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
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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 the menopausal symptoms, black cohosh
was more effective in relieving hot flashes and night sweats than the
antidepressant fluoxetine (Prozac).
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
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 (Nolvadex) 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 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.
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. However, there is not enough human research to make a clear
recommendation about the use of black cohosh alone for arthritis.
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
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
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.
Interactions, Adverse Effects, and Contraindications
With the exception of a possible interaction with tamoxifen, there are no
known interactions between black cohosh extract and any medications. In
clinical studies, 8 the only adverse effect reported with any significant
frequency was gastrointestinal discomfort. In larger doses, black cohosh
can cause dizziness, headaches, giddiness, nausea, and vomiting. 9 One case
report 10 centers on a woman who developed a seizure after taking a
combination of black cohosh, chasteberry, and evening primrose oil, but no
clear cause-and-effect relationship was documented. No other reports of
seizure in association with black cohosh have been published.
Black cohosh is contraindicated during pregnancy because of its potential
ability to stimulate uterine contraction. 11 The safety of black cohosh in
breastfeeding mothers and the degree of transmission of black cohosh in
breast milk are unknown. Controversy remains regarding the safety of black
cohosh in women with a personal history or strong family history of breast
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
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
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.
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@example.com ).
Reprints are not available from the author.
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
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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