cancer Research 62: 3448-3452, 2002.
  10. Gruenwald J: Standardized black cohosh (Cimicifuga) extract clinical monograph. Quarterly Review of Natural Medicine Summer: 117-125, 1998.
  11. Gunn TR, Wright IM: The use of black and blue cohosh in labour. New Zealand Medical Journal 109: 410-411, 1996.
  12. Jacobson JS, Troxel AB, Evans J, et al.: Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. Journal of Clinical Oncology 19: 2739-2745, 2001.
  13. Jones TK, Lawson BM: Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication. Journal of Pediatrics 132: 550-552, 1998.
  14. Kruse SO, Lohning A, Pauli GF, Winterhoff H, Nahrstedt A: Fukiic and piscidic acid esters from the rhizome of Cimicifuga racemosa and the in vitro estrogenic activity of fukinolic acid. Planta Medica 65: 763-764, 1999.
  15. Lehmann-Willenbrock E, Riedel H-H: Clinical and endocrinological studies on the therapy of ovarian defunctionalization symptoms after hysterectomy sparing the adnexa (in German). Zentralblatt fur Gynakologie 110: 611-618, 1988.
  16. Liske E, Hanggi MD, 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. Journal of Women's Health & Gender-Based Medicine 11: 163-174, 2002.
  17. Liu J, Burdette JE, Xu H, et al.: Evaluation of estrogenic activity of plant extracts for the potential treatment of menopausal symptoms. Journal of Agricultural and Food Chemistry. 49:2472-2479, 2001.
  18. Liu Z, Yang Z, Zhu M, Huo J: Estrogenicity of black cohosh (Cimicifuga racemosa) and its effect on estrogen receptor level in human breast cancer MCF-7 cells (in Chinese). Wei Sheng Yan Jiu 30: 77-80, 2001.
  19. Mills S, Bone K: Principles and Practice of Phytotherapy. Edinburgh: Churchill Livingstone, 2000: 303-309.
  20. Nesselhut T, Schellhas C, Deitrich R, Kuhn W: Studies of the proliferative potency of phytodrugs with estrogen-like effect in breast cancer cells (in German). Archives of Gynecology and Obstetrics 254: 817-818, 1993.
  21. Stoll W: Phytotherapy influences atrophic vaginal epithelium: Double-blind study of Cimicifuga vs. estrogenic substances (in German). Therapeutikon 1: 23-31, 1987.
  22. Upton, R, ed. Black Cohosh Rhizome Actaea racemosa L. syn. Cimicifuga racemosa (L.) Nutt. Standards of analysis, quality control, and therapeutics. American Herbal Pharmacopoeia and Therapeutic Compendium. Santa Cruz, CA. American Herbal Pharmacopoeia, 2002: 1-38.
  23. Warnecke, G: Influencing of menopausal complaints with a phytodrug: successful therapy with Cimicifuga monoextract (in German). Medizinische Welt 36: 871-874, 1985.
  24. Whiting PW, Clouston A, Kerlin P: Black cohosh and other herbal remedies associated with acute hepatitis. Medical Journal of Australia 177: 432-435, 2002.
  25. Writing Group for the Women's Health Initiative Investigators: Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women's Health Initiative randomized controlled trial. Journal of the American Medical Association 288: 321-333, 2002.
  26. Zava DT, Dollbaum CM, Blen M: Estrogen and progestin bioactivity of foods, herbs, and spices. Proceedings of the Society for Experimental Biology and Medicine 217: 369-378, 1998.
  27. Zierau O, Bodinet C, Kolba S, Wulf M, Vollmer G: Antiestrogenic activities of Cimicifuga racemosa extracts. Journal of Steroid Biochemistry and Molecular Biology 80: 125-130, 2002.
  28. Wikipedia about Menopause.

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