Black Cohosh Introduction
Also referenced as: Blacksnake root, Bugbane, Bugwort, Rattleroot, Richweed
Botanical Names: Cimicifuga racemosa, Actea racemosa, Actea macrotys
Black cohosh is a perennial plant that grows in higher wooded elevations. It is found in both the northern and southern parts of the United States. It grows to a height of 2 to 4 feet with oblong leaves, white flowers, and produces a small oval fruit. The plant has a distinct, and particularly strong odor.
Black cohosh has been used since the 1500’s by Europeans and early Americans, including Native Americans, for various gynecological conditions. [1] It was used during periods of pregnancy and birth, as well as for various complaints of women who were not pregnant. It was also used as a remedy for snakebites, which is how it got the names Blacksnake root and Rattleroot. In the 1800’s it was introduced as a remedy for rheumatism and nervous disorders. Since the onset of its use, black cohosh has been used most often for gynecological and obstetric complaints.
The active constituents of Black cohosh include; triterpene glycosides, actein and cimicifugoside; resins such as cimicifugin; and the cinnamic acid derivatives, ferulic acid and isoferulic acid. It was also postulated to contain the isoflavone formononetin, but this constituent has not been detected in the modern testing of extracts from the root/rhizome. [2]
Black cohosh is often referred to as a phytoestrogen, or a plant that exerts the same activity as estrogen. In recent studies, this estrogenic effect has been refuted due to a lack of evidence. [3] However it is believed that Black cohosh may have estrogen receptor modulating activity.
Black cohosh is also considered to be an anti-spasmodic, anti-inflammatory, analgesic, and uterine tonic. [4]
Black Cohosh Uses
Parts Used
The root or rhizome is used medicinally. It can be used in several different forms. The rhizome can be dried and decocted in a tea, or powdered and taken in a capsule. The rhizome can be extracted into ethanol at various concentrations from 1:2 to a 1:10. [5]
Black Cohosh Uses
Black cohosh has been shown in several studies to be a safe treatment for menopause and an alternative to estrogen replacement therapy. [6] It has shown the ability to reduce the symptoms of menopause, including hot flashes, anxiety, sweating, insomnia, and vaginal dryness or atrophy. [7]
- Black cohosh has also been shown to be a safe and effective treatment for women with a history of Breast cancer, who are experiencing symptoms of menopause such as hot flashes. [8, 9] Black cohosh decreased the sweating associated with hot flashes in women who were taking the drug tamoxifen in study. [10]
- Black cohosh does not exert estrogenic effects on breast cancer cells and has not caused growth of breast cancer cells in vitro. [11]
- Black cohosh can reduce the occurrence and severity of migraine headaches associated with the menstrual cycle. [12] Many times, women will get migraine headaches associated with the fluctuations in various hormones involved in the menstrual cycle such as progesterone and estrogen. Black cohosh was used in combination with soy and dong quai, two other phytoestrogens.
- Black cohosh can lower blood pressure by dilating the blood vessels in peripheral circulation. It may also improve circulation to areas that are compromised by chronic disease. [13]
Black Cohosh Contraindications and Interactions
- Black cohosh is contraindicated in pregnancy due to possible uterine stimulating effects. [15] It is also contraindicated during lactation. [16]
- Black cohosh should not be used in individuals with hormone dependant cancers such as Breast, Uterine, Ovarian, and Prostate cancers. [17]
- Because Black cohosh has the potential to lower blood pressure, it should not be combined with other anti-hypertensive medications without first consulting with a physician. [19]
- Black cohosh has been shown in studies to potentiate, or act synergistically with, tamoxifen. [20]
Black Cohosh Dosages
Two different approaches regarding the administration of Black cohosh exist. The first is one from traditional use, the second is from use in Germany, primarily with the preparation Remifemin. [18]
Traditional Black Cohosh preparations:
- 0.5 - 1.0 grams of dried root/rhizome, taken 3-4 times daily
- 1.5 - 3.0 milliliters (ml) of 1:2 liquid extract per day
- 3.5 - 7.0 ml of 1:5 tincture per day
- 6 - 12 ml of 1:10 tincture per day
German preparations:
- 40 - 200 milligrams (mg) of dried rhizome/root per day (standardized to contain at least 1 mg of triterpenes)
- 0.4 - 2.0 ml of 1:10 tincture in 60% ethanol base, per day
Black Cohosh Toxicities
Side effects include vomiting, headache, dizziness, limb pain, and low blood pressure. [21] In one study, women reported slight GI distress and rash. [22] Overdose is potentially dangerous and can cause nervous system disturbances, vertigo, and visual changes. [23]
References
[1] Foster S. Black cohosh (Cimicifuga racemosa): a literature review. Herbalgram. 1999; 45: 35-49.
