What are the potential interactions of black cohosh with other medications. How does black cohosh affect menopausal symptoms. What precautions should be taken when using black cohosh. What is the recommended dosage for black cohosh supplements.

Understanding Black Cohosh: An Overview of Its Uses and Benefits

Black cohosh (Cimicifuga racemosa) is a popular herbal supplement that has been used for centuries in traditional medicine. Native to North America, this perennial plant has gained significant attention in recent years for its potential health benefits, particularly in managing menopausal symptoms.

But what exactly is black cohosh, and how does it work? Black cohosh is a member of the buttercup family and contains various compounds, including triterpene glycosides, which are believed to be responsible for its therapeutic effects. While its exact mechanism of action is not fully understood, research suggests that it may have estrogen-like properties or interact with certain neurotransmitters in the brain.

Common Uses of Black Cohosh

• Alleviating menopausal symptoms, such as hot flashes and night sweats
• Reducing menstrual cramps and premenstrual syndrome (PMS) symptoms
• Supporting bone health in postmenopausal women
• Potentially aiding in the management of anxiety and mood swings

Is black cohosh effective for all these purposes? While some studies have shown promising results, particularly for menopausal symptom relief, more research is needed to fully establish its efficacy for other uses. It’s important to consult with a healthcare professional before using black cohosh for any specific condition.

The Science Behind Black Cohosh: Examining Clinical Evidence

Several systematic reviews and clinical trials have investigated the efficacy of black cohosh in managing menopausal symptoms. A review by Borrelli and Ernst (2008) analyzed multiple studies and found that black cohosh may be effective in reducing the frequency and severity of hot flashes in menopausal women. However, the authors noted that the quality of evidence varied among studies.

Another systematic review by Cheema et al. (2007) focused on non-hormonal therapies for postmenopausal vasomotor symptoms. The researchers concluded that while some studies showed positive results for black cohosh, the overall evidence was inconclusive due to methodological limitations in many trials.

Do these findings mean that black cohosh is ineffective? Not necessarily. The mixed results highlight the need for further high-quality research to better understand the herb’s potential benefits and limitations. It’s also worth noting that individual responses to herbal supplements can vary significantly.

Potential Mechanisms of Action

Scientists have proposed several theories to explain how black cohosh might work in the body:

1. Estrogen-like effects: Some researchers suggest that compounds in black cohosh may mimic estrogen’s actions in certain tissues.
2. Neurotransmitter modulation: Black cohosh may affect serotonin and other neurotransmitters involved in regulating body temperature and mood.
3. Anti-inflammatory properties: Certain compounds in the herb have demonstrated anti-inflammatory effects in laboratory studies.
4. Antioxidant activity: Black cohosh contains substances that may help protect cells from oxidative stress.

Understanding these potential mechanisms can help researchers design more targeted studies and possibly develop more effective formulations in the future.

Side Effects and Safety Concerns: What You Need to Know

While black cohosh is generally considered safe for short-term use, it’s crucial to be aware of potential side effects and safety concerns. A systematic review by Borrelli and Ernst (2008) examined adverse events associated with black cohosh use.

What are the most common side effects of black cohosh? The review found that gastrointestinal issues, such as nausea and vomiting, were the most frequently reported side effects. Other potential adverse reactions include:

• Headaches
• Dizziness
• Rash or skin reactions
• Muscle pain
• Weight gain

In rare cases, more serious side effects have been reported, including liver toxicity. However, the causal relationship between black cohosh and liver damage remains controversial and requires further investigation.

Special Precautions and Warnings

Certain individuals should exercise caution or avoid using black cohosh altogether:

• Pregnant or breastfeeding women: Due to a lack of safety data, it’s best to avoid black cohosh during pregnancy and lactation.
• People with liver disorders: Given the potential risk of liver toxicity, those with pre-existing liver conditions should consult their healthcare provider before using black cohosh.
• Individuals with hormone-sensitive conditions: Since black cohosh may have estrogen-like effects, people with conditions such as breast cancer, uterine cancer, or endometriosis should use caution.
• Those taking blood thinners: Black cohosh may interact with anticoagulant medications, potentially increasing the risk of bleeding.

Are there any long-term safety concerns with black cohosh use? Most studies have focused on short-term use (up to six months), and the long-term safety profile of black cohosh is not well-established. It’s advisable to consult with a healthcare professional before using black cohosh for extended periods.

Interactions with Medications: Navigating Potential Risks

Understanding potential interactions between black cohosh and other medications is crucial for safe use. Booth et al. (2004) highlighted the importance of being aware of possible interactions, particularly with anticoagulant medications.

Which medications may interact with black cohosh? While research is ongoing, some potential interactions include:

• Blood thinners (e.g., warfarin): Black cohosh may increase the risk of bleeding when combined with anticoagulant drugs.
• Hormone replacement therapy (HRT): The herb’s potential estrogen-like effects may interfere with or enhance the effects of HRT.
• Liver-metabolized medications: Since black cohosh is processed by the liver, it may affect the metabolism of other drugs that use similar pathways.
• Chemotherapy drugs: Some studies suggest that black cohosh may interact with certain cancer treatments, potentially enhancing or inhibiting their effects.

How can you minimize the risk of drug interactions? Always inform your healthcare provider about all medications, supplements, and herbal products you’re taking. They can help assess potential risks and adjust your treatment plan if necessary.

Case Study: Black Cohosh and Chemotherapy

Einbond et al. (2006) conducted an interesting study examining the potential interaction between black cohosh and chemotherapy agents. The researchers found that certain compounds in black cohosh, particularly actein, enhanced the antiproliferative effects of some chemotherapy drugs on human breast cancer cells in laboratory tests.

While these findings are intriguing, it’s important to note that cell culture studies don’t always translate directly to clinical outcomes. More research is needed to understand the implications of these interactions in real-world scenarios. Patients undergoing cancer treatment should always consult their oncologist before using any herbal supplements, including black cohosh.

Dosage and Administration: Finding the Right Balance

Determining the appropriate dosage of black cohosh can be challenging due to variations in product formulations and the lack of standardized guidelines. However, several clinical trials have provided insights into potentially effective doses.

What is the typical recommended dosage for black cohosh? While there’s no universally agreed-upon dose, many studies have used the following range:

• 40-80 mg of dried root extract per day, standardized to contain 1-2.5% triterpene glycosides
• Divided into 1-2 doses, taken for up to 6 months

It’s important to note that these dosages are based on specific formulations used in clinical trials and may not apply to all black cohosh products. Always follow the instructions on the product label or consult with a healthcare professional for personalized dosing recommendations.

Factors Affecting Dosage

Several factors can influence the appropriate dosage of black cohosh:

1. Individual response: Some people may experience benefits at lower doses, while others may require higher amounts.
2. Severity of symptoms: More severe menopausal symptoms may necessitate higher doses or longer duration of use.
3. Product quality and standardization: The concentration of active compounds can vary among different black cohosh products.
4. Overall health status: Pre-existing health conditions or medications may affect the optimal dosage.

How long should you take black cohosh? Most studies have investigated short-term use, typically up to 6 months. Long-term safety and efficacy data are limited, so it’s advisable to reassess the need for continued use with your healthcare provider periodically.

Quality Control and Product Selection: Ensuring Safety and Efficacy

Choosing a high-quality black cohosh supplement is crucial for both safety and efficacy. The herbal supplement market is largely unregulated, which can lead to variations in product quality and purity.

How can you ensure you’re getting a reliable black cohosh product? Consider the following factors:

• Third-party testing: Look for products that have been independently tested for quality and purity.
• Standardization: Choose supplements standardized to contain a specific percentage of triterpene glycosides, the presumed active compounds.
• Reputable manufacturers: Opt for products from well-established companies with a history of quality production.
• Clear labeling: The product should clearly state the amount of black cohosh extract per serving and any additional ingredients.
• USP verification: The United States Pharmacopeia (USP) Verified mark indicates that a product has met strict quality standards.

Are there any specific brands or formulations that are recommended? While it’s not appropriate to endorse specific brands, look for products that meet the above criteria and have positive reviews from reputable sources.

The Importance of Proper Identification

One critical issue in black cohosh supplementation is the potential for product adulteration or misidentification. Some products labeled as black cohosh have been found to contain other plant species, which may not have the same effects and could potentially be harmful.

A study by Jiang et al. (2006) used DNA barcoding techniques to analyze commercial black cohosh products and found that a significant percentage contained plant species other than Cimicifuga racemosa. This highlights the importance of choosing products from reputable sources and, when possible, those that have undergone botanical authentication.

Integrating Black Cohosh into a Holistic Health Approach

While black cohosh may offer potential benefits for certain health concerns, it’s important to view it as part of a broader approach to health and wellness. Integrating black cohosh into a holistic health plan can potentially enhance its effectiveness and promote overall well-being.

What other strategies can complement black cohosh use for managing menopausal symptoms? Consider the following approaches:

• Lifestyle modifications: Regular exercise, stress reduction techniques, and maintaining a healthy weight can help alleviate menopausal symptoms.
• Dietary changes: Incorporating foods rich in phytoestrogens, such as soy products and flaxseeds, may provide additional support.
• Other complementary therapies: Acupuncture, yoga, and mindfulness practices have shown promise in managing menopausal symptoms.
• Adequate sleep hygiene: Establishing good sleep habits can help mitigate night sweats and improve overall quality of life.
• Staying hydrated: Proper hydration can help regulate body temperature and potentially reduce the frequency of hot flashes.

How can you develop a personalized approach to managing menopausal symptoms? Work closely with your healthcare provider to create a comprehensive plan that addresses your specific needs and takes into account your medical history, lifestyle, and preferences.

The Role of Ongoing Research

As interest in black cohosh continues to grow, researchers are exploring new potential applications and seeking to better understand its mechanisms of action. Some areas of ongoing research include:

1. Long-term safety studies: Investigating the effects of prolonged black cohosh use on various organ systems.
2. Combination therapies: Exploring the potential synergistic effects of black cohosh with other herbs or conventional treatments.
3. Molecular studies: Delving deeper into the specific compounds responsible for black cohosh’s effects and their interactions with cellular pathways.
4. Personalized medicine approaches: Investigating genetic factors that may influence individual responses to black cohosh.

These ongoing studies may provide valuable insights that could shape future recommendations for black cohosh use and potentially expand its therapeutic applications.

In conclusion, black cohosh remains a subject of scientific interest and debate. While it shows promise for managing certain menopausal symptoms, its use should be approached thoughtfully and in consultation with healthcare professionals. By staying informed about the latest research, being aware of potential risks and interactions, and integrating black cohosh into a holistic health approach, individuals can make more informed decisions about its use as part of their wellness journey.

Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews

Antoine, C., Liebens, F., Carly, B., Pastijn, A., and Rozenberg, S. Safety of alternative treatments for menopausal symptoms after breast cancer: a qualitative systematic review. Climacteric. 2007;10(1):23-26. View abstract.

Boblitz N, Schrader E, Henneicke-von Zepelin HH, and et al. Benefit of a fixed drug combination containing St. John’s wort and black cohosh for climacteric patients — results of a randomised clinical trial (poster presentaion from 6th Annual Symposium on Complementary Health Care, Exeter, England, December 2-4, 1999). Focus Alt Comp Ther (FACT) 2000;5(1):85-86.

Booth, N. L., Nikolic, D., van Breemen, R. B., Geller, S. E., Banuvar, S., Shulman, L. P., and Farnsworth, N. R. Confusion regarding anticoagulant coumarins in dietary supplements. Clin Pharmacol.Ther 2004;76(6):511-516. View abstract.

Borrelli F, Mascolo N, Russo A, and et al. Cimicifuga racemosa: a systematic review of its clinical and pharmacological effects. 8th Annual Symposium on Complementary Health Care, 6th-8th December 2001 2001;

Borrelli, F. and Ernst, E. Black cohosh (Cimicifuga racemosa) for menopausal symptoms: a systematic review of its efficacy. Pharmacol.Res 2008;58(1):8-14. View abstract.

Borrelli, F. and Ernst, E. Black cohosh (Cimicifuga racemosa): a systematic review of adverse events. Am J Obstet.Gynecol. 2008;199(5):455-466. View abstract.

Borrelli, F. and Ernst, E. Cimicifuga racemosa: a systematic review of its clinical efficacy. Eur J Clin Pharmacol 2002;58(4):235-241. View abstract.

Bruno, D. and Feeney, K. J. Management of postmenopausal symptoms in breast cancer survivors. Semin.Oncol. 2006;33(6):696-707. View abstract.

Buettner, C., Mukamal, K. J., Gardiner, P., Davis, R. B., Phillips, R. S., and Mittleman, M. A. Herbal supplement use and blood lead levels of United States adults. J.Gen.Intern.Med. 2009;24(11):1175-1182. View abstract.

Burdette, J. E., Chen, S. N., Lu, Z. Z., Xu, H., White, B. E., Fabricant, D. S., Liu, J., Fong, H. H., Farnsworth, N. R., Constantinou, A. I., van Breemen, R. B., Pezzuto, J. M., and Bolton, J. L. Black cohosh (Cimicifuga racemosa L.) protects against menadione-induced DNA damage through scavenging of reactive oxygen species: bioassay-directed isolation and characterization of active principles. J Agric.Food Chem 11-20-2002;50(24):7022-7028. View abstract.

Carroll, D. G. Nonhormonal therapies for hot flashes in menopause. Am Fam.Physician 2-1-2006;73(3):457-464. View abstract.

Centre for Reviews and Dissemination. Complementary and alternative therapies for the management of menopause-related symptoms: a systematic evidence review (;Structured abstract). Database of Abstracts of Reviews of Effects, 2012;(3)

Cheema, D., Coomarasamy, A., and El Toukhy, T. Non-hormonal therapy of post-menopausal vasomotor symptoms: a structured evidence-based review. Arch Gynecol.Obstet 2007;276(5):463-469. View abstract.

Cimicifuga racemosa – Monograph. Altern.Med Rev 2003;8(2):186-189. View abstract.

Daiber W. Menopause symptoms: success without hormones. Arztl Praxis 1983;35:1946-1947.

Einbond, L. S., Shimizu, M., Ma, H., Wu, H. A., Goldsberry, S., Sicular, S., Panjikaran, M., Genovese, G., and Cruz, E. Actein inhibits the Na+-K+-ATPase and enhances the growth inhibitory effect of digitoxin on human breast cancer cells. Biochem.Biophys.Res Commun. 10-31-2008;375(4):608-613. View abstract.

Einbond, L. S., Shimizu, M., Nuntanakorn, P., Seter, C., Cheng, R., Jiang, B., Kronenberg, F., Kennelly, E. J., and Weinstein, I. B. Actein and a fraction of black cohosh potentiate antiproliferative effects of chemotherapy agents on human breast cancer cells. Planta Med 2006;72(13):1200-1206. View abstract.

Einbond, L. S., Soffritti, M., Esposti, D. D., Park, T., Cruz, E., Su, T., Wu, H. A., Wang, X., Zhang, Y. J., Ham, J., Goldberg, I. J., Kronenberg, F., and Vladimirova, A. Actein activates stress- and statin-associated responses and is bioavailable in Sprague-Dawley rats. Fundam.Clin Pharmacol. 2009;23(3):311-321. View abstract.

Einbond, L. S., Su, T., Wu, H. A., Friedman, R., Wang, X., Jiang, B., Hagan, T., Kennelly, E. J., Kronenberg, F., and Weinstein, I. B. Gene expression analysis of the mechanisms whereby black cohosh inhibits human breast cancer cell growth. Anticancer Res 2007;27(2):697-712. View abstract.

