Black Cohosh
Specifically for Menopause
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Why it works for Menopause:
Evidence is mixed. Large evidence summaries conclude results are inconsistent, with several well-designed RCTs showing no benefit over placebo for hot flashes/night sweats, while some trials of specific extracts report improvements. The NIH Office of Dietary Supplements (ODS) and NCCIH both characterize the evidence as insufficient or inconsistent overall. Office of Dietary Supplements
Proposed mechanisms (not proven): Unlike estrogen therapy, black cohosh does not have a clear estrogenic mechanism; leading references note the active compounds and mechanism are unknown. Hypotheses include serotonergic modulation of thermoregulation and anti-inflammatory/antioxidant actions. Office of Dietary Supplements
How to use for Menopause:
Common studied regimens: Many clinical studies used standardized extracts in the range of 20–40 mg of dried extract once or twice daily (median 40 mg/day across trials; some trials used up to 160 mg/day depending on extract). One widely studied preparation (isopropanolic extract, often marketed as Remifemin) has been dosed at 1 tablet twice daily in trials. Office of Dietary Supplements
Duration: Most safety data come from short-term use (≤6–12 months); long-term safety beyond a year is not established. Reassess benefit after 8–12 weeks; discontinue if ineffective. NCCIH
Quality matters: Choose products with clear standardization (e.g., triterpene glycosides amount) and reputable manufacturing; mislabeling/adulteration is documented in the market and may relate to safety issues. NCCIH
Scientific Evidence for Menopause:
Cochrane Review (2012): 16 RCTs (n=2,027). Conclusion: “Insufficient evidence to support or oppose” black cohosh for menopausal symptoms due to heterogeneity and inconsistent findings. Cochrane
Two notable RCTs summarized by NIH ODS:
- 2006 multi-arm RCT (n=351): 160 mg/day ethanolic extract vs multibotanical, HT, placebo—no difference vs placebo for vasomotor symptoms at 3–12 months. Office of Dietary Supplements
- 2009 RCT (n=88): 128 mg/day ethanolic extract vs red clover, HT, placebo—no significant benefit vs placebo; some worse symptom intensity at certain time points. Office of Dietary Supplements
More recent summaries: NCCIH’s 2024 update notes a 2023 review of 22 studies (products alone or in combos) suggesting potential overall benefit, but symptom-specific effects remain inconsistent (hot flashes may improve; anxiety/depression not clearly improved). NCCIH
Guidelines: ACOG (and North American Menopause Society) have stated that data do not show herbal supplements like black cohosh are efficacious for vasomotor symptoms; hormone therapy remains the most effective treatment. (Summary referenced within ODS). Office of Dietary Supplements
Specific Warnings for Menopause:
Liver injury (rare but serious): Multiple regulators have issued cautions due to case reports of hepatitis and liver failure.
- Australia (TGA) requires a label: “Warning: Black cohosh may harm the liver in some individuals. Use under the supervision of a healthcare professional.” (since 2007). Office of Dietary Supplements
- UK MHRA advisory found the evidence supports an association with hepatotoxicity and recommended class-wide liver warnings. (PDF) GOV.UK Assets
- ODS counts >80 worldwide reports of liver damage linked in time to black cohosh use (causality uncertain; adulteration/mislabelling possible). If you develop dark urine, fatigue, jaundice, abdominal pain—stop and seek care immediately. Office of Dietary Supplements
Pregnancy & breastfeeding: Avoid. Safety is not established; there are concerns about possible uterine effects and uncertain transfer in milk. Major references (NCCIH; LactMed via NCCIH) advise against use. NCCIH
Hormone-sensitive conditions (e.g., breast/uterine cancer): Safety is uncertain. NCCIH notes uncertainty; discuss with your oncology/gynecology team before use. (See NCI PDQ for breast-cancer contexts.) Cancer.gov
Drug interactions: Formal interaction data are limited, but because of liver risk, be cautious with other hepatotoxic drugs and always disclose supplement use to your clinician. Quality/adulteration issues raise additional uncertainty. Office of Dietary Supplements
General supplement cautions: Supplements aren’t drug-approved; potency/purity vary. Prefer third-party tested products and avoid multi-herb blends that obscure dosing. NCCIH
General Information (All Ailments)
What It Is
Black Cohosh (Actaea racemosa, formerly Cimicifuga racemosa) is a perennial herb native to North America. It has been traditionally used by Native American tribes for centuries as a natural remedy for women’s health issues, particularly those related to menopause and menstruation. The root and rhizome (underground stem) of the plant are used medicinally, typically in the form of capsules, tinctures, or teas.
How It Works
The exact mechanism of action isn’t fully understood, but several theories explain how Black Cohosh affects the body:
- Phytoestrogenic Activity (Weak Estrogen-Like Effect): Black Cohosh is thought to contain compounds that mimic estrogen in the body. This can help balance hormone fluctuations during menopause, potentially reducing symptoms like hot flashes, night sweats, and mood swings.
- Serotonergic Modulation: Some studies suggest it influences serotonin receptors in the brain, which may help regulate body temperature and mood, offering another explanation for its relief of menopausal symptoms.
- Anti-inflammatory and Antioxidant Properties: It contains triterpene glycosides and other compounds that have anti-inflammatory and antioxidant effects, which may contribute to pain relief (e.g., menstrual cramps, arthritis).
- Central Nervous System Effects: Certain constituents may interact with neurotransmitters, explaining its potential benefits for sleep disturbances and anxiety during menopause.
Why It’s Important
Black Cohosh is valued for its non-hormonal alternative to conventional hormone replacement therapy (HRT). Its importance lies in:
Managing Menopausal Symptoms Naturally
- Used widely to ease vasomotor symptoms like hot flashes, night sweats, and irritability.
Alternative for Women Who Can’t Take Estrogen
- Beneficial for those who cannot undergo HRT due to medical reasons (e.g., breast cancer survivors).
Potential Bone and Heart Health Support
- Some studies suggest modest benefits in supporting bone density and cardiovascular health, though evidence remains mixed.
Traditional and Holistic Appeal
- It fits within integrative medicine approaches, offering a plant-based option for women seeking natural remedies.
Considerations
While Black Cohosh is generally considered safe for short-term use (up to 6 months), several factors should be considered:
Potential Side Effects
- Stomach upset
- Headache
- Dizziness
- Rash
- Rarely, liver toxicity (though causality is debated)
Liver Health
- There have been isolated reports of liver damage linked to Black Cohosh. Anyone with liver disease or symptoms such as jaundice (yellowing of skin/eyes) should avoid it or use with medical supervision.
Pregnancy and Breastfeeding
- Not recommended due to unknown safety during pregnancy and lactation.
Drug Interactions
- May interact with hormone therapies, birth control pills, or hepatotoxic drugs.
- Caution with medications affecting the liver.
Quality and Standardization
- Herbal supplements can vary in potency and purity. Always choose reputable brands standardized to known active components.
Long-Term Use
- Evidence on long-term safety is limited; monitor use and reassess periodically with a healthcare provider.
Helps with these conditions
Black Cohosh is most effective for general wellness support with emerging research . The effectiveness varies by condition based on clinical evidence and user experiences.
Detailed Information by Condition
Menopause
Evidence is mixed. Large evidence summaries conclude results are inconsistent, with several well-designed RCTs showing no benefit over placebo for hot...
Osteoporosis
Possible SERM-like/central actions (not proven): Black cohosh’s active constituents and exact mechanism remain unclear; it does not reliably act like...
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Remedy Statistics
Helps With These Conditions
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