Black Cohosh

If we were only allowed one herb to treat symptoms of menopause, we would choose Black Cohosh. This venerable herb is native to North America and was extensively used by Native Americans to treat menstrual irregularities of all sorts.

But what about today? Does Black Cohosh withstand the objective scientific scrutiny of the twenty-first century? We think so.

Black Cohosh is one of the world's most widely used herbal extracts, and is the most popular and potent Western herb for the treatment of menopause. Its clinical value has been well documented by prestigious German Commission E (an expert committee that evaluates the safety and efficacy of phytomedicines). The German Commission E Monograph on Black Cohosh states that it is a useful phytomedicine for premenstrual discomfort, dysmenorrhea (painful menstruation) or climacteric (menopausal) ailments.

How It Works

The active constituents in Black Cohosh are numerous, but several stand out. Black Cohosh contains triterpene glycosides which include actin and cimicifugoside. It also contains an isoflavone, known as formononetin that may inhibit receptor sites in the pituitary gland and hypothalamus.

As women age, the chemical signals between the pituitary and the ovaries are disrupted, resulting in decreased estrogen and increased luteinizing hormone (LH). High levels of LH in the blood are linked to night sweats,  hot flashes, palpitations and thinning of the vaginal walls.

In a study on menopausal women and the effects of Black Cohosh, it was shown that after two months of treatment LH levels were significantly reduced.

Impressive Clinical Trials

Many clinical trials have demonstrated the efficacy of Black Cohosh for the relief of menopausal symptoms. It was also shown that Black Cohosh phytoestrogen constituents bind to estrogen receptors. This estrogen effect is controversial, as repeated studies have not confirmed this effect.

A large open study followed 131 doctors and 629 menopausal women who supplemented 80 mg of Black Cohosh extract for six to eight weeks. Most of the women notice beneficial results within four weeks of beginning treatment. Within eight weeks, a large percentage of women reported complete resolution of symptoms. The treatment was well tolerated with only 7% of patients reporting mild digestive upset.

Another study followed 60 women  that were given either Black Cohosh (80 mg/day) extract, conjugated estrogens (0.625 mg/day), or diazepam (a sedative drug)(2 mg daily). This double-blind study showed those women receiving Black Cohosh had greater relief of menopausal symptoms than the other two groups. Also, Black Cohosh was superior in relieving the symptoms of depression and anxiety than conjugated estrogens and diazepam, with fewer side effects.

In another double blind study, 80 menopausal women were followed for 12 weeks. Patients were given either Black Cohosh extract (80 mg/day), conjugated estrogens (0.625 mg/day), or placebo. Women taking Black Cohosh had the best results, including the most relief for anxiety. Hot flashes dropped from an average 5 per day to 1 in the Black Cohosh group, and 3.5 in the estrogen group. There was a significant improvement in the vaginal cell lining in the Black Cohosh group there was little effect in the conjugated estrogens and placebo group. 

Again, this suggests a phytoestrogen effect by Black Cohosh. The authors of the study noted: "The compound has an advantage of a hormone like mode of action without developing the known side effects of a hormone therapy."

Not For Women Only

While most of our recent literature on Black Cohosh focuses on its value for women, herbalists have long been aware of its usefulness as a nervine and muscle relaxant and have used Black Cohosh to treat headache, muscle spasms, and the like.

Renowned herbalist, David Hoffman, describes other uses for Black Cohosh. "It is very active in the treatment of rheumatic pains, rheumatoid arthritis, osteoarthritis, and in muscular and neurological pain. It finds use in sciatica and neuralgia. As a relaxing nervine it may be used in many situations where such an agent in needed... It has been found beneficial in cases of tinnitus."

Source: Natural Factors

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Scientific References

1. Duker, E. M. et al. "Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats. Planta Medica. 1991. 57: 420-24.

2. Stolze, H. "The other way to treat symptoms of menopause." Gyne. 1982. 1: 14-16.

3. Warnecke, G. "Using phyto-treatment to influence menopause symptoms." Med. Welt. 1985. 36: 87 1-4.

4. Stoll, W. "Phytotherapy influences atrophic vaginal epithelium." Theripeuticon. 1987. 1: 23-31.

5. Harnischfeger, G. Stolze, H. "Black Cohosh." Notabene Medici. 1980. 10:446-50.

6. Hoffman, David, The Complete Illustrated Holistic Herbal: A Safe and Practical Guide to Making and Using Herbal Remedies. 1996. Element Books.