Einbond, L. S., Su, T., Wu, H. A., Friedman, R., Wang, X., Ramirez, A., Kronenberg, F., and Weinstein, I. B. The growth inhibitory effect of actein on human breast cancer cells is associated with activation of stress response pathways. Int J Cancer 11-1-2007;121(9):2073-2083. View abstract.

Ernst, E. and Chrubasik, S. Phyto-anti-inflammatories. A systematic review of randomized, placebo-controlled, double-blind trials. Rheum.Dis Clin North Am 2000;26(1):13-27, vii. View abstract.

Fugh-Berman, A. and Ernst, E. Herb-drug interactions: review and assessment of report reliability. Br J Clin Pharmacol 2001;52(5):587-595. View abstract.

Garita-Hernandez, M., Calzado, M. A., Caballero, F. J., Macho, A., Munoz, E., Meier, B., Brattstrom, A., Fiebich, B. L., and Appel, K. The growth inhibitory activity of the Cimicifuga racemosa extract Ze 450 is mediated through estrogen and progesterone receptors-independent pathways. Planta Med 2006;72(4):317-323. View abstract.

Geller, S. E. and Studee, L. Contemporary alternatives to plant estrogens for menopause. Maturitas 11-1-2006;55 Suppl 1:S3-13. View abstract.

Genazzani E and Sorrentino L. Vascular action of acteina: active constituent of Actaea racemosa L. Nature 1962;194(4828):544-545.

Gingrich, P. M. and Fogel, C. I. Herbal therapy use by perimenopausal women. J Obstet.Gynecol.Neonatal Nurs. 2003;32(2):181-189. View abstract.

Guttuso, T., Jr. Effective and clinically meaningful non-hormonal hot flash therapies. Maturitas 2012;72(1):6-12. View abstract.

Hanna K, Day A O’Neill S Patterson C Lyons-Wall P. Does scientific evidence support the use of non-prescription supplements for treatment of acute menopausal symptoms such as hot flushes? Nutrition & Dietetics 2005;62(4):138-151.

He, K., Zheng, B., Kim, C. H., Rogers, L., and Zheng, Q. Direct analysis and identification of triterpene glycosides by LC/MS in black cohosh, Cimicifuga racemosa, and in several commercially available black cohosh products. Planta Med 2000;66(7):635-640. View abstract.

Hirschberg, A. L., Edlund, M., Svane, G., Azavedo, E., Skoog, L., and von, Schoultz B. An isopropanolic extract of black cohosh does not increase mammographic breast density or breast cell proliferation in postmenopausal women. Menopause. 2007;14(1):89-96. View abstract.

Hostanska, K., Nisslein, T., Freudenstein, J., Reichling, J., and Saller, R. Apoptosis of human prostate androgen-dependent and -independent carcinoma cells induced by an isopropanolic extract of black cohosh involves degradation of cytokeratin (CK) 18. Anticancer Res 2005;25(1A):139-147. View abstract.

Hostanska, K., Nisslein, T., Freudenstein, J., Reichling, J., and Saller, R. Inhibitory effect of an isopropanolic extract of black cohosh on the invasiveness of MDA-mB 231 human breast cancer cells. In Vivo 2007;21(2):349-355. View abstract.

Huntley, A. L. and Ernst, E. A systematic review of herbal medicinal products for the treatment of menopausal symptoms. Menopause. 2003;10(5):465-476. View abstract.

Johnson, B. M. and van Breemen, R. B. In vitro formation of quinoid metabolites of the dietary supplement Cimicifuga racemosa (black cohosh). Chem.Res Toxicol. 2003;16(7):838-846. View abstract.

Julia Molla, M. D., Garcia-Sanchez, Y., Romeu, Sarri A., and Perez-lopez, F. R. Cimicifuga racemosa treatment and health related quality of life in post-menopausal Spanish women. Gynecol.Endocrinol. 2009;25(1):21-26. View abstract.

Kanadys, W. M., Leszczynska-Gorzelak, B., and Oleszczuk, J. [Efficacy and safety of Black cohosh (Actaea/Cimicifuga racemosa) in the treatment of vasomotor symptoms–review of clinical trials]. Ginekol.Pol. 2008;79(4):287-296. View abstract.

Kang, H. J., Ansbacher, R., and Hammoud, M. M. Use of alternative and complementary medicine in menopause. Int.J Gynaecol.Obstet. 2002;79(3):195-207. View abstract.

Kelley, K. W. and Carroll, D. G. Evaluating the evidence for over-the-counter alternatives for relief of hot flashes in menopausal women. J.Am.Pharm.Assoc.(2003.) 2010;50(5):e106-e115. View abstract.

Kim, C. D., Lee, W. K., Lee, M. H., Cho, H. S., Lee, Y. K., and Roh, S. S. Inhibition of mast cell-dependent allergy reaction by extract of black cohosh (Cimicifuga racemosa). Immunopharmacol Immunotoxicol. 2004;26(2):299-308. View abstract.

Kupferer, E. M., Dormire, S. L., and Becker, H. Complementary and alternative medicine use for vasomotor symptoms among women who have discontinued hormone therapy. J Obstet.Gynecol.Neonatal Nurs. 2009;38(1):50-59. View abstract.

Li, W., Sun, Y., Liang, W., Fitzloff, J. F., and van Breemen, R. B. Identification of caffeic acid derivatives in Actea racemosa (Cimicifuga racemosa, black cohosh) by liquid chromatography/tandem mass spectrometry. Rapid Commun.Mass Spectrom. 2003;17(9):978-982. View abstract.

Liske E and Wüstenberg P. Therapy of climacteric complaints with Cimicifuga racemosa: herbal medicine with clinically proven evidence [poster presentation]. Menopause 1998;5(4):250.

Liske E, Wüstenberg P, and Boblitz N. Human-pharmacological investigations during treatment of climacteric complaints with Cimicifuga racemosa (Remifemin): No estrogen-like effects. ESCOP 2001;1:1.

Long, L., Soeken, K., and Ernst, E. Herbal medicines for the treatment of osteoarthritis: a systematic review. Rheumatology.(Oxford) 2001;40(7):779-793. View abstract.

Loprinzi, C. L., Barton, D. L., Sloan, J. A., Novotny, P. J., Dakhil, S. R., Verdirame, J. D., Knutson, W. H., Kelaghan, J., and Christensen, B. Mayo Clinic and North Central Cancer Treatment Group hot flash studies: a 20-year experience. Menopause. 2008;15(4 Pt 1):655-660. View abstract.

Low, Dog T. Menopause: a review of botanical dietary supplements. Am J Med 12-19-2005;118 Suppl 12B:98-108. View abstract.

Lundstrom, E., Christow, A., Kersemaekers, W., Svane, G., Azavedo, E., Soderqvist, G., Mol-Arts, M., Barkfeldt, J., and von, Schoultz B. Effects of tibolone and continuous combined hormone replacement therapy on mammographic breast density. Am J Obstet.Gynecol. 2002;186(4):717-722. View abstract.

Lundstrom, E., Hirschberg, A. L., and Soderqvist, G. Digitized assessment of mammographic breast density–effects of continuous combined hormone therapy, tibolone and black cohosh compared to placebo. Maturitas 2011;70(4):361-364. View abstract.

Maclennan, A. H. Evidence-based review of therapies at the menopause. Int.J Evid.Based.Healthc. 2009;7(2):112-123. View abstract.

Mahady, G., Low, Dog T., Sarma, D. N., and Giancaspro, G. I. Suspected black cohosh hepatotoxicity–causality assessment versus safety signal. Maturitas 10-20-2009;64(2):139-140. View abstract.

Mazaro-Costa, R., Andersen, M. L., Hachul, H., and Tufik, S. Medicinal plants as alternative treatments for female sexual dysfunction: utopian vision or possible treatment in climacteric women? J.Sex Med. 2010;7(11):3695-3714. View abstract.

McBane, S. E. Easing vasomotor symptoms: Besides HRT, what works? JAAPA. 2008;21(4):26-31. View abstract.

McKenna, D. J., Jones, K., Humphrey, S., and Hughes, K. Black cohosh: efficacy, safety, and use in clinical and preclinical applications. Altern Ther Health Med 2001;7(3):93-100. View abstract.

McKenzie, S. C. and Rahman, A. Bradycardia in a patient taking black cohosh. Med J Aust. 10-18-2010;193(8):479-481. View abstract.

Naser, B. and Liske, E. Liver failure associated with the use of black cohosh for menopausal symptoms. Med J Aust. 1-19-2009;190(2):99. View abstract.

Nash LI, Desindes S. Canadian consensus conference on menopause 2006 update. J Obstet Gynaecol Can 2006;28:S69-74.

Nedrow, A., Miller, J., Walker, M., Nygren, P., Huffman, L. H., and Nelson, H. D. Complementary and alternative therapies for the management of menopause-related symptoms: a systematic evidence review. Arch Intern.Med 7-24-2006;166(14):1453-1465. View abstract.

Nesselhut T, Schellhase C, Dietrich R, and et al. [Investigations into the growth-inhibitive efficacy of phytopharmacopia with estrogen-like influences on mammary gland carcinoma cells] (translated from German). Arch Gynecol Obstet 1993;254:817-818.

Newton, K. M., Reed, S. D., LaCroix, A. Z., Grothaus, L. C., Ehrlich, K., and Guiltinan, J. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial. Ann Intern Med 12-19-2006;145(12):869-879. View abstract.

Ng, S. S. and Figg, W. D. Antitumor activity of herbal supplements in human prostate cancer xenografts implanted in immunodeficient mice. Anticancer Res 2003;23(5A):3585-3590. View abstract.

Nisslein, T. and Freudenstein, J. Effects of an isopropanolic extract of Cimicifuga racemosa on urinary crosslinks and other parameters of bone quality in an ovariectomized rat model of osteoporosis. J Bone Miner.Metab 2003;21(6):370-376. View abstract.

Noguchi, M., Nagai, M., Koeda, M., Nakayama, S., Sakurai, N., Takahira, M., and Kusano, G. Vasoactive effects of cimicifugic acids C and D, and fukinolic acid in cimicifuga rhizome. Biol Pharm Bull 1998;21(11):1163-1168. View abstract.

Nuntanakorn, P., Jiang, B., Einbond, L. S., Yang, H., Kronenberg, F., Weinstein, I. B., and Kennelly, E. J. Polyphenolic constituents of Actaea racemosa. J Nat Prod 2006;69(3):314-318. View abstract.

Nuntanakorn, P., Jiang, B., Yang, H., Cervantes-Cervantes, M., Kronenberg, F., and Kennelly, E. J. Analysis of polyphenolic compounds and radical scavenging activity of four American Actaea species. Phytochem.Anal. 2007;18(3):219-228. View abstract.

Onorato, J. and Henion, J. D. Evaluation of triterpene glycoside estrogenic activity using LC/MS and immunoaffinity extraction. Anal.Chem 10-1-2001;73(19):4704-4710. View abstract.

Palacio, C., Masri, G., and Mooradian, A. D. Black cohosh for the management of menopausal symptoms : a systematic review of clinical trials. Drugs Aging 2009;26(1):23-36. View abstract.

Petho A. Climacteric complaints are often helped with black cohosh. Ärztliche Praxis 1987;47:1551-1553.

Pierard, S., Coche, J. C., Lanthier, P., Dekoninck, X., Lanthier, N., Rahier, J., and Geubel, A. P. Severe hepatitis associated with the use of black cohosh: a report of two cases and an advice for caution. Eur J Gastroenterol Hepatol. 2009;21(8):941-945. View abstract.

Pinkerton, J. V., Stovall, D. W., and Kightlinger, R. S. Advances in the treatment of menopausal symptoms. Womens Health (Lond Engl.) 2009;5(4):361-384. View abstract.

Rhyu, M. R., Lu, J., Webster, D. E., Fabricant, D. S., Farnsworth, N. R., and Wang, Z. J. Black cohosh (Actaea racemosa, Cimicifuga racemosa) behaves as a mixed competitive ligand and partial agonist at the human mu opiate receptor. J Agric.Food Chem 12-27-2006;54(26):9852-9857. View abstract.

Richardson, M. K. Black cohosh…a cautionary tale! Menopause. 2008;15(4 Pt 1):583. View abstract.

Roberts, H. Safety of herbal medicinal products in women with breast cancer. Maturitas 2010;66(4):363-369. View abstract.

Rock, E. and DeMichele, A. Nutritional approaches to late toxicities of adjuvant chemotherapy in breast cancer survivors. J Nutr 2003;133(11 Suppl 1):3785S-3793S. View abstract.

Ross, S. M. Menopause: a standardized isopropanolic black cohosh extract (remifemin) is found to be safe and effective for menopausal symptoms. Holist.Nurs.Pract. 2012;26(1):58-61. View abstract.

Rostock, M., Fischer, J., Mumm, A., Stammwitz, U., Saller, R., and Bartsch, H. H. Black cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints – a prospective observational study. Gynecol.Endocrinol. 2011;27(10):844-848. View abstract.

Sammartino, A., Tommaselli, G. A., Gargano, V., di, Carlo C., Attianese, W., and Nappi, C. Short-term effects of a combination of isoflavones, lignans and Cimicifuga racemosa on climacteric-related symptoms in postmenopausal women: a double-blind, randomized, placebo-controlled trial. Gynecol.Endocrinol. 2006;22(11):646-650. View abstract.

Schmid, D., Woehs, F., Svoboda, M., Thalhammer, T., Chiba, P., and Moeslinger, T. Aqueous extracts of Cimicifuga racemosa and phenolcarboxylic constituents inhibit production of proinflammatory cytokines in LPS-stimulated human whole blood. Can J Physiol Pharmacol. 2009;87(11):963-972. View abstract.

Sevior, D. K., Hokkanen, J., Tolonen, A., Abass, K., Tursas, L., Pelkonen, O., and Ahokas, J. T. Rapid screening of commercially available herbal products for the inhibition of major human hepatic cytochrome P450 enzymes using the N-in-one cocktail. Xenobiotica 2010;40(4):245-254. View abstract.

Shao, Y., Harris, A., Wang, M., Zhang, H., Cordell, G. A., Bowman, M., and Lemmo, E. Triterpene glycosides from Cimicifuga racemosa. J Nat Prod 2000;63(7):905-910. View abstract.

Shord, S. S., Shah, K., and Lukose, A. Drug-botanical interactions: a review of the laboratory, animal, and human data for 8 common botanicals. Integr Cancer Ther 2009;8(3):208-227. View abstract.

Shulman, L. P., Banuvar, S., Fong, H. H., and Farnsworth, N. R. Discussion of a well-designed clinical trial which did not demonstrate effectiveness: UIC center for botanical dietary supplements research study of black cohosh and red clover. Fitoterapia 2011;82(1):88-91. View abstract.

Stolze H. [An alternative to treat menopausal complaints]. Gynecologie 1982;1:14-16.

Struck D, Tegtmeier M, and Harnischfeger G. Flavones in extracts of

Umland, E. M. Treatment strategies for reducing the burden of menopause-associated vasomotor symptoms. J.Manag.Care Pharm. 2008;14(3 Suppl):14-19. View abstract.

van Breemen, R. B., Liang, W., Banuvar, S., Shulman, L. P., Pang, Y., Tao, Y., Nikolic, D., Krock, K. M., Fabricant, D. S., Chen, S. N., Hedayat, S., Bolton, J. L., Pauli, G. F., Piersen, C. E., Krause, E. C., Geller, S. E., and Farnsworth, N. R. Pharmacokinetics of 23-epi-26-deoxyactein in women after oral administration of a standardized extract of black cohosh. Clin Pharmacol.Ther 2010;87(2):219-225. View abstract.

van de Meerendonk, H. W., van Hunsel, F. P., and van der Wiel, H. E. [Autoimmune hepatitis induced by Actaea racemosa. Side affects of an herb extract]. Ned.Tijdschr.Geneeskd. 2-7-2009;153(6):246-249. View abstract.

