Black cohosh
Also listed as: Actaea reacemosa; Black snakeroot; Bugbane; Bugwort; Cimicifuga racemosa; Rattle weed; Squawroot
Overview
More than two centuries ago, Native Americans discovered that the root of the black cohosh plant (
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.
Menopausal Symptoms
More than a dozen studies confirm that long-standing use of black cohosh is effective for improving menopausal symptoms. For example, in a German study involving 629 women, black cohosh improved physical and psychological menopausal symptoms in more than 80% of the participants within four weeks. A second German study of 304 women showed that a daily dose of 40 mg of black cohosh was more effective than a placebo ("dummy" pill) in relieving hot flashes, particularly among newly symptomatic women. In fact, researchers claim the effects of black cohosh were similar to results of estrogen replacement therapy (ERT). In another study, 80 menopausal women were treated for 12 weeks with black cohosh extract, ERT, or placebo. Black cohosh improved anxiety, menopause, and vaginal symptoms. In addition, the number of hot flashes on average dropped from 5 a day to less than 1 a day in the black cohosh group. Those taking estrogen had hot flashes drop from 5 to 3.5 times a day.
Given these examples, and results of other studies, some experts conclude that black cohosh may be a safe and effective alternative for women who cannot or will not take ERT for menopause.
However, the American College of Obstetricians and Gynecologists (ACOG) reports that many of these studies were poorly designed and did not evaluate the safety and effectiveness of black cohosh beyond 6 months of use. A study in the December 2006
Annals of Internal Medicine
, moreover, reported that black cohosh did NOT relieve hot flashes. Still, the ACOG recognizes the value of black cohosh for menopausal symptoms.
Until further studies are conducted, some experts 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 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 is some concern that black cohosh may contain plant based estrogens, or phytoestrogens, which stimulate the growth of breast tumors. This idea has not been scientifically confirmed. In fact, some studies suggest the complete opposite -- that black cohosh may prevent the growth of breast cancer cells in test tubes. Additional studies are needed.
Arthritis
Preliminary studies suggest that black cohosh may help reduce inflammation associated 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.
Osteoporosis
Some experts believe that plant based estrogens in black cohosh may prevent osteoporosis. This theory has yet to be scientifically tested.
Plant Description
Black cohosh is a tall, flowering plant found in rich, shady woods in eastern areas of North America. A member of the buttercup family, black cohosh is also known as black snakeroot, bugbane, bugwort, and squawroot. Its rhizomes and roots (both underground parts of the plant) are used for medicinal purposes.
What's It Made Of?
Black cohosh contains glycosides (sugar compounds), isoferulic acids (substances with anti-inflammatory effects), and, possibly, phytoestrogens (plant based estrogens), among several other active substances.
Available Forms
Black cohosh is available in capsules, tablets, liquid tincture that can be mixed in water, and dried root that can be simmered in water.
Black cohosh should not be confused with blue cohosh, a nicotine-like herb that has similar effects, but has not been thoroughly tested for its safety and effectiveness.
How to Take It
Pediatric
There are no known scientific reports on the pediatric use of black cohosh, and it is not currently recommended for children.
Adult
The recommended dose of black cohosh ranges from 40 to 80 mg per day. For black cohosh tincture, that equals 2 to 4 mL, three times per day in water or tea. Two capsules or tablets will likely provide the recommended daily dose.
To make a black cohosh drink, put 20 g of dried root in 34 oz of water. Bring to a boil and then simmer 20 to 30 minutes until the liquid is reduced by a third. Strain, cover, and store in the refrigerator or a cool, dry place. The liquid keeps for up to 48 hours. Drink one cup three times daily.
Precautions
The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a practitioner knowledgeable in the field of botanical medicine.
Some individuals taking high doses of black cohosh report side effects including abdominal pain, diarrhea, dizziness, headaches, joint pains, nausea, slow heart rate, tremors, visual dimness, and vomiting.
It is not clear whether black cohosh stimulates the growth of breast cancer cells or inhibits their growth. Research has been limited and has produced mixed results. Women with a history of breast cancer, and those at a high risk for developing breast cancer (for example, a strong family history like a mother or sister with breast cancer), should not take black cohosh without talking to a healthcare provider.
Pregnant and breastfeeding women should avoid black cohosh as the herb may stimulate contractions and lead to premature labor.