[2] Struck D, Tegtmeirer M, Harnischfeger G. Flavones in extracts of Cimicifuga racemosa. Planta Med. 1997; 63: 289-290.
[3] Liu J, Burdette JE, Xu H et al. Evaluation of estrogenic activity of plant extracts for the potential treatment of menopausal symptoms. J Agric Food Chem. 2001; 49: 2472-2479.
[4] Mills S, Bone K. Principles and Practice of Phytotherapy. Churchill Livingstone, London, UK; 2000: 303-309. [5] Mills S, Bone K. Principles and Practice of Phytotherapy. Churchill Livingstone, London, UK; 2000: 303-309.
[6] Doy TL, Powell KL, Weisman SM. Critical evaluation of the safety of Cimicifuga racemosa in menopause symptom relief. Menopause. 2003 Jul-Aug; 10(4): 299-313.
[7] Cimicifuga racemosa: monograph. Altern Med Rev. 2003 May; 8(2): 186-189.
[8] Doy TL, Powell KL, Weisman SM. Critical evaluation of the safety of Cimicifuga racemosa in menopause symptom relief. Menopause. 2003 Jul-Aug; 10(4): 299-313.
[9] Pockaj BA et al. Pilot evaluation of black cohosh for the treatment of hot flashes in women. Cancer Invest. 2004; 22(4): 515-521.
[10] 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. J Clin Oncol. 2001; 19: 2739-2745.
[11] Lupu R et al. Black cohosh, a menopausal remedy, does not have estrogenic activity and does not promote breast cancer cell growth. Int J Oncol. 2003 Nov; 23(5): 1407-1412.
[12] Burke BE, Olsen RD, Cusack BJ. Randomized controlled trial of phytoestrogen in the prophylactic treatment of menstrual migraine. Biomed Pharmocother. 2002; 56: 283-288.
[13] Cimicifuga racemosa: monograph. Altern Med Rev. 2003 May; 8(2): 186-189.
[14] Kim CD, Lee WK, Lee MH, Cho HS, Lee YK, Roh SS. Inhibition of mast cell dependant allergy reaction by extract of black cohosh (Cimicifuga racemosa). Immunopharmacol Immunotoxicol. 2004 May; 26(2): 299-308.
[15] Brinker F. Herb Contraindications and Drug Interactions, 2nd Ed. Sandy, OR; Eclectic Medicinal; 1998:40.
[16] McFarlin BL, Gibson MH, O’Rear J, Harmon P. A national survey of herbal preparations used by midwives for labor stimulation. Review of the literature and recommendations for practice. J Nurse Midwifery. 1999 May; 44(3): 205-216.
[17] Wade C, Kronenberg F, Kelly A, Murphy PA. Hormone modulating herbs: implications for women’s health. J Am Med Womens Assoc. 1999; 54(4): 181-183.
[18] Mills S, Bone K. Principles and Practice of Phytotherapy. Churchill Livingstone, London, UK; 2000: 303-309.
[19] www.pdrhealth.com Black Cohosh. January 2005.
[20] Bodinet C, Freudenstein J. influence of Cimicifuga racemosa on the proliferation of estrogen receptor positive human breast cancer cells. Breast Cancer Res Treat. 2002; 76: 1-10.
[21] PDR for Herbal Medicines, 2nd Ed. Montvale, NJ, Medical Economics Company; 2000: 93.
[22] Huntly A, Ernst E, A systematic review of the safety of black cohosh. Menopause. 2003 Jan-Feb; 10(1): 58-64.
[23] Mills SY. The A-Z of modern herbalism. Thorsons, London; 1989:39.