Vannacci, A., Lapi, F., Gallo, E., Vietri, M., Toti, M., Menniti-Ippolito, F., Raschetti, R., Firenzuoli, F., and Mugelli, A. A case of hepatitis associated with long-term use of Cimicifuga racemosa. Altern.Ther Health Med 2009;15(3):62-63. View abstract.

Viereck, V., Grundker, C., Friess, S. C., Frosch, K. H., Raddatz, D., Schoppet, M., Nisslein, T., Emons, G., and Hofbauer, L. C. Isopropanolic extract of black cohosh stimulates osteoprotegerin production by human osteoblasts. J Bone Miner.Res 2005;20(11):2036-2043. View abstract.

Vorberg G. Treatment of menopause symptoms. ZFA 1984;60:626-629.

Walji, R., Boon, H., Guns, E., Oneschuk, D., and Younus, J. Black cohosh (Cimicifuga racemosa [L.] Nutt.): safety and efficacy for cancer patients. Support.Care Cancer 2007;15(8):913-921. View abstract.

Warnecke G. Using phyto-treatment to influence menopause symptoms. Med Welt 1985;36:871-874.

Wong, V. C., Lim, C. E., Luo, X., and Wong, W. S. Current alternative and complementary therapies used in menopause. Gynecol.Endocrinol. 2009;25(3):166-174. View abstract.

Wuttke, W. and Seidlova-Wuttke, D. News about Black cohosh. Maturitas 2012;71(2):92-93. View abstract.

Yang, C. L., Chik, S. C., Li, J. C., Cheung, B. K., and Lau, A. S. Identification of the bioactive constituent and its mechanisms of action in mediating the anti-inflammatory effects of black cohosh and related Cimicifuga species on human primary blood macrophages. J Med Chem 11-12-2009;52(21):6707-6715. View abstract.

Zierau, O., Bodinet, C., Kolba, S., Wulf, M., and Vollmer, G. Antiestrogenic activities of Cimicifuga racemosa extracts. J Steroid Biochem.Mol.Biol 2002;80(1):125-130. View abstract.

Zimmermann, R., Witte, A., Voll, R. E., Strobel, J., and Frieser, M. Coagulation activation and fluid retention associated with the use of black cohosh: a case study. Climacteric. 2010;13(2):187-191. View abstract.

Shams T, Setia MS, Hemmings R, et al. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Altern Ther Health Med 2010;16:36-44. View abstract.

Amato P, Christophe S, Mellon PL. Estrogenic activity of herbs commonly used as remedies for menopausal symptoms. Menopause 2002;9:145-50. View abstract.

Amsterdam JD, Yao Y, Mao JJ, Soeller I, Rockwell K, Shults J. Randomized, double-blind, placebo-controlled trial of Cimicifuga racemosa (black cohosh) in women with anxiety disorder due to menopause. J Clin Psychopharmacol 2009;29:478-83. View abstract.

Assessment of case reports connected to herbal medicinal products containing cimicifugae racemosa rhizoma (black cohosh, root). Doc. Ref. EMEA/269259/2006. Available at: www.emea.eu.int/pdfs/human/hmpc/26925806en.pdf (Accessed 30 November 2007).

Australian Adverse Drug Reactions Advisory Committee. Black cohosh and liver toxicity – an update. Aust Adv Drug Reactions Bull 2007;26:11.

Bai W, Henneicke-von Zepelin HH, Wang S, et al. Efficacy and tolerability of a medicinal product containing an isopropanolic black cohosh extract in Chinese women with menopausal symptoms: A randomized, double blind, parallel-controlled study versus tibolone. Maturitas 2007;58:31-41. View abstract.

Bai WP, Wang SY, Liu JL, Geng L, Hu LN, Zhang ZL, Chen SL, Zheng SR. [Efficacy and safety of remifemin compared to tibolone for controlling of perimenopausal symptoms]. Zhonghua Fu Chan Ke Za Zhi 2009;44:597-600. View abstract.

Baillie N, Rasmussen P. Black and blue cohosh in labour. N Z Med J 1997;110:20-1.

Bebenek M, Kemmler W, von Stengel S, Engelke K, Kalender WA. Effect of exercise and Cimicifuga racemosa (CR BNO 1055) on bone mineral density, 10-year coronary heart disease risk, and menopausal complaints: the randomized controlled Training and Cimicifuga racemosa Erlangen (TRACE) study. Menopause 2010;17:791-800. View abstract.

Beck V, Unterrieder E, Krenn L, et al. Comparison of hormonal activity (estrogen, androgen and progestin) of standardized plant extracts for large scale use in hormone replacement therapy. J Steroid Biochem Mol Biol 2003;84:259-68.. View abstract.

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.. View abstract.

Bodinet C, Freudenstein J. Influence of marketed herbal menopause preparations on MCF-7 cell proliferation. Menopause 2004;11:281-9.. View abstract.

Brasky TM, Lampe JW, Potter JD, et al. Specialty supplements and breast cancer risk in the VITamins And Lifestyle (VITAL) cohort. Cancer Epidemiol Biomarkers Prev 2010;19:1696-708. View abstract.

Briese V, Stammwitz U, Friede M, Henneicke-von Zepelin HH. Black cohosh with or without St. John’s wort for symptom-specific climacteric treatment–results of a large-scale, controlled, observational study. Maturitas 2007;57:405-14. View abstract.

Burdette JE, Liu J, Chen SN, et al. Black cohosh acts as a mixed competitive ligand and partial agonist of the serotonin receptor. J Agric Food Chem 2003;51:5661-70. View abstract.

Burke BE, Olson RD, Cusack BJ. Randomized, controlled trial of phytoestrogen in the prophylactic treatment of menstrual migraine. Biomed Pharmacother 2002;56:283-8. View abstract.

Cheong JL, Bucknall R. Retinal vein thrombosis associated with a herbal phytoestrogen preparation in a susceptible patient. Postgrad Med J 2005;81:266-7.. View abstract.

Chitturi S, Farrell GC. Hepatotoxic slimming aids and other herbal hepatotoxins. J Gastroenterol Hepatol 2008;23:366-73. View abstract.

Chow ECY, Teo M, Ring JA, Chen JW. Liver failure associated with the use of black cohosh for menopausal symptoms. Med J Aust 2008;188:420-2. View abstract.

Chung DJ, Kim HY, Park KH, et al. Black cohosh and St. John’s wort (GYNO-Plus) for climacteric symptoms. Yonsei Med J 2007;48:289-94. View abstract.

Cohen B, Schardt D. Center for Science in the Public Interest. Letter to Food and Drug Administration. Commissioner Mark McClellan, MD, PhD. March 4, 2004.

Cohen SM, O’Connor AM, Hart J, et al. Autoimmune hepatitis associated with the use of black cohosh: a case study. Menopause 2004;11:575-7. View abstract.

Davis VL, Jayo MJ, Hardy ML, et al. Effects of black cohosh on mammary tumor development and progression in MMTV-neu transgenic mice. 94th Annual Meeting of the American Association for Cancer Research, Washington, DC. July 11-14, 2003;abstract R910.

Dixon-Shanies D, Shaikh N. Growth inhibition of human breast cancer cells by herbs and phytoestrogens. Oncol Rep 1999;6:1383-7.. View abstract.

Dog TL, Powell KL, Weisman SM. Critical evaluation of the safety of Cimicifuga racemosa in menopause symptom relief. Menopause 2003;10:299-313.. View abstract.

Dugoua JJ, Seely D, Perri D, et al. Safety and efficacy of black cohosh (cimicifuga racemosa) during pregnancy and lactation. Can J Clin Pharmacol 2006;13:e257-61. View abstract.

Dunbar K, Solga SF. Black cohosh, safety, and public awareness. Liver Int 2007;27:1017. View abstract.

Einbond LS, Shimizu M, Xiao D, et al. Growth inhibitory activity of extracts and purified components of black cohosh on human breast cancer cells. Breast Cancer Res Treat 2004;83:221-31. View abstract.

Einer-Jensen N, Zhao J, Andersen KP, Kristoffersen K. Cimicifuga and Melbrosia lack oestrogenic effects in mice and rats. Maturitas 1996;25:149-53. View abstract.

Enbom ET, Le MD, Oesterich L, Rutgers J, French SW. Mechanism of hepatotoxicity due to black cohosh (Cimicifuga racemosa): histological, immunohistochemical and electron microscopy analysis of two liver biopsies with clinical correlation. Exp Mol Pathol. 2014;96(3):279-83. View abstract.

Fernandes ES, Celani MFS, Fistarol M, Geber S. Effectiveness of the short-term use of Cimicifuga racemosa in the endothelial function of postmenopausal women: a double-blind, randomized, controlled trial. Climacteric. 2019. View abstract.

Franco OH, Chowdhury R, Troup J, et al. Use of Plant-Based Therapies and Menopausal Symptoms: A Systematic Review and Meta-analysis. JAMA. 2016 Jun 21;315(23):2554-63. View abstract.

Frei-Kleiner S, Schaffner W, Rahlfs VW, et al. Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial. Maturitas 2005;51:397-404. View abstract.

Freudenstein J, Dasenbrock C, Nisslein T. Lack of promotion of estrogen-dependent mammary gland tumors in vivo by an isopropanolic Cimicifuga racemosa extract. Cancer Res 2002;62:3448-52.. View abstract.

Fuchikami H, Satoh H, Tsujimoto M, Ohdo S, Ohtani H, Sawada Y. Effects of herbal extracts on the function of human organic anion-transporting polypeptide OATP-B. Drug Metab Dispos 2006;34:577-82. View abstract.

Garcia-Pérez MA, Pineda B, Hermenegildo C, Tarin JJ, Cano A. Isopropanolic Cimicifuga racemosa is favorable on bone markers but neutral on an osteoblastic cell line. Fertil Steril 2009;91:1347-50. View abstract.

Geller SE, Shulman LP, van Breemen RB, et al. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause 2009;16:1156-66. View abstract.

Gori L, Firenzuoli F. Is black cohosh a hepatotoxic medicinal herb? Forsch Komplementarmed 2007;14:109-10. View abstract.

Gunn TR, Wright IM. The use of black and blue cohosh in labour. N Z Med J 1996;109:410-1.

Gurley B, Hubbard MA, Williams DK, et al. Assessing the clinical significance of botanical supplementation on human cytochrome P450 3A activity: comparison of a milk thistle and black cohosh product to rifampin and clarithromycin. J Clin Pharmacol 2006;46:201-13. View abstract.

Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo effects of goldenseal, kava kava, black cohosh, and valerian on human cytochrome P450 1A2, 2D6, 2E1, and 3A4/5 phenotypes. Clin Pharmacol Ther 2005;77:415-26. View abstract.

Gurley BJ, Swain A, Hubbard MA, et al. Clinical assessement of CYP2D6-mediated herb-drug interactions in humans: Effects of milk-thistle, black cohosh, goldenseal, kava kava, St. John’s wort, and Echinacea. Mol Nutr Food Res 2008;52:755-63. View abstract.

Guzman G, Kallwitz ER, Wojewoda C, et al. Liver Injury with Features Mimicking Autoimmune Hepatitis following the Use of Black Cohosh. Case Rep Med. 2009;2009:918156. View abstract.

Henneicke-von Zepelin HH, Meden H, Kostev K, Schröder-Bernhardi D, Stammwitz U, Becher H. Isopropanolic black cohosh extract and recurrence-free survival after breast cancer. Int J Clin Pharmacol Ther 2007;45:143-54. View abstract.

Hepatotoxicity with black cohosh. Australian Adv Drug Reactions Bull 2006;25:6. Available at: www.tga.gov.au/adr/aadrb/aadr0604.htm#a1.

Hernandez Munoz G, Pluchino S. Cimicifuga racemosa for the treatment of hot flushes in women surviving breast cancer. Maturitas 2003;44:S59-65.. View abstract.

Hoban CL, Byard RW, Musgrave IF. Analysis of spontaneous adverse drug reactions to echinacea, valerian, black cohosh and ginkgo in Australia from 2000 to 2015. J Integr Med. 2019;17(5):338-343. View abstract.

Huntley A, Ernst E. A systematic review of the safety of black cohosh. Menopause 2003;10:58-64.. View abstract.

Ingraffea A, Donohue K, Wilkel C, Falanga V. Cutaneous vasculitis in two patients taking an herbal supplement containing black cohosh. J Am Acad Dermatol 2007;56:S124-6. View abstract.

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;19:2739-45. View abstract.

Jarry H, Thelen P, Christoffel V, et al. Cimicifuga racemosa extract BNO 1055 inhibits proliferation of the human prostate cancer cell line LNCaP. Phytomedicine 2005;12:178-82. View abstract.

Jiang B, Kronenberg F, Nuntanakorn P, et al. Evaluation of the botanical authenticity and phytochemical profile of black cohosh products by high-performance liquid chromatography with selected ion monitoring liquid chromatography-mass spectrometry. J Agric Food Chem 2006;54:3242-53. View abstract.

Jiang K, Jin Y, Huang L, et al. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric 2015;18(4):559-67. View abstract.

Joy D, Joy J, Duane P. Black cohosh: a cause of abnormal postmenopausal liver function tests. Climacteric 2008;11:84-8. View abstract.

Kennelly EJ, Baggett S, Nuntanakorn P, et al. Analysis of thirteen populations of black cohosh for formononetin. Phytomedicine 2002;9:461-7.. View abstract.

Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Intern Med 2002;137:805-13.. View abstract.

Kruse SO, Lohning A, Pauli GF, et al. Fukiic and piscidic acid esters from the rhizome of Cimicifuga racemosa and the in vitro estrogenic activity of fukinolic acid. Planta Med 1999;65:763-4. View abstract.

Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012;9:CD007244. View abstract.

Lehmann-Willenbrock E, Riedel HH. [Clinical and endocrinologic studies of the treatment of ovarian insufficiency manifestations following hysterectomy with intact adnexa]. Zentralbl Gynakol 1988;110:611-8. View abstract.

Levitsky J, Alli TA, Wisecarver J, Sorrell MF. Fulminant liver failure associated with the use of black cohosh. Dig Dis Sci 2005;50:538-9. View abstract.

Lieberman S. A Review of the effectiveness of cimicifuga racemosa (Black Cohosh) for the symptoms of menopause. J Womens Health 1998;7:525-9. View abstract.

Liske E, Hanggi W, Henneicke-von Zepelin HH, et al. Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med 2002;11:163-74.. View abstract.

Liske E, Wustenberg P. Therapy of climacteric complaints with Cimicifuga racemosa: herbal medicine with clinically proven evidence. Menopause 1998;5:250.

Liske E. Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders. Adv Ther 1998;15:45-53. View abstract.

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;49:2472-9.. View abstract.

Lontos S, Jones RM, Angus PW, Gow PJ. Acute liver failure associated with the use of herbal preparations containing black cohosh. Med J Aust 2003;179:390-1.. View abstract.

Loser B, Kruse SO, Melzig MF, Nahrstedt A. Inhibition of neutrophil elastase activity by cinnamic acid derivatives from Cimicifuga racemosa. Planta Med 2000;66:751-3.. View abstract.