Possible Interactions
There are no known scientific reports of interactions between black cohosh and conventional medications.
Supporting Research
Blumenthal M, Busse WR, Goldberg A, et al.
The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines
. Boston, Mass: Integrative Medicine Communications; 19998:90.
Blumenthal M, Goldberg A, Brinkmann J, eds.
Herbal Medicine: Expanded Commission E Monographs. Newton, Mass
: Integrative Medicine Communications; 2000:22-26.
Dixon-Shanies D, Shaikh N. Growth inhibition of human breast cancer cells by herbs and phytoestrogens.
Oncol Rep
. 1996;6(6):1383-1387.
Einbond L, Shimizu M, Xiao D, Nuntanakorn P, Lim JT, Suzui M, Seter C, Pertel T, Kennelly E, Kronenberg F, Weinstein IB. Growth inhibitory activity of extracts and purified components of black cohosh on human breast cancer cells.
Breast Cancer Research and Treatment
. 2004;83(3):221-231.
Ernst E, Chrubasik S. Phyto – anti-inflammatories. A systematic review of randomized, placebo-controlled, double-blind trials.
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. 2000;26(1):13-27.
Foster S. Black Cohosh:
Cimicifuga racemosa
. A literature review.
HerbalGram
. 1999;45:37-49.
Foster S, Tyler V.
Tyler
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. Binghamton, NY: The Haworth Herbal Press; 2000.
Guillaume G. Postmenopausal osteoporosis and Chinese medicine.
Am J Acupuncture
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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.
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Lieberman S. A review of the effectiveness of
Cimicifuga racemosa
(black cohosh) for the symptoms of menopause.
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. 1998;5:525 – 529.
Liske E. Therapeutic efficacy and safety of
Cimicifuga racemosa
for gynecologic disorders.
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. 1998;75:45-53.
McFarlin BL, Gibson MH, O'Rear J, et al. A national survey of herbal preparation use by nurse-midwives for labor stimulation. Review of the literature and recommendations for practice.
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Newton KM, Reed SR, LaCroix AZ, Grothaus LC, Ehrlich K, Guiltinan J. Treatment of Vasomotor Symptoms of Menopause with Black Cohosh, Multibotanicals, Soy, Hormone Therapy, or Placebo. Annals of Internal Medicine. 2006 December;145(12):869-879.
Pepping J. Alternative therapies: black cohosh:
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Am J Health-Syst Pharm
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Rockwell S, Liu Y, Higgins S. Alteration of the effects of cancer therapy agents on breast cancer cells by the herbal medicine black cohosh.
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. Philadelphia, PA: Hanley & Belfus, Inc.;2002:98-103.
Ruediger O, Friede M, Liske E, Schnitker J, Freudenstein J, Zepelin H. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms.
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. 2005;105:1074-1083.
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. Berlin, Germany: Springer-Verlag; 1998.
Taylor M.
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. 1997;23:514 – 532.
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Cleveland
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. 1999;66(40):213 – 218.
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Review Date:
9/12/2005
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Reviewed By: Steven D. Ehrlich, N.M.D., True Harmony Medical Center, Mesa, AZ. Review provided by VeriMed Healthcare Network. Previously reviewed by: Constance Grauds (April 1999), RPh, President, Association of Natural Medicine Pharmacists, San Rafael, CA; Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University and Senior Medical Editor Integrative Medicine, Boston, MA; Gary Kracoff, RPh (Pediatric Dosing section February 2001), Johnson Drugs, Natick, MA; Steven Ottariono, RPh (Pediatric Dosing section February 2001), Veteran's Administrative Hospital, Londonderry, NH; R. Lynn Shumake, PD, Director, Alternative Medicine Apothecary, Blue Mountain Apothecary & Healing Arts, University of Maryland Medical Center, Glenwood, MD; Tom Wolfe, P.AHG (April 1999), Smile Herb Shop, College Park, MD. All interaction sections have also been reviewed by a team of experts including Joseph Lamb, MD (July 2000), The Integrative Medicine Works, Alexandria, VA;Enrico Liva, ND, RPh (August 2000), Vital Nutrients, Middletown, CT; Brian T Sanderoff, PD, BS in Pharmacy (March 2000), Clinical Assistant Professor, University of Maryland School of Pharmacy; President, Your Prescription for Health, Owings Mills, MD; Ira Zunin, MD, MPH, MBA (July 2000), President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.
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