Cohosh Extract Plus
40 mg - 120 Caps
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!
to Help With*:
BENJAMIN KLIGLER, M.D.,
M.P.H., Albert Einstein College of Medicine, New York , New York
The herb black cohosh,
or Actaea racemosa (formerly named Cimicifuga racemosa), is native to North
America. The roots and rhizomes of this herb are widely used in the treatment
of menopausal symptoms and menstrual dysfunction. Studies have demonstrated
that this botanic medicine, when standardized properly to the terpene glycoside
fraction, appears to be effective in alleviating menopausal symptoms. Adverse
effects are extremely uncommon, and there are no known significant adverse drug
interactions. (Am Fam Physician 2003;68:114-6. Copyright 2003 American Academy
of Family Physicians .)
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 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
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
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 cancer.
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 a 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
BENJAMIN KLIGLER, M.D.,
M.P.H., is 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.
to Benjamin Kligler, M.D., M.P.H., Beth Israel Center for Health and Healing,
245 Fifth Avenue, New York, NY 10016 (e-mail: firstname.lastname@example.org
). 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 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 the menopausal symptoms, black cohosh was more effective in relieving hot
flashes and night sweats than the antidepressant fluxetine (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 hormonal 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
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
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
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
Black Cohosh Root, shown to help with hot flashes, night sweats, headaches,
breast soreness, fatigue, mood swings, heart palpitations, cramps, swelling,
Vitamins product exceeds the standards and requirements set forth in the FDA’s
Code of Federal Regulation (21 CFR, 111) Current Good Manufacturing Practices
in the USA, with ALL USA Ingredients!
Foster S. Black cohosh: Cimicifuga racemosa: a literature review. HerbalGram 1999;45:35-50.
McKenna DJ, Jones K, Humphrey S, Hughes K. Black cohosh: efficacy, safety, and use in clinical and preclinical applications. Altern Ther Health Med 2001;7:93-100.
Dog TL, Riley D, Carter T. An integrative approach to menopause. Altern Ther Health Med 2001;7:45-55.
Duker EM, Kopanski L, Jarry H, Wuttke W. Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats. Planta Med 1991;57:420-4.
Liske E, Wustenberg P. Therapy of climacteric complaints with cimicifuga racemosa: herbal medicine with clinically proven evidence [Abstract]. Menopause 1998;5:250.
Jacobson JS, Troxel AB, Evans J, Klaus L, Vahdat L, Kinne D, et al. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol 2001; 19:2739-45.
ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists. Use of botanicals for management of menopausal symptoms. Obstet Gynecol 2001;97:suppl 1-11.
Blumenthal M. German Federal Institute for Drugs and Medical Devices. Commission E. The Complete German Commission E monographs: therapeutic guide to herbal medicines. Austin , Tex. : American Botanical Council, 1998.
Duke JA. CRC handbook of medicinal herbs. Boca Raton , Fla. : CRC Press, 1985.
Shuster J. Black cohosh root? Chasteberry tree? Seizures! Hospital Pharmacy [ USA ] 1996;31:1553-4.
Brinker FJ. Herb contraindications and drug interactions: with extensive appendices addressing specific conditions, herb effects, critical medications, and nutritional supplements. 2d ed. Sandy , Ore. : Eclectic Medical, 1998.
Copyright c 2003 by the American Academy of Family Physicians.
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