Lynch CR, Folkers ME, Hutson WR. Fulminant hepatic failure associated with the use of black cohosh: a case report. Liver Transpl 2006;12:989-92. View abstract.

Mahady GB, Low Dog T, Barrett ML, et al. United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause 2008;15:628-38. View abstract.

Maki PM, Rubin LH, Fornelli D, et al. Effects of botanicals and combined hormone therapy on cognition in postmenopausal women. Menopause 2009;16:1167-77. View abstract.

McFarlin BL, Gibson MH, O’Rear J, Harman P. A national survey of herbal preparation use by nurse-midwives for labor stimulation. Review of the literature and recommendations for practice. J Nurse Midwifery 1999;44:205-16. View abstract.

Meyer S, Vogt T, Obermann EC, et al. Cutaneous pseudolymphoma induced by Cimicifuga racemosa. Dermatology 2007;214:94-6. View abstract.

MHRA. Black cohosh (Cimicifuga racemosa) – risk of liver problems. Herbal Safety News July 2006. Available at: https://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&useSecondary= true&ssDocName=CON2024131&ssTargetNodeId=663.

Mills SY, Jacoby RK, Chacksfield M, Willoughby M. Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: a double-blind study. Br J Rheumatol 1996;35:874-8. View abstract.

Minciullo PL, Saija A, Patafi M, et al. Muscle damage induced by black cohosh (Cimicifuga racemosa). Phytomedicine 2006;13:115-8. View abstract.

Nappi RE, Malavasi B, Brundu B, Facchinetti F. Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol. Gynecol Endocrinol 2005;20:30-5. View abstract.

Newton KM, Reed SD, LaCroix AZ, et al. Treatment of vasomotor symptoms of menopause with black cohosh, mulitbotanicals, soy, hormone therapy, or placebo. Ann Intern Med 2006;145:869-79. Available at: https://www.annals.org/cgi/reprint/145/12/869.pdf.

Obi N, Chang-Claude J, Berger J, Braendle W, Slanger T, Schmidt M, Steindorf K, Ahrens W, Flesch-Janys D. The use of herbal preparations to alleviate climacteric disorders and risk of postmenopausal breast cancer in a German case-control study. Cancer Epidemiol Biomarkers Prev 2009;18:2207-13. View abstract.

Oktem M, Eroglu D, Karahan HB, Taskintuna N, Kuscu E, Zeyneloglu HB. Black cohosh and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized trial. Adv Ther 2007;24:448-61. View abstract.

Osmers R, Friede M, Liske E, et al. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol 2005;105:1074-83. View abstract.

Patel NM, Derkits RM. Possible increase in liver enzymes secondary to atorvastatin and black cohosh administration. J Pharm Pract 2007;20:341-6.

Pepping J. Black cohosh: Cimicifuga racemosa. Am J Health Syst Pharm 1999;56:1400-2.

Pkhaladze L, Davidova N, Khomasuridze A, Shengelia R, Panossian AG. Actaea racemosa L. is more effective in combination with Rhodiola rosea L. for relief of menopausal symptoms: a randomized, double-blind, placebo-controlled study. Pharmaceuticals (Basel). 2020;13(5):102. View abstract.

Pockaj BA, Gallagher JG, Loprinzi CL, et al. Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1. J Clin Oncol 2006;24:2836-41. View abstract.

Pockaj BA, Loprinzi CL, Sloan JA, et al. Pilot evaluation of black cohosh for the treatment of hot flashes in women. Cancer Invest 2004;22:515-21. View abstract.

Raus K, Brucker C, Gorkow C, Wuttke W. First-time proof of endometrial safety of the special black cohosh extract (Actaea or Cimicifuga racemosa extract) CR BNO 1055. Menopause 2006;13:678-91. View abstract.

Rebbeck TR, Troxel AB, Norman S, Bunin GR, DeMichele A, Baumgarten M, Berlin M, Schinnar R, Strom BL. A retrospective case-control study of the use of hormone-related supplements and association with breast cancer. Int J Cancer 2007;120:1523-8. View abstract.

Rockwell S, Fajolu O, Liu Y, et al. The herbal medicine black cohosh alters the response of breast cancer cells to some agents used in cancer therapy. Annual Meeting of the American Association for Cancer Research, Washington, DC. July 11-14, 2003;abstract 2721.

Rockwell S, Liu Y, Higgins SA. Alteration of the effects of cancer therapy agents on breast cancer cells by the herbal medicine black cohosh. Breast Cancer Res Treat 2005;90:233-9. View abstract.

Rotem C, Kaplan B. Phyto-Female Complex for the relief of hot flushes, night sweats and quality of sleep: randomized, controlled, double-blind pilot study. Gynecol Endocrinol 2007;23:117-22. View abstract.

Sakurai N, Wu JH, Sashida Y, et al. Anti-AIDS agents. Part 57: Actein, an anti-HIV principle from the rhizome of Cimicifuga racemosa (black cohosh), and the anti-HIV activity of related saponins. Bioorg Med Chem Lett 2004;14:1329-32. View abstract.

Seidlova-Wuttke D, Hesse O, Jarry H, et al. Evidence for selective estrogen receptor modulator activity in a black cohosh (Cimicifuga racemosa) extract: comparison with estradiol-17beta. Eur J Endocrinol 2003;149:351-62. View abstract.

Seidlova-Wuttke D, Thelen P, Wuttke W. Inhibitory effects of a black cohosh (Cimicifuga racemosa) extract on prostate cancer. Planta Med 2006;72:521-6. View abstract.

Sen A. Orobuccolingual dyskinesia after long-term use of black cohosh and ginseng. J Neuropsychiatry Clin Neurosci 2013 Fall;25(4):E50. View abstract.

Shahin AY, Ismail AM, Shaaban OM. Supplementation of clomiphene citrate cycles with Cimicifuga racemosa or ethinyl oestradiol–a randomized trial. Reprod Biomed Online 2009;19:501-7. View abstract.

Shahin AY, Ismail AM, Zahran KM, Makhlouf AM. Adding phytoestrogens to clomiphene induction in unexplained infertility patients–a randomized trial. Reprod Biomed Online 2008;16:580-8. View abstract.

Spangler L, Newton KM, Grothaus LC, et al. The effects of black cohosh therapies on lipids, fibrinogen, glucose and insulin. Maturitas 2007;57:195-204. View abstract.

Stoll W. Phytotherapeutikum beeinflusst atrophisches Vaginal epithel. Doppelblindversuch Cimicifuga vs. Oestrogenpraeparat [Phytopharmaceutical influences on atrophic vaginal epithelium. Double-blind study on Cimicifuga vs. an estrogen preparation]. Therapeutickon 1987;1:23-32.

Sun J. Morning/evening menopausal formula relieves menopausal symptoms: a pilot study. J Altern Complement Med 2003;9:403-9. View abstract.

Teschke R, Bahre R, Genthner A, et al. Suspected black cohosh hepatotoxicity – challenges and pitfalls of causality assessment. Maturitas 2009;63:302-14. View abstract.

Thomsen M, Vitetta L, Schmidt M, Sali A. Acute liver failure associated with the use of herbal preparations containing black cohosh. Med J Aust 2004;180:598-600.. View abstract.

Tsukamoto S, Aburatani M, Ohta T. Isolation of CYP3A4 Inhibitors from the Black Cohosh (Cimicifuga racemosa). Evid Based Complement Alternat Med 2005;2:223-6. View abstract.

Uebelhack R, Blohmer JU, Graubaum HJ, et al. Black cohosh and St. John’s wort for climacteric complaints: a randomized trial. Obstet Gynecol 2006;107(2 Pt 1):247-55. View abstract.

van der Sluijs CP, Bensoussan A, Chang S, Baber R. A randomized placebo-controlled trial on the effectiveness of an herbal formula to alleviate menopausal vasomotor symptoms. Menopause 2009;16:336-44. View abstract.

Verhoeven MO, van der Mooren MJ, van de Weijer PH, et al. CuraTrial Research Group. Effect of a combination of isoflavones and Actaea racemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind study. Menopause 2005;12:412-20. View abstract.

Vermes G, Bánhidy F, Acs N. The effects of remifemin on subjective symptoms of menopause. Adv Ther 2005;22:148-54. View abstract.

Vitetta L, Thomsen M, Sali A. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust 2003;178:411-2.. View abstract.

Whiting PW, Clouston A, Kerlin P. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust 2002;177:440-3. View abstract.

Wuttke W, Gorkow C, Seidlova-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study. Menopause 2006;13:185-96. View abstract.

Wuttke W, Seidlova-Wuttke D, Gorkow C. The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers. Maturitas 2003;44:S67-77. View abstract.

Yalçin M, Oguz A, Bestepe EE, Saglam NGU, Ergelen M. Black cohosh associated mania in a patient with unipolar depression. Int J Psychiatry Med 2020 Sep 21:91217420961185. doi: 10.1177/0091217420961185. View abstract.

Black Cohosh – Side Effects, Dosage, Interactions

Black cohosh is an herb also known as Actaea racemosa, Actée à Grappes Noires, Actée Noire, Aristolochiaceae Noire, Baie d’actée, Baneberry, Black Snakeroot, Bugwort, Cimicaire à Grappes, Cimicifuga, Cytise, Herbe aux Punaises, Macrotys, Phytoestrogen, Racine de Serpent, Rattlesnake Root, Rhizoma Cimicifugae, Sheng Ma, Squaw Root, and many other names.

Black cohosh should not be confused with blue cohosh or white cohosh. Blue cohosh can have harmful effects on the heart.

Black cohosh has been used in alternative medicine in a specific preparation called Remifemin as a possibly effective aid in REDUCING the frequency of hot flashes caused by menopause.

Other uses not proven with research have included premenstrual syndrome (PMS), infertility, breast cancer, heart disease, osteoporosis, arthritis, rheumatism, migraine headaches, mental function, and many other conditions.

It is not certain whether black cohosh is effective in treating any medical condition. Medicinal use of this product has not been approved by the FDA. Black cohosh should not be used in place of medication prescribed for you by your doctor.

Black cohosh is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Black cohosh may also be used for purposes not listed in this product guide.

Follow all directions on the product label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before using black cohosh, talk to your healthcare provider. You may not be able to use black cohosh if you have certain medical conditions, especially.

• liver disease;
• past or present cancer of the breast, ovary, or uterus;
• a history of endometriosis or uterine fibroids;
• a genetic blood-clotting disorder; or
• if you have ever had a kidney transplant.

It is not known whether black cohosh will harm an unborn baby. However, this product may increase your risk of having a miscarriage. Do not use this product without medical advice if you are pregnant.

It is not known whether black cohosh passes into breast milk or if it could harm a nursing baby. Do not use this product without medical advice if you are breast-feeding a baby.

Do not give any herbal/health supplement to a child without medical advice.

Black cohosh Drug Interactions – Drugs.com

1. Drugs A to Z
2. Black cohosh

A total of 292 drugs are known to interact with
black cohosh.

• 6 major
  drug interactions
• 284 moderate
  drug interactions
• 2 minor
  drug interactions

View all medications that may interact with black cohosh.

Does black cohosh interact with my other drugs?

Enter other medications to view a detailed report.

Most frequently checked interactions

View interaction reports for black cohosh and the medicines listed below.

Black cohosh alcohol/food interactions

There is 1 alcohol/food interaction with black cohosh

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major	Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate	Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor	Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown	No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Black Cohosh – Health Professional Fact Sheet

Introduction

Black cohosh (Actaea racemosa or Cimicifuga racemosa), a member of the buttercup family, is a perennial plant native to North America. Other, mostly historical, names for this herb include snakeroot, black bugbane, rattleweed, macrotys, and rheumatism weed [1,2]. Black cohosh has a long history of use. Native Americans used it, for example, to treat musculoskeletal pain, fever, cough, pneumonia, sluggish labor, and menstrual irregularities [3]. European settlers used black cohosh as a tonic to support women’s reproductive health [4].

Today, black cohosh is most commonly used for menopausal symptoms, including hot flashes (also called hot flushes) and night sweats (together known as vasomotor symptoms), vaginal dryness, heart palpitations, tinnitus, vertigo, sleep disturbances, nervousness, and irritability [5,6]. Menopause, which typically occurs in women at about 51 years of age, is the cessation of menstruation and the end of a woman’s reproductive period [5].

This fact sheet provides an overview of the use of black cohosh to relieve menopausal symptoms.

Black Cohosh Dietary Supplements

Preparations of black cohosh are made from its roots and rhizomes (underground stems). They are sold as dietary supplements in such forms as powdered whole herb, liquid extracts, and dried extracts in pill form [7].

Available preparations vary considerably in their chemical composition, in part because the compounds in black cohosh that may be responsible for any relief of menopausal symptoms are not known. Substances in black cohosh that may account for its activity include triterpene glycosides such as actein, 23-epi-26-deoxyactein, and cimicifugoside; resins, such as cimicifugin; and aromatic acid derivatives such as caffeic, isoferulic, and fukinolic acids [8,9].

Products containing black cohosh extract are frequently standardized to provide at least 1 mg triterpene glycosides per daily dose [10]. Remifemin, a commercial black cohosh product used in several studies included in a 2012 Cochrane review described below, is an extract currently standardized to be equivalent to 40 mg black cohosh root/rhizome (extracted with isopropyl alcohol) per daily dose of two tablets, but it is not standardized to triterpene glycoside content [7,11]. The product has been on the market for years and has been reformulated over time [10].

Black Cohosh and Menopausal Symptoms

Studies using various designs since the 1950s have attempted to determine whether black cohosh affects menopausal symptoms [12]. Complicating efforts to understand the efficacy of black cohosh for treating menopausal symptoms is the wide variation in the chemical compositions of formulations. Black cohosh’s active ingredients and potential mechanism(s) of action are unknown. Studies have found varying results for the plant’s effects on human physiology as to whether, for example, it raises the body’s levels of estrogen which is present in lower levels in menopausal women than in premenopausal women, or whether it affect levels of luteinizing hormone or follicle-stimulating hormone [13,14]. It is not clear whether black cohosh affects the structure and activity of vaginal and uterine tissues [5,15]. Some researchers believe that black cohosh might exert its effects through a brain-related action, such as moduation of serotonergic pathways, or through its potential ability to act as an antioxidant, anti-inflammatory, or selective estrogen receptor modulator [5,15-17].

Two high-quality randomized controlled trials investigating black cohosh for menopausal symptoms are described here. One, published in 2006, assigned 351 women aged 45–55 years experiencing daytime hot flashes and night sweats into one of five groups to take one of the following [18]:

1. 160 mg/day black cohosh (70% ethanolic extract standardized to contain 2.5% triterpene glycosides)
2. A multibotanical preparation containing 200 mg black cohosh along with Siberian ginseng, dong quai, and other ingredients
3. The same multibotanical preparation plus two daily servings of soy foods providing 12-20 g soy protein
4. Hormone therapy (estrogen with or without progesterone)
5. A placebo

After 3, 6, and 12 months of supplementation or placebo, the number and intensity of hot flashes and night sweats did not differ between the herbal-intervention groups and the placebo group, with one exception. At 12 months, participants consuming the multibotanical preparation plus soy foods had significantly worse symptom intensity than those consuming the placebo.

Another randomized controlled trial published in 2009 assigned 88 perimenopausal and postmenopausal women (mean age 53 years; 55% from underrepresented minority groups) who were experiencing at least 35 hot flashes and night sweats per week into one of four groups to take one of the following [19]:

1. 128 mg/day black cohosh (75% ethanolic extract standardized to contain 5.7% triterpene glycosides)
2. 398 mg/day red clover (ethanolic extract of the aerial parts standardized to 120 mg isoflavones)
3. Hormone therapy (estrogen and progesterone)
4. A placebo

After 3, 6, 9, and 12 months of supplementation or placebo, the number of vasomotor symptoms declined significantly in all groups. However, there were no statistically significant differences between the black cohosh and red clover groups compared to placebo, with one exception. The black cohosh group showed worse symptom intensity at 6 and 9 months. This study also investigated secondary endpoints such as somatic symptoms (e.g., insomnia and fatigue), mood changes (e.g., depression and anxiety), and sexual dysfunction (e.g., vaginal dryness). For most of these outcomes, no significant differences were observed between any of the treatment groups at any time.

A 2012 Cochrane review evaluated 16 randomized clinical trials on the effectiveness of black cohosh in reducing menopausal symptoms, including hot flushes, night sweats, vaginal dryness, and combinations of symptoms measured by validated rating scales [5]. (The two trials discussed above were included in this Cochrane review.) The 16 included trials randomized a total of 2,027 women (mean age 50.5 to 56.4 years), and their samples ranged from 23 to 351 participants. Study durations were 8 to 54 weeks, with a mean duration of 22.8 weeks. Participants received a daily dose of various formulations of 8 to 160 mg/day black cohosh extract, with a median dose of 40 mg/day. In some cases, the authors of the original study reports indicated that the extract they used came from the root/rhizome, they had extracted the product using isopropyl alcohol or ethanol, and/or they had standardized the extract to contain a specific amount of triterpene glycosides. The studies were highly heterogeneous with respect to such factors as design, duration, type and amount of black cohosh used, and main findings. The review’s authors concluded that there was “insufficient evidence” from these trials “to either support or oppose the use of black cohosh for menopausal symptoms.”

A 2016 systematic review and meta-analysis of randomized clinical trials examined four studies of herbal and plant-based therapies that included black cohosh (three of which were examined in the Cochrane review described above) to treat menopausal symptoms [20]. The trials randomized a total of 511 women to a daily dose of various formulations of 6.5 to 160 mg/day black cohosh extract or placebo. There were no significant associations between supplementation with black cohosh and reduction in the number of vasomotor symptoms, such as hot flashes. Furthermore, there were no beneficial associations between black cohosh use and relief of menopausal symptoms using self-reported rating scales.

The American College of Obstetricians and Gynecologists, in its 2015 clinical guidelines for managing menopausal symptoms, concluded that “data do not show that” herbal dietary supplements like black cohosh “are efficacious for the treatment of vasomotor symptoms” [21]. The North American Menopause Society advises clinicians against recommending herbal therapies such as black cohosh because “they are unlikely to be beneficial” (italics in original) in alleviating vasomotor symptoms [15].

The Cochrane review found adequate justification for conducting further studies on black cohosh’s use to treat menopausal symptoms [5]. Its authors recommended that researchers conduct higher-quality trials with larger samples and provide more details about their experimental protocols. Others have recommended that researchers should completely and comprehensively describe the black cohosh preparation they used so that other researchers could use the same or similar products [22]. It is also important to independently analyze and verify the product’s composition to ensure its identity and quality [23].

Health Risks

Clinical trials using various black cohosh preparations to treat menopausal symptoms have shown that its use is associated with a low incidence of adverse effects. The most commonly reported side effects are gastrointestinal upset and rashes, both of which are mild and transient [1,24]. Other reported adverse effects in clinical trials have included breast pain/enlargement, infection, vaginal bleeding/spotting, and musculoskeletal complaints, although their incidence was similar in women taking black cohosh and those taking placebo [5]. Most studies have examined black cohosh use for short periods, typically 6 months or less, so no published studies have assessed the long-term safety of black cohosh in humans.

Across the world, reports have described at least 83 cases of liver damage—including hepatitis, liver failure, elevated liver enzymes, and assorted other liver injuries—associated with black cohosh use [1,25]. However, there is no evidence of a causal relationship. It is possible that at least some reported cases of hepatotoxicity were due to impurities, adulterants, or incorrect Acteae species in the black cohosh products used. However, no one independently analyzed these products to confirm the existence of these problems [3,26-28].

In 2007, the Australian Department of Health began requiring that products containing black cohosh carry the following label statement: “Warning: Black cohosh may harm the liver in some individuals. Use under the supervision of a healthcare professional” [29]. In 2008, the U.S. Pharmacopeia (a nonprofit standard-setting organization for foods and drugs) recommended labeling black cohosh products with the following cautionary statement: “Discontinue use and consult a healthcare practitioner if you have a liver disorder or develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice” [30]. However, the U.S. Food and Drug Administration does not require such a warning on black cohosh product labels.

The American Herbal Products Association recommends that pregnant women not take black cohosh except under the supervision of their healthcare provider because studies have not rigorously evaluated its use during pregnancy [1]. The U.S. Pharmacopeia advises that individuals with liver disorders should also avoid black cohosh [30]. It adds that users who develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice, while taking the supplement should discontinue use and contact their doctor.

Interactions with Medications

Black cohosh is not known to have any clinically relevant interactions with medications, although this has not been systematically studied [1].

References

1. Gardner Z, McGuffin M, eds. American Herbal Products Association’s botanical safety handbook. Second ed. Boca Raton, FL: CRC Press; 2013.




2. Gafner S. Black cohosh laboratory guidance document. 2015.




3. Betz JM, Anderson L, Avigan MI, Barnes J, Farnsworth NR, Gerdén B, et al. Black cohosh: considerations of safety and benefit. Nutr Today 2009;44:155-62.




4. Foster S. Black cohosh: a literature review. HerbalGram 1999;45:35-50.




5. Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev 2012:CD007244. [PubMed abstract]




6. Foster S. Exploring the peripatetic maze of black cohosh adulteration. HerbalGram 2013;May-July:32-51.




7. National Institutes of Health. Dietary Supplement Label Database. 2017.




8. Mills S, Bone K. Principles and practice of phytotherapy. Edinburgh: Churchill Livingstone; 2000.




9. Kruse SO, Lohning A, Pauli GF, Winterhoff H, Nahrstedt A. Fukiic and piscidic acid esters from the rhizome of Cimicifuga racemosa and the in vitro estrogenic activity of fukinolic acid.
   
   Planta Med 1999;65:763-4. [PubMed abstract]




10. ConsumerLab.com. Product review: menopause supplements (soy and red clover isoflavones, black cohosh) and progesterone creams. 2016.




11. Schwabe North American, Incorporated. Remifemin®.




12. Fabricant DS, Krause EC, Farnsworth NR. Black cohosh. In: Coates PM, Betz JM, Blackman MR, et al., eds. Encyclopedia of dietary supplements. Second ed. New York: Informa Healthcare;2010:60-74.




13. Raus K, Brucker C, Gorkow C, Wuttke W. First-time proof of endometrial safety of the special black cohosh extract (Actaea or Cimicifuga racemosa extract) CR BNO 1055. Menopause 2006;13:678-91. [PubMed abstract]




14. Liske E, Hanggi W, Henneicke-von Zepelin HH, Boblitz N, Wustenberg P, Rahlfs VW. Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med 2002;11:163-74. [PubMed abstract]




15. The North American Menopause Society. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause 2015;22:1155-72. [PubMed abstract]




16. Borrelli F, Izzo AA, Ernst E. Pharmacological effects of Cimicifuga racemosa. Life Sci 2003;73:1215-29. [PubMed abstract]




17. Wuttke W, Jarry H, Becker T, Schultens A, Christoffel V, Gorkow C, et al. Phytoestrogens: endocrine disrupters or replacement for hormone replacement therapy? Maturitas 2003;44 Suppl 1:S9-20. [PubMed abstract]




18. Newton KM, Reed SD, LaCroix AZ, Grothaus LC, Ehrlich K, Guiltinan J. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial. Ann Intern Med 2006;145:869-79. [PubMed abstract]




19. Geller SE, Shulman LP, van Breemen RB, Banuvar S, Zhou Y, Epstein G, et al. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause 2009;16:1156-66. [PubMed abstract]




20. Franco OH, Chowdhury R, Troup J, Voortman T, Kunutsor S, Kavousi M, et al. Use of plant-based therapies and menopausal symptoms: a systematic review and meta-analysis. JAMA 2016;315:2554-63. [PubMed abstract]




21. ACOG Practice Bulletin No. 141: management of menopausal symptoms. Obstet Gynecol 2014;123:202-16. [PubMed abstract]




22. Swanson CA. Suggested guidelines for articles about botanical dietary supplements. Am J Clin Nutr 2002;75:8-10. [PubMed abstract]




23. Office of Dietary Supplements, National Institutes of Health. Dietary Supplement Analytical Methods and Reference Materials Program (AMRM).




24. Borrelli F, Ernst E. Black cohosh (Cimicifuga racemosa): a systematic review of adverse events. Am J Obstet Gynecol 2008;199:455-66. [PubMed abstract]




25. Teschke R, Schwarzenboeck A, Schmidt-Taenzer W, Wolff A, Hennermann KH. Herb induced liver injury presumably caused by black cohosh: a survey of initially purported cases and herbal quality specifications. Ann Hepatol 2011;10:249-59. [PubMed abstract]




26. National Center for Complementary and Alternative Medicine, Office of Dietary Supplements. Workshop on the safety of black cohosh in clinical studies. 2004.




27. Jiang B, Kronenberg F, Nuntanakorn P, Qiu MH, Kennelly EJ. Evaluation of the botanical authenticity and phytochemical profile of black cohosh products by high-performance liquid chromatography with selected ion monitoring liquid chromatography-mass spectrometry. J Agric Food Chem 2006;54:3242-53. [PubMed abstract]




28. Health Canada. Black cohosh products and liver toxicity: update. 2010.




29. Australian Government Department of Health, Therapeutic Goods Administration. New labelling requirements and consumer information for medicines containing black cohosh. 2007.




30. Mahady GB, Low Dog T, Barrett ML, Chavez ML, Gardiner P, Ko R, et al. United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause 2008;15:628-38. [PubMed abstract]

Disclaimer

This fact sheet by the Office of Dietary Supplements (ODS) provides information that should not take the place of medical advice. We encourage you to talk to your healthcare providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. Any mention in this publication of a specific product or service, or recommendation from an organization or professional society, does not represent an endorsement by ODS of that product, service, or expert advice.

Updated: June 3, 2020 History of changes to this fact sheet

Black cohosh | DrugBank Online

Name

Black cohosh

Accession Number

DB13975

Description

Black cohosh (Actaea racemosa or Cimicifuga racemosa), a member of the buttercup family, is a perennial plant which native to North America. Historical names for this plant include snakeroot, black bugbane, rattleweed, macrotys, and rheumatism weed. Black cohosh has a long history of use. Native Americans used it for its purported benefits in treating musculoskeletal pain, fever, cough, pneumonia, sluggish labor, and menstrual irregularities. European settlers were said to use black cohosh as a tonic to support female reproductive health.¹⁰

Hormone replacement therapy (HRT) is the standard treatment for early symptoms in post-menopausal women, however, increases the risk of stroke, heart diseases, as well as breast cancer in older women. Various studies have shown that the number of post-menopausal women using hormone replacement therapy is currently low and that the effects of hormone replacement therapy in reducing menopausal symptoms are not as positive as expected. For these reasons, there has been a trend toward using alternative therapies to relieve menopausal symptoms.⁸

Black cohosh has been associated with serious safety concerns.¹ Results from studies suggest that C. racemosa possesses a central activity instead of a hormonal effect.²

The American College of Obstetrics and Gynecology guidelines on the use of botanicals, such as black cohosh, for the management of menopausal symptoms the use of for up to six months, especially in treating the symptoms of sleep and mood disturbance, and hot flushes.¹²

Type

Biotech

Groups

Experimental

Synonyms

• Black cohosh
• Black snakeroot
• Cimicifuga racemosa
• Cimicifuga racemosa rhizome
• Cimicifuga racemosa root
• Cimicifuga racemosa root with rhizome
• Cimicifugae rhizoma
• Fairy candle root
• Rattleroot

Accelerate your drug discovery research with the industry’s only fully connected ADMET dataset, ideal for:

Machine Learning

Data Science

Drug Discovery

Accelerate your drug discovery research with our fully connected ADMET dataset

Indication

Treatment of menopausal symptoms and menstrual dysfunction ¹².

Associated Conditions

Contraindications & Blackbox Warnings

Contraindications & Blackbox Warnings

With our commercial data, access important information on dangerous risks, contraindications, and adverse effects.

Our Blackbox Warnings cover Risks, Contraindications, and Adverse Effects

Pharmacodynamics

This agent is purported to relieve some of the vasomotor symptoms of menopause, including hot flashes and night sweats.^8,10,11

A 2012 Cochrane review analyzed 16 randomized clinical trials on the effectiveness of black cohosh in reducing menopausal symptoms, including hot flushes, night sweats, vaginal dryness, and numerous combinations of symptoms which were measured by validated rating scales.⁸ There is currently insufficient evidence to support the use of black cohosh for menopausal symptoms.⁸ The studies were quite heterogeneous in design, duration, type and amount of black cohosh used, and main findings.⁸

A 2016 systematic review and meta-analysis of randomized clinical trials analyzed four studies of herbal and plant-based therapies that included black cohosh to treat menopausal symptoms.⁵ It was suggested that composite and specific phytoestrogen supplementations were associated with small reductions in the incidence of hot flashes and vaginal dryness, however, no significant reduction in night sweats.⁵

Mechanism of action

Although the mechanism by which black cohosh relieves menopausal symptoms is unknown, several hypotheses have been made. It is believed to act through the following mechanisms/effects:⁹

1) as a selective estrogen receptor modulator
2) through serotonergic pathways
3) as an antioxidant
4) on inflammatory pathways

The primary active component of the black cohosh root is believed to be the terpene glycoside fraction, including actein and cimifugoside.⁹ The triterpenes are one of the most ubiquitous and diverse groups of plant natural products.¹³ They are classified as complex molecules that are beyond the reach of chemical synthesis in the laboratory. Simple triterpenes are constituents of surface waxes and specialized plant membranes and may possibly serve as signaling molecules. More complex glycosylated triterpenes (also known as saponins) provide protection against pathogens and pests.¹³ The rhizome (stem portion of the plant) also contains other potentially biologically active substances, including alkaloids, flavonoids, and tannins. The therapeutic activity of black cohosh was initially believed to be the activation of estrogen receptors; however, more recent studies show that although some components of the extract bind to at least one subtype of estrogen receptor, the receptor binding produces very little (if any) estrogenic effect, and may selectively block some of the effects.⁹

An early study reported that treatment with black cohosh leads to a decrease in luteinizing hormone (LH) levels consistent with its purported estrogenic effect. Despite this, more recent studies have shown no effect on levels of LH, follicle-stimulating hormone (FSH), or prolactin. To this day it is unclear whether black cohosh exerts its effect via estrogen receptors or through another mechanism.¹²

One study observed that while the most prominent triterpene in black cohosh, known as 23-epi-26-deoxyactein, inhibits cytokine-induced nitric oxide production in brain microglial cells, the complete black cohosh extract demonstrated to enhance this pathway.⁹ A variety of activities have been reported for black cohosh and its compounds, however, the absorption and tissue distribution of these compounds is not known.⁹

Cimicifuga racemosa (black cohosh) is used most often to treat symptoms occurring during menopause. However, in recent years, several concerns regarding its safety have been voiced.¹

Absorption

Not Available

Volume of distribution

Not Available

Protein binding

Not Available

Metabolism

Not Available

Route of elimination

Not Available

Half-life

Approximately 2h.⁷

Clearance

Not Available

Adverse Effects

Reduce medical errors

and improve treatment outcomes with our comprehensive & structured data on drug adverse effects.

Reduce medical errors & improve treatment outcomes with our adverse effects data

Toxicity

The oral LD50 for rats is 17,000 to 27,211 mg/kg.^MSDS

Clinical trials using a variety of black cohosh formulas to manage menopausal symptoms have shown that its use is associated with a low incidence of adverse effects. The most commonly reported side effects are gastrointestinal discomfort and rashes, both of which have shown to be mild and transient. Some other adverse effects in clinical trials have included breast pain or enlargement, infection, vaginal bleeding or spotting, and musculoskeletal discomfort. The incidence of these symptoms, however, was similar in women taking black cohosh and those taking a placebo.¹⁰

Reports have been made globally of at least 83 cases of liver damage—including hepatitis, liver failure, elevated liver enzymes, and various other liver injuries—associated with black cohosh use. However, no evidence of a causal relationship exists. It is possible that a subset of reported cases of hepatotoxicity were due to impurities, adulterants, or incorrect Acteae species in the black cohosh products used. However, no independent analysis of these drugs has been done to confirm the existence of these problems.¹⁰

The American Herbal Products Association recommends that pregnant women not ingest black cohosh, except under the supervision of their healthcare provider because studies have not thoroughly evaluated its use during pregnancy. The U.S. Pharmacopeia advises that individuals with liver disorders should also avoid the use of black cohosh. In addition, users who develop symptoms of liver disease, such as abdominal pain, dark urine, or jaundice, while taking the supplement should discontinue use and contact their healthcare provider.¹⁰

As with other drugs believed to have potential estrogenic effects, there has been concern about the safety of black cohosh in women with a personal history or family history of breast cancer. Though further research is warranted, at least one tissue-culture study showed no stimulation of estrogen receptor-positive breast cancer cell lines by black cohosh extract.⁶ This study found that black cohosh extract amplified the inhibitory action of tamoxifen (Nolvadex) on breast cancer cell lines. Because this question has not yet been fully answered, physicians should discuss this issue with their patients who are at risk of breast cancer while considering taking black cohosh.¹²

Black cohosh is contraindicated during pregnancy due to its potential ability to promote uterine contraction. The safety of black cohosh in breastfeeding mothers and the level of transmission of black cohosh in breast milk are both unknown.¹²

Affected organisms

Pathways

Not Available

Pharmacogenomic Effects/ADRs

Not Available

Benefits, Side Effects, Dosage, and Interactions

Black cohosh (Cimicifuga racemosa) is a plant commonly used in herbal medicine for the relief of menopausal symptoms. A member of the buttercup family, it has a long history of use in the treatment of arthritis and muscle pain.

A key component of black cohosh is fukinolic acid, a compound that has estrogen-like properties. Proponents suggest this may be beneficial to women as they experience age-related declines in estrogen levels, a key factor in the development of menopausal symptoms.

Verywell / Gary Ferster

Black cohosh is sometimes touted as a natural alternative to hormone replacement therapy. It is used as a natural remedy for a number of menopause-related symptoms, including hot flashes, night sweats, disturbances in mood, and vaginal dryness.

In addition, black cohosh is sometimes used to treat menstrual irregularities and alleviate symptoms of premenstrual syndrome.

Commonly Known As

• black cohosh
• black cohosh root

Health Benefits

While black cohosh is among the most popular natural remedies for menopausal symptoms, studies testing its effectiveness have produced conflicting results. Here’s a look at the science:

Menopause Symptoms

The most comprehensive research on black cohosh and menopausal symptoms include a report published in the Cochrane Database of Systematic Reviews in 2012. For this report, scientists looked at 16 previously published clinical trials (with a total of 2,027 women) that compared the effects of black cohosh to those of a placebo, hormone replacement therapy, red clover, and other interventions in the treatment of menopausal symptoms.

In their analysis, the review’s authors found no significant difference between black cohosh and placebo in the relief of hot flashes. What’s more, hormone replacement therapy appeared to be more effective than black cohosh for hot flash relief. Due to insufficient data, no firm conclusions could be drawn as to black cohosh’s effectiveness in treating symptoms such as vaginal dryness and night sweats.

Since the reviewed studies were of “uncertain quality,” the report’s authors concluded that further research on the use of black cohosh in the treatment of menopausal symptoms is warranted.

Possible Side Effects

Side effects of black cohosh include headache, heaviness in the legs, indigestion, low blood pressure, nausea, perspiration, vomiting, and weight gain.

In excessive doses, black cohosh may cause seizures, visual disturbances, and slow or irregular heartbeat. Discontinue the use of black cohosh and seek medical attention if you experience symptoms such as abdominal pain, dark urine, and jaundice.

Contraindications

If you have any of the following conditions, do not take black cohosh:

• Hormone-sensitive conditions, such as breast cancer, prostate cancer, endometriosis, or uterine fibroids
• A history of blood clots, stroke, seizures, or liver disease
• Are taking medications for high blood pressure
• Are allergic to plants in the buttercup (Ranunculaceae) family
• Are allergic to aspirin or salicylates, as black cohosh contains small amounts of salicylic acid
• Are pregnant as black cohosh may stimulate uterine contractions

Interactions

Due to its possible estrogen-like activity, black cohosh may interfere with the effectiveness of hormone replacement therapy or oral contraceptives.

Black cohosh may interfere with the effectiveness of the chemotherapy drug cisplatin.

Dosage and Preparation

 

Black cohosh is sold as capsules, gel caps, and tinctures. There is no recommended daily allowance for black cohosh.

What to Look For

 

The part of the black cohosh plant used medicinally is the root and most preparations of it specify it is from the root.

When selecting a brand of supplements, look for products that have been certified by Consumer Labs, The U.S. Pharmacopeial Convention, or NSF International. 

Other Questions

 

Are there other natural remedies for menopause symptoms I could use?

There’s some evidence that alternative therapies like acupuncture may be of some benefit to women going through menopause. Studies from 2016 suggest that acupuncture may help reduce hot flashes and improve sleep quality in menopausal women.

Natural remedies such as red clover, soy, St. John’s wort, progesterone cream, and evening primrose oil also show promise in the treatment of menopause-related symptoms. However, as in the case of black cohosh, more research is needed to determine the effectiveness of these remedies.

Is black cohosh the same as blue cohosh?

No. Black cohosh should not be confused with the herb blue cohosh (Caulophyllum thalictroides), white cohosh, bugbane, Cimicifuga foetida, or white baneberry. These species have different effects, and blue cohosh and white cohosh, in particular, can be toxic. There is a case report of neurological complications in a post-term baby after labor induction with a herbal blend of black cohosh and blue cohosh.

Black Cohosh | Memorial Sloan Kettering Cancer Center

Obtained from root of the plant, black cohosh is used as a dietary supplement to relieve symptoms of menopause and dysmenorrhea. It has antiosteoporotic effects ⁽⁸⁾ and enhances bone formation ⁽⁹⁾. Clinical studies indicate that black cohosh by itself ^(2) (3), or in combination with other herbs ^(4) (5), is effective in the treatment of menopausal symptoms, although data are conflicting ^{(6) (31) (32) (36) (45)}. Conclusions of a meta analysis cite insufficient evidence to support use for menopausal symptoms ⁽⁴⁰⁾.

Investigations of black cohosh for treating hot flashes, due to breast cancer treatment, yielded mixed results ^{(10) (11) (12)}. But supplementation was found effective in treating menopausal syndrome induced by luteinizing hormone-releasing hormone analogue (LHRH-a) ⁽⁵⁷⁾. In other studies, black cohosh did not enhance bone density, improve menopausal symptoms nor improve the 10-year risk of coronary heart disease in early postmenopausal women ⁽³⁷⁾, although it has been reported to improve sleep ⁽⁵³⁾.

A black cohosh extract demonstrated anti-diabetic potential in a murine model ⁽⁴⁶⁾. Human studies have yet to be conducted.

Preclinical findings indicate that black cohosh decreased proliferation of prostate cancer cells ⁽¹⁴⁾ and induced an apoptotic response in liver cells ⁽²¹⁾. However, it also increased the incidence of metastatic disease in mice ⁽¹⁶⁾. Whether it has similar effects in breast cancer patients is not clear, although a retrospective observational study of breast cancer patients found that black cohosh enhanced disease-free survival ⁽¹⁵⁾.

Concomitant use of black cohosh with prescription medications has been associated with adverse drug reactions, most commonly involving abnormal hepatic function, hepatitis or hepatotoxicity ⁽⁵⁸⁾. Black cohosh should not be confused with blue cohosh, which has a different medicinal profile. It is also not clear whether or not black cohosh acts as a phytoestrogen. Patients with breast cancer or at risk of breast cancer should consult with their physicians before taking it.

Black Cohosh in English – Item

Can Black Cohosh be used for menstrual cramps and symptoms of menopause?

Yes, menstrual cramps and menopause symptoms are among the most common reported uses for Black Cohosh. Please do not use Black Cohosh for menstrual cramps and menopause symptoms without consulting first with your doctor. Click here and view the survey results to see how other users are using Black Cohosh.

Should I use this product empty stomach, before food or after food?

Users of Lekarstvo.net reported taking Black Cohosh on an empty stomach. However, this information may not be appropriate for your specific situation. Please consult your healthcare professional for an appointment schedule. Click here and view the survey results to see what other users have to say about the best time to take Black Cohosh.

Is it safe to drive or operate heavy equipment while using this product?

If you experience drowsiness, dizziness, hypotension or headache while taking Black Cohosh, then you may need to give up driving and heavy industrial equipment. You should stop driving if taking the drug makes you drowsy, dizzy, or hypotensive. Doctors recommend giving up alcohol with such drugs, i.e.because alcohol significantly increases side effects and drowsiness. Please check your body’s response when taking Black Cohosh. Be sure to contact your healthcare professional for advice based on your body and overall health.

Is this medication (product) addictive or addictive?

Most drugs are not addictive or addictive. In most cases, the government classifies drugs that can be addictive as controlled dispensing drugs.For example, the H or X chart in India and the II-V chart in the USA. Please review the information on the drug packaging to make sure this drug is not a controlled drug. Also, do not self-medicate or train your body to medication without consulting your healthcare professional.

Can I stop using this product immediately or do I need to slowly stop using it?

Some drugs need to be stopped gradually due to the recovery effect.Be sure to contact your healthcare professional for advice based on your body, general health, and other medications you are taking.

BLACK COHOSH: BENEFITS, DOSAGE, SIDE EFFECTS AND MUCH MORE – HEALTH

Black cohosh is a flowering plant native to North America. Its scientific names are Actaea racemoa and Cimicifuga racemoa, and it is sometimes called black beetle, black snakehead, beinberry or ox

Content:

What is Black Cohosh?

Black cohosh is a flowering plant native to North America.Its scientific names are Actaea racemosa and Cimicifuga racemosa , and it is sometimes called black beetle, black snakehead, beinberry, or magic candle ( 1 ).

Popular supplement for women’s health, Remifemin contains black cohosh as an active ingredient.

Its flowers and roots were commonly used in traditional Native American medicine and are today a popular women’s health supplement claimed to help with menopausal symptoms, fertility and hormonal balance.

It may be effective because it acts as a phytoestrogen, a plant-derived compound that mimics the hormone estrogen. However, there is some controversy as to whether black cohosh can be classified as a true phytoestrogen ( 2 , 3 ).

However, black cohosh is beneficial for relieving symptoms of menopause. However, there is no evidence of its use for other purposes.

Benefits and Uses

Black cohosh has a number of potential benefits, most of which are related to women’s health or hormonal balance.However, with the exception of menopausal symptoms, there is little evidence to support its use for any of these conditions.

Menopause and Menopause Symptoms

Menopause symptom relief is the reason most people use black cohosh, and this is one of the most compelling evidence for this use.

In one study of 80 menopausal women who experienced hot flashes, those who took 20 mg of black cohosh daily for 8 weeks reported significantly fewer and less severe hot flashes than before starting the supplement ( 4 ).

Moreover, other human studies have confirmed similar findings. Although more research is needed, black cohosh appears to be beneficial in relieving symptoms of menopause ( 5 ).

fertility

While there are many claims on the Internet that black cohosh can improve fertility or help you get pregnant, there is not much evidence to support this.

However, studies show that black cohosh may increase the effectiveness of the fertility drug Clomid (clomiphene citrate) in infertile people, increasing their chances of becoming pregnant ( 6 , 7 , 8 ).

Three small human studies show improved pregnancy or ovulation rates in infertile women who took black cohosh supplements with clomid ( 6 , 7 , 8 ).

However, these studies were small and more research is needed to confirm this effect.

Women’s Health

Black cohosh is also used for a number of other women’s health purposes.However, the evidence supporting these benefits is not as compelling as the evidence supporting its benefits for menopause and fertility.

Here are some more reasons why women may use black cohosh to maintain hormonal balance:

• Polycystic ovary syndrome (PCOS). Black cohosh supplementation may increase the chances of a woman with PCOS getting pregnant from Clomid. Black cohosh supplementation can also help regulate your cycle if you have PCOS ( 8 , 9 ).
• Myoma. One 3-month study in 244 postmenopausal women showed that a daily intake of 40 mg of black cohosh can reduce the size of uterine fibroids by up to 30% ( 10 ).
• Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD). Although there are several claims on the Internet that black cohosh can help with PMS or PMDD, there is no substantial evidence to support this.
• Regulation of the menstrual cycle. In women with or without PCOS receiving fertility treatments such as clomid, black cohosh can help regulate the menstrual cycle ( 6 , 7 , 8 ).

cancer

Black cohosh has some potential estrogenic activity, which means that it behaves like an estrogen hormone, which can aggravate breast cancer or increase the risk of breast cancer ( 11 ).

However, most studies show that black cohosh does not affect breast cancer risk.In two human studies, taking black cohosh was associated with a reduced risk of breast cancer ( 11 ).

In test-tube studies, black cohosh extract showed anti-estrogenic activity and helped slow the spread of breast cancer cells ( 12 ).

However, more research is needed to understand the link between breast cancer and black cohosh.

Mental Health

Black cohosh may have beneficial effects on mental health, especially in postmenopausal women.

One review of studies looked at the use of herbal supplements for anxiety and depression in menopausal women. The researchers found that the addition of black cohosh did not affect anxiety, but was associated with a significant improvement in psychological symptoms ( 13 ).

However, more research is needed to fully understand the effects of black cohosh on mental health.

Sleep

While there is little evidence that black cohosh can improve sleep, it may help reduce symptoms that cause sleep disturbances in menopausal women, such as hot flashes.

However, one small study in 42 menopausal women found that black cohosh supplementation appeared to improve the duration and quality of sleep ( 14 ).

Another study noted that a combination of black cohosh and other compounds, including blueberries, zinc, ginger, and hyaluronic acid, helped reduce hot flashes, which were associated with insomnia and anxiety ( 15 ).

However, it is difficult to tell if black cohosh or one of the other ingredients was a beneficial compound in this mixture.

Weight loss

Menopausal women may be at increased risk of unwanted weight gain as their estrogen levels naturally decline ( 16 ).

In theory, because black cohosh may exhibit estrogenic effects, it may have a small beneficial effect on weight control in postmenopausal women ( 16 ).

However, the evidence to support this is minimal. More and more human studies are needed to understand the link, if any, between black cohosh and weight control.

Side Effects and Precautions

Black cohosh has some potential side effects, but they are usually mild. These include indigestion, nausea, skin rash, infection, muscle pain, breast pain or enlargement, and spotting or bleeding outside of the menstrual cycle (17).

However, black cohosh has also been associated with some serious cases of liver damage. For this reason, you should not take black cohosh if you have liver disease or are taking any other supplements or medications that may harm your liver (17).

Moreover, a recent animal study showed that high doses of black cohosh were associated with damage to red blood cells, leading to anemia. However, more research is needed to investigate these potential effects in humans ( 18 ).

Because black cohosh has not been studied extensively, you may experience some side effects that are not yet widespread. If you have any problems, see your doctor.

Dosage and How to Take

Black cohosh is available as capsules, liquid extract or tea.

Dosing recommendations vary greatly depending on the brand of black cohosh. Typical doses are 20 to 120 mg of standardized black cohosh extract or powder per day (17).

For menopausal symptoms, a daily intake of at least 20 mg of black cohosh, which is offered by most brands ( 4 ), is effective.

Some healthcare professionals state that you should not take black cohosh for more than 6 months to 1 year due to its slight potential to cause liver damage (17).

Since additives are primarily subject to aftermarket government regulation, you should choose black cohosh additives that have been third party verified. Some of these third party testing organizations include the United States Pharmacopoeia (USP) and ConsumerLab.

In addition, black cohosh is often sold in blends containing other herbal supplements, including:

• Red Clover. Black cohosh and red clover can be taken together to help manage symptoms of menopause, but there is no evidence that they are more effective than placebo ( 19 ).
• Soy isoflavones. Like black cohosh, soy contains phytoestrogens that may help improve hormonal problems or symptoms of menopause, but there is little evidence to support these potential effects ( 20 ).
• St. John’s wort. In combination with black cohosh, St. John’s wort has a positive effect on the symptoms of menopause ( 21 ).
• Chasteberry. Blueberry and black cohosh supplements are marketed to relieve symptoms of menopause, but there is little evidence that they are more effective than placebo ( 22 ).
• Dong Quai , Black cohosh and dong quai have been claimed to reduce menopausal symptoms and possibly induce labor in pregnant women, but there is no evidence to support this.
• Vitamin C. Vitamin C is recommended online along with black cohosh to induce miscarriage or abortion in case of unwanted pregnancy. However, there is no evidence to support this use.

Stopping and withdrawing

Abrupt cessation of black cohosh has been reported to cause no complications or known withdrawal symptoms.

Because black cohosh can potentially affect your hormones, you may experience changes in your menstrual cycle when you stop taking it.

If you have any concerns about stopping black cohosh, talk to your doctor.

overdose

It is not known if an overdose of black cohosh is possible. To ensure your safety and minimize the risk of liver damage, take no more than the recommended daily dose of your chosen black cohosh supplement.

If possible, buy a supplement that has been tested by a third party such as ConsumerLab or USP to ensure the ingredients in the supplement meet the label claims.

interactions

Black cohosh may interact with other medications and treatments. Its known interactions are:

• Hormone Replacement Therapy (HRT). Black cohosh may have some effect on hormone levels, especially estrogen levels, which may have unexpected effects when combined with HRT ( 23 ).
• Birth control pills. Most birth control pills are composed of estrogen and / or progesterone, so black cohosh, which can affect hormone levels, can interfere with hormonal birth control ( 6 , 7 , 8 ).

Black cohosh may have additional drug interactions that have not yet been identified. If you are taking any of the medicines listed above or have any concerns about black cohosh and other medicines, check with your doctor before taking them.

In addition, since one of the most serious side effects of black cohosh is liver damage, you should use caution when taking black cohosh in combination with any other supplement or medication that could damage your liver. Check with your healthcare professional.

Storage and Handling

Black cohosh should be stored unopened at room temperature. Typically, herbal supplements have a shelf life of less than 2 years after they are manufactured.For your safety, it is best to use or discard the supplement before the expiration date.

Pregnancy and Breastfeeding

In traditional Native American medicine, black cohosh was often used to increase breast milk production ( 24 ).

However, there is little evidence that it works for this purpose.

Black cohosh can also increase your chances of getting pregnant if you’re on fertility treatments, so your doctor may recommend adding it to your daily routine if you’re struggling to get pregnant.

Although most side effects are mild, little is known about the effects of black cohosh on pregnant women, lactating women, and babies.

However, the supplement has been used to induce labor and miscarriage, and while there is not enough evidence to support its use, some people on the Internet report success. However, labor should only be called on as directed by a qualified healthcare professional.

For these reasons, it is best to avoid it or discontinue use when you become pregnant or breastfeeding ( 24 ).

Use in Specific Populations

As a general rule, black cohosh is safe for most people who are not pregnant or breastfeeding.

However, there is no need to give the supplement to children. Because it can affect hormone levels, it should only be given to adolescents as directed by a qualified healthcare provider.

People with kidney disease should use caution when using black cohosh because little is known about the body’s ability to excrete it from the body if the kidneys are damaged.

In addition, given that one of the most serious potential side effects is liver damage, you should avoid black cohosh supplements if you have liver disease.

Alternatives

Some potential alternatives to black cohosh include blue cohosh, rapontic rhubarb, and evening primrose oil.

Blue cohosh is not related to black cohosh, but it is also a North American flowering plant that is used for women’s health.However, as with black cohosh, there is little evidence to support its use. It can also have serious side effects ( 25 ).

Rapontic rhubarb is used for many of the same reasons as black cohosh and is the active ingredient in the popular Estroven menopause supplement. It appears to have some benefits in treating menopausal symptoms ( 26 ).

Finally, evening primrose oil has the same effect as black cohosh on hot flashes, so it could be a promising alternative ( 4 ).

90,000 Black Cohosh efficacy, safety and drug interactions

• What other names is Black Cohosh known by?
• What is Black Cohosh?
• Is Black Cohosh Effective?
• How does Black Cohosh work?
• Is there a security problem?
• Are there any drug interactions?
• Dosing recommendations for Black Cohosh.

What other names is Black Cohosh known by?

Actaea macrotys, Actaea racemosa, Actée à Grappes, Actée à Grappes Noires, Actée Noire, Aristolochiaceae Noire, Baie d’actée, Black Cohosh, Baneberry, Black Aristolochiaceae, Black Snakeroot, Bugbane, Cimwicice Cugica , Cimica Cimica Cimica, Cimica Cimica, Cimica Cimica, Cimica Cimica, Cimica, Cimica, Cimica, Cimica, Cimica, Cimica, Cimica, Cimica, Cimica, Cimica, Cimica, Cimica, Cimica, Cimica Cimica, Cimica – Cimica – Cimica , Cim.Cimicifuge, Cohosh Negro, Cohosh Noir, Cytise, Herbe aux Punaises, Macrotys, Phytoestrogen, Phytoestrogen, Racine de Serpents, Racine de Squaw, Racine Noir de Snakes, Rattle Root, Rattle Top, Rattle Snake Roygat, Horned Horn Sheep Snakeroot, Squaw Root.

What is Black Cohosh?

Black cohosh is herb. The root of this herb is used medicinally. Black cohosh was first used medicinally by the Indian Indians who introduced it to European colonists.In the mid-1950s, black cohosh became a popular treatment for women’s health problems in Europe.

Since then, black cohosh has been widely used to treat menopausal symptoms, premenstrual syndrome (PMS), painful menstruation, weakened bones (osteoporosis) and to initiate labor in pregnant women. It is also used to improve sleep, breast cancer, heart disease, mental function, infertility, arthritis and indigestion.

Black cohosh has also been tested for many additional uses such as anxiety, fever, sore throat, and cough, but it is not often used for these purposes these days.

Some people also apply black cohosh directly to their skin. This is because some thought that black cohosh would improve the appearance of the skin. Likewise, people have used black cohosh for other skin conditions like acne, removing warts, and even removing moles, but this is rarely done anymore.

Black cohosh is also known as bugbein because it was once used as an insect repellent. It is no longer used for this purpose. Border guards said the black snail was good for rattlesnake bites, but no modern researcher has tested this.

Do not confuse black cohosh with blue cohosh or white cohosh. These are unrelated plants. Blue and white cohosh plants do not have the same effects as black cohosh and may be unsafe.

Is Black Cohosh Effective?

There is some scientific evidence that black cohosh can help relieve some of the symptoms of menopause, such as hot flashes, after about a month of treatment. But black cohosh doesn’t seem to help reduce hot flashes in women who have had breast cancer.

Insufficient information is available to know if black cog is effective for other conditions for which it is used, including: premenstrual syndrome (PMS), painful periods, indigestion, muscle aches, fever, sore throat, cough, and insect repellent.

Possibly Effective for …

• Menopause Symptoms , Research shows that certain black cohosh extracts can reduce some menopausal symptoms when taken internally.Much of this research relates to a specific commercial black cohosh product, Remifemin. Research shows that the effects of Remifemin on menopausal symptoms are comparable to hormone therapy. Not all products that contain black cohosh may have benefits.

  Studies using black cohosh products other than Remifemin have not always shown benefits of menopausal symptoms. Some studies show that other black cohosh foods do not reduce hot flashes or menopause symptoms better than sugar pills (“placebo”).

  Several studies have examined products containing black cohosh and other ingredients. Foods containing black cohosh plus St. John’s wort appear to reduce menopausal symptoms. Similar results were obtained for products containing black cohosh, Panax ginseng, soy and green tea extract or black cohosh, kava, hops and valerian extract. However, a homeopathic product containing black cohosh does not seem to be effective in reducing common symptoms of menopause, although it may reduce hot flashes.

  Some women take black cohosh for hot flashes associated with breast cancer treatments. Women with breast cancer should not use black cohosh without talking to their cancer specialist or other health care provider. Some early studies suggested that black cohosh may reduce hot flashes in breast cancer patients, but more recent, better quality research suggests that black cohosh does not reduce hot flashes in women with breast cancer.There is some question as to whether black cohosh is safe for women with breast cancer. It is important for a woman with breast cancer to discuss any use of black cohosh with her healthcare provider before using it.

Insufficient evidence to assess effectiveness …

• Breast cancer , One study suggests that taking black cohosh supplements is associated with a risk of death from breast cancer.However, other studies have found no connection. One study suggests that taking black cohosh can increase survival in women who are already diagnosed with breast cancer.
• Heart Disease , Early research shows that taking 40 mg per day of a specific black cohosh extract (CR BNO 1055) does not reduce the risk of heart disease in postmenopausal women.
• Mental function , Early research suggests that taking 128 mg of black cohosh daily for 12 months does not improve memory or attention in postmenopausal women.
• infertility , Early research suggests that taking 120 mg of black cohosh extract per day plus 150 mg of clomiphene citrate may increase the frequency of pregnancy in infertile women compared to clomiphene citrate alone. Other studies show that taking 120 mg of black cohosh and 150 mg of clomiphene citrate leads to pregnancy rates that are similar to those seen when taking clomiphene citrate with another fertility drug.
• Labor Induction .Some people report that black cohosh can help get you started.About 45% of nursing midwives use black cohosh to give birth to pregnant women on time. Despite its general use, there is no reliable scientific evidence that black cohosh works for this purpose.
• Migraine , Early research shows that taking 25 mg of black cohosh extract plus 75 mg of soy extract and 50 mg of dong quai twice daily for 24 weeks reduces the likelihood of menstrual migraines.
• Osteoarthritis , Early research suggests that taking a specific product containing black cohosh and other ingredients (Reumalex) daily for 2 months improves pain, but not joint function, in people with osteoarthritis.
• Weak bones (osteoporosis) , There is conflicting evidence on the benefits of black cohosh for the treatment or prevention of osteoporosis. One study shows that taking a product containing 40 mg of black cohosh (Remifemin, Schaper & Brümmer) for 3 months improves bone formation and reduces bone breakdown. Another study shows that taking another product containing 40 mg of black cohosh extract (CR BNO 1055, Klimadynon / Menofem, Bionorica AG) for 3 months increases markers of bone formation in postmenopausal women.However, other studies show that taking this black product does not improve bone mineral density. It is not known whether black cohosh reduces the risk of bone fractures.
• Rheumatoid Arthritis , Early research shows that taking a specific product containing black cohosh (Reumalex, Gerard House Ltd.) twice daily for 2 months improves pain, but not joint function, in people with rheumatoid arthritis.
• Acne .
• anxiety .
• Beetle bites .
• Cough .
• fever .
• Mole removal .
• Painful periods .
• Premenstrual Syndrome (PMS) .
• rheumatism .
• Snake bite .
• Sore throat .
• Removal of warts .

More evidence is needed to evaluate black cohosh for these uses.

Hot flashes – a directory of diseases – HealthInfo

Estrogens are most effective for treating hot flashes, but taking these hormones increases the risk of developing other health problems. Medications such as antidepressants and anticonvulsants can also reduce hot flashes.

Discuss the pros and cons of different treatments with your doctor. If hot flashes aren’t getting in your way, then you may not need treatment. For most women, hot flashes resolve on their own within a few years.

Hormone therapy
Estrogens and progesterones are hormones used to reduce hot flashes. Women who have had a hysterectomy (removal of the uterus) can only take estrogens. But if the uterus is preserved, then it is necessary to take progesterone together with estrogen to prevent the development of endometrial cancer.

In both cases, the latest guidelines from the American College of Obstetrics and Gynecology prescribe hormones in the lowest effective doses and for the shortest period of time necessary to relieve symptoms.

A combination drug – bazedoxifene and conjugated estrogens – has been approved for the treatment of menopausal symptoms. This drug does not increase the risk of cancer, but further research is needed for wider use.

Estrogen therapy is contraindicated in those with a history of thrombosis and breast cancer.

Antidepressants
Low doses of some antidepressants can reduce hot flashes. For example:

• Venlafaxine
• Paroxetine
• Fluoxetine

Brizdell is the only FDA approved antidepressant for the treatment of hot flashes, but it is more expensive than generics.The rest of the drugs are available without a prescription.

Antidepressants are not as effective as hormones in treating severe hot flashes, but may be helpful for women who cannot or do not want to take hormonal drugs. Possible side effects include headache, fatigue, nausea, dizziness, weight gain, dry mouth, sexual dysfunction, suicidal ideation, and withdrawal from abrupt withdrawal. Some side effects may diminish over time or after dosage adjustments.If you have suicidal thoughts while taking antidepressants, seek immediate medical attention.

Other drugs
Other drugs that may help some women:

• Gabapentin . Gabapentin is an anticonvulsant drug that is moderately effective in treating hot flashes. Side effects include drowsiness, dizziness, and headache.
• Clonidine . Clonidine, as a pill or patch used to treat high blood pressure, may help with hot flashes.Side effects include dizziness, drowsiness, dry mouth, and constipation.

Effect of black cohosh (Cimicifuga racemosa) on perfusion and liver function in postmenopausal women | Nasr A., ​​Nafeh H.

Due to the increase in life expectancy, women spend more than a third of their lives in postmenopausal women. Symptoms associated with menopause are known throughout the world [1]. Hormone replacement therapy (HRT) is an established form of treatment for these symptoms. However, both patients and healthcare practitioners have significantly changed their views on HRT after the publication of the results of two studies focused on the risks of HRT – the Initiative Randomized Controlled Study of Women’s Health in 2002.and an observational study involving 1 million women in 2003 [1,2]. HRT has also been associated with an increased risk of breast cancer [3]. And it was quite natural for scientists to actively use alternative treatments – safe, effective and non-hormonal.

Black cohosh (Cimicifuga racemosa) is one of the most commonly used herbal remedies for correcting menopausal symptoms, with a proven very good safety profile over the years [4,5].At the same time, the safety of C. racemosa has recently been questioned after the report of isolated, but serious cases of hepatotoxicity [6-8]. In 2006, hepatotoxic reactions were reported in 42 women using C. racemosa. Nevertheless, experts from the European Medicines Agency stated that all such cases and pharmacovigilance reports described in the literature were “poorly documented” [9]. We believe that it is obvious that there is a need for clinical trials devoted to induced C.racemosa of hepatotoxicity, since only a few clinical observations have appeared in recent reports. All this prompted us to conduct our own prospective clinical study in order to get a real picture of how safe the use of C. racemosa is for women’s health.
After receiving the approval of the ethical committee, 100 healthy women in menopause were included in the study – patients of the gynecological clinic of the Hospital for Women’s Health of the University of Assiut in Egypt.The final analysis included 87 women who completed the entire 12-month follow-up period. Their age ranged from 45 to 54 years (average age – 50.21 ± 2.18 years). Inclusion criteria: age over 40 years with the expiration of 1 year after the last menstrual period, presence of symptoms associated with menopause, absence of gynecological diseases, natural nature of menopause, not using HRT for> 6 months before the start of the study, obtaining written consent to participate in the study after detailed familiarization with the study design, as well as the possibility of regular visits to the doctor during the observation period.Exclusion criteria: vaginal bleeding, active or chronic liver disease and / or liver dysfunction, history of thromboembolism, breast or uterine tumors, endometrial thickness greater than 5 mm on transvaginal ultrasound, and the use of alternative, complementary, or herbal medicines to relieve symptoms menopause within 3 months prior to study initiation.
Menopause was confirmed by high FSH levels in all study participants. All women underwent a full clinical examination, ultrasound of the abdominal cavity and small pelvis, and were tested for hepatitis B and C.Before starting a daily dose of 40 mg of dry extract of C. racemosa (Klimadinon; Bionorica AG, Neumarkt, Germany) and 12 months after starting treatment, patients completed a questionnaire on the subjective assessment of menopausal symptoms (in particular, hot flashes). Total hepatic blood flow was also assessed using color Doppler scanning. In addition, prothrombin time and the concentration of serum albumin, bilirubin, γ-glutamyl transferase (GGT), alkaline phosphatase, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined.Ultrasound equipment used for Doppler studies – Siemens Sonoline Sienna Ultrasound Imaging (Siemens, Munich, Germany). The system operates in several modes: real-time 2D, B- and M-modes, spectral and color Doppler modes, and standby. Doppler study was carried out in accordance with the standard settings [10]. The study was carried out by the same specialist after an overnight fast of the patient and rest for 15 minutes in the supine position while holding the breath in the middle of the expiration.The examination included assessment of the portal vein and major hepatic arteries. Calculating blood flow requires measuring the diameter of the portal vein (in cm) and the maximum flow rate (in cm / s):
portal blood flow = 22 / 7x (d2) / 4xVmax / 2×60 (mm / min) [11].
Likewise, hepatic artery blood flow was measured in the main hepatic artery. Total hepatic blood flow was calculated as the average of three measurements of the sum of flows in the common hepatic artery and portal vein (total hepatic blood flow = hepatic arterial blood flow + portal vein blood flow).Prothrombin time was assessed using the DiaPlastin kit [12] (DiaMed AG, Morat, Switzerland). Serum albumin, total and direct bilirubin, ALT, AST, alkaline phosphatase, alkaline phosphatase (ALP), UUN levels were measured using a colorimetric test on an automated clinical chemistry analyzer (BM / Hitachi 911; Beringer, Mannheim, Germany).
Microsoft Access (Microsoft Corporation, Redmond, WA) was used to collect data that included the demographic and clinical characteristics of patients before and after treatment.Data were reported statistically as mean ± standard deviation (SD) for continuous values ​​and as frequencies and percentages for categorical values. Indicators were analyzed using the Social Science Statistical Package (version 13: SPSS Inc. Chicago, IL). Comparison of quantitative variables was performed using Student’s t-test, Wilcoxon and Pearson correlation analysis to examine individual correlations between measurements made before and after treatment.To compare categorical data, the x2 test was performed. Differences were considered statistically significant at p <0.05.
There were no statistically significant changes in weight or systolic and diastolic blood pressure after 12 months of Klimadinon use. However, there was a significant reduction in the prevalence, daily frequency and severity of hot flashes at 12 months (Table 1). There were no significant changes according to the results of the Doppler study of the blood flow of the hepatic artery, portal vein, or the total blood flow of the liver after 12 months of using Klimadinon (Table 1).1), as well as the studied parameters of liver function (Table 1).
Every year in the world, millions of women enter the menopausal period. The World Health Organization indicates that by 2030, approximately 1.2 billion women will be over 50, nearly 3 times the number of women in this age group in 1990 [13]. Many women refrain from using HRT to treat menopausal symptoms and turn to herbal remedies. Unfortunately, in most parts of the world, herbal medicines are not well regulated by federal agencies, such as the FDA in the United States.This leads to significant fluctuations in the composition, standardization, dosage and quality of available drugs [13].
Research has shown that more than three quarters of peri- and postmenopausal women in the richest countries take or have taken herbal medicines in the past. More than 2/3 of women describe them as healthy, natural, safer and more in line with their values, beliefs and lifestyle [13]. C. racemosa is a racemose black cohosh, a herbaceous perennial plant characteristic of North America, from the buttercup family, containing triterpene glycosides, flavonoids, aromatic acids, and other constituents [5].Many studies have shown the efficacy of C. racemosa in the control of vasomotor symptoms with a reduction in hot flashes [5,14]. Black cohosh has been reported to have a favorable safety profile with a shelf life of up to 6 months. The most common side effects are minor stomach complaints, which usually disappear over time. High doses, however, can cause headache, vomiting and dizziness [14]. There are no documented cases of drug interactions with black cohosh racemes [15].
Recently, there have been several alarming reports of cases of liver failure in women using black cohosh [16-18]. As mentioned above, in 2006 the European Medicines Agency reported on hepatotoxic reactions in 42 women treated with C. racemosa, but only in 4 cases the connection with the drug intake was reliable, in 2 cases it was possible and in 2 –X – probable [9]. The US National Institutes of Health recently stated that there is no known potential biological mechanism that could explain the hepatotoxic effects of black cohosh, and that millions of women using black cohosh have minimal side effects.Nevertheless, it was proposed to monitor liver function when studying black cohosh [19].
In the present study, C. racemosa was effective in relieving vasomotor symptoms, particularly hot flashes, resulting in significant reductions in prevalence, daily frequency and severity after 12 months of treatment (p <0.001). These positive results are consistent with the findings of many other studies [5,14]. With regard to hepatotoxic reactions, the potential mechanisms of drug-mediated hepatotoxicity were tested.The first is the vascular mechanism, through a possible change in blood flow to the liver, which was assessed using color Doppler ultrasonography. The second mechanism - direct toxic effect on liver cells was assessed according to the selected indicators of liver function. Given the dual blood supply to the liver, blood flow was measured in both the portal vein and the common hepatic artery.
This is, to our knowledge, the first report on the effect of C. racemosa on hepatic perfusion. There were no significant changes in the blood flow of the hepatic artery according to the results of Doppler examination, portal vein and general blood flow after 12 months of using C.racemosa. In addition, there were no significant changes in any indicator of liver function after 1 year of application of C. racemosa, and the level of all markers remained within the normal range of values. These results are consistent with data from two recently completed studies [9,20]. However, our data are inconsistent with the results of a recent animal study in which C. racemosa exerted a hepatotoxic effect in vivo and in vitro, which manifested itself in apoptotic cell death in rats [21].
Based on the results of this study and the available current literature, we believe that the use of a daily dose of 40 mg dry extract of C. racemosa for 12 months in healthy postmenopausal women with no history of liver disease and normal liver function is safe. We also suggest monitoring liver function while treating women with impaired liver function. We hope that this study will be a valuable contribution to the evidence base for the safety of C.racemosa (black cohosh) in relation to the liver. Nevertheless, large randomized controlled trials are required to confirm the validity of this statement.

The abstract was prepared by E.A. Klimova
based on article
A. Nasr, H. Nafeh “Influence of black cohosh
(Cimicifuga racemosa) use by postmenopausal women
on total hepatic perfusion and liver functions,
Fertility and Sterility, Vol. 92, No.5, November 2009

Literature
1. Heinemann K. Riibig A, Sixothmann A. Nairnm GG. Heinemann LA. Prevalence and opinions of hormone therapy prior to the Women’s Health Initiative: a multinational survey on four continents. .1 Womens Health (Larchmt) 2008; 17: I 151–66.
2. van de Weijer PH. Risks of hormone therapy in the 50–59 year age group. Maturitas 2008: 60: 59–64.
3. Clemons M, Goss P. Estrogen and the risk of breast cancer. N Engl J Med 2001; 344: 276-85.
4. Huntley A, Ernst E. A systematic review of the safety of black cohosh. Menopause 2003; 10: 58–64.
5. Nappi RE, Malavasi B. Brondu B, Facchinetti F. Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low – dose transdermal estradiol. Gynecol Endocrinol 2005; 20: 30-5.
6. Chow EC, Teo M, Ring JA, Chen JW. Liver failure associated with the use of black cohosh for menopausal symptoms. Med J Aust 2008; 188: 420-2.
7. Joy D, Joy J, Duane P.Black cohosh: a cause of abnormal postmenopausal liver function tests. Climacteric 2008: 11: 84-8.
8. Mabady GB, Low Dog T, Barrett ML. Chavez ML, Gardiner P, Co. R. el al. United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause 2008; 15: 628–38.
9. Firenzuoli F, Goril L, di Sarsina PR. Black cohosh hepatic safety: follow – up of 107 patients consuming a special cimicifuga racemosa rhizome herbal extract and review of literature. Evid Based Complement Alternal Med.In press.
10. Partiquin H. Lafortune M, Bums PN. Dauzat M. Duplex Doppler examination in portal hypertension: technique and anatomy. AJR Am J Roentgenol 1987: 149: 71-6.
11. Moriyasu F, Ban N. Nishida O, Nakamura T, Miyake T. Uchino H. et al. Clinical application on an ultrasonic duplex system in the quantitative measurement of portal blood flow. J Clin Ultrasound 1986; 14: 579-88.
12. Quick AJ. cd. Haemorrhagic diseases and thrombosis. Philadelphia: Lee and Febiger.1966.
13. Geller SE, Studee L. Contemporary alternatives to plant estrogens for menopause. Maturitas 2006; 55 (Suppl 1): S3-13.
14. Blumenthal M, ed. Cohosh, the ABC clinical guide to herbs. Austin, TX: American Botanical Council. 2002.
15. Pepping J. Black cohosh: Cimicifuga racemosa. Am Journal Health Syst Pharm 1999: 56: 1400-2.
16. Whiting PW. Clouston A. Kerlin P. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust 2002; 177: 440-3.
17. Lontos S, Jones RM. Angus PW. Gow PJ. Acute liver failure associated with the use of herbal preparations containing black cohosh. Med J Aust 2003; 179: 390-1.
18. Cohen SM, O’Connor AM, Hart J, Merel NH, Te HS. Autoimmune hepatitis associated with the use of black cohosh: a case study. Menopause 2004; 11: 575-7.
19. National Institutes of Health. Workshop on the safety of black cohosh in clinical studies. Washington, DC: National Center for Complementary and Alternative Medicine.National Institutes of Health Office of Dietary Supplements. 2004.
20. Mazzanti G. Di Sotto A. Franchitto A. Mastrangelo S. Pezzella M, Vitalone A. et al. Effects of Cimicifuga racemosa extract on liver morphology and hepatic function indices. Phytomedicine. In press.
21. Lude S, Torok M, Dieterle S. Knapp AC. Kaeufeler R. Jaggi R. et al. Hepatic effects of Cimicifuga racemosa extract in vivo and in vitro. Cell Mol Life Sci 2007; 64: 2848-57.

.

Complex for women to relieve symptoms of menopause Erbenobili MenopaVin drops 50 ml (EOV84)

Recommended for:

• symptoms of menopause
• tide
• alarming attacks
• unstable emotional background
• joint pain
• hormonal disorders

What is this?

Erbenobili MenopaVin is a plant-based multivitamin complex that can help women cope with the symptoms of menopause and improve their quality of life during this difficult period.

How does it work?

The main component of the MenopaVin complex is black cohosh, which is widely known as a helper for the female body. It relieves hot flashes in women during menopause, promotes the production of hormones of joy endorphins, that is, it improves mood and soothes the nervous system. Vitamins C and E are powerful antioxidants that slow down the aging process of the body. The minerals in the composition will strengthen bones, joints and tendons. Vitamin D has also been added to the formula for overall tone and health.

Indications for use

Take 20-30 drops, 2 times a day, diluted with a little water, preferably in the morning. Shake well before use.

Black

906 E tocopherol)

element	Weight	Unit	Percentage
Portion	20-30	drops
Portions per pack	a 17-256
600	mg
Chinese sage root extract	600	mg
Vitamin C (ascorbic acid)	80	mg	12	mg	100
Zinc	1.5	mg	15
Manganese	0.3	mg	156 0.15	mg	15
Vitamin D	5	μg	100 906 19

EFFECT FROM CHEREN KOHOSH WHEN REMOVED – VITAMINI AND ADDITIVES

Otzivite for cheren cohosh speak strongly for the additive.But the sponsor of the National Center for the extra and integrative health (NCCIH) for carrying out a little lesson and it comes from tyach sa with a low quality. Can you really help for slacking off or inflicting an overload on the taglo?

Otzivite for cheren cohosh they say strongly for the additive. Credit: Foodcollection RF / Foodcollection / GettyImages

What is Black Cohosh?

NCCIH kazwa, black cohosh plant, native to North America, member of the peperudite family.Dokato the Chinese and Indian Bilkari have crawled the plant for treatment on a radish of non-location, and for a little lesson in reinforcement for a lot from the health of the building.

Cheren cohosh has been crawling into the khorat sa teaching clinic for a single year without serious harm. Nay-cheto communicate the pages of the efektica shaved and upset with stomas. It is important to pay attention to the quality and type of additives that have been crawled, that is, it has been established that some of the Turgov additives from black cohosh will eat mixtures from black cohosh and other bilks, which are not suitable for the label.

Do not break black cohosh with sin cohosh. This ima is different and may not be safe to use from the choir. Ima communion for a combination of blues and black cohosh for a pre-labor. Because of this, it starts with more and more unfavorable effects for the future.

Crawling cohosh

Spored clinic in Cleveland, creeping cohosh crawling for menopausal symptoms but not FDA approved for any purpose.

Spared systematic pregled from September 2012 to a lot of teachings, published in Intervention , there is not enough evidence in reinforcement for creeping cohosh for menopausal symptoms, kato naddavane for teglo. Pregled iziskva additional research, for yes, teach me a lesson about the influence on the black cohosh in varchu, other important aspects are on the health of the marriage, the cat of sexuality, the health on the bone and the innocent quality on the belly.

Systematic pregled from February 2013On many lessons, published in Integrirana Cancer Therapy, all have been described by you and defined as a blackened cohosh influencing the highest risk of cancer on the gardat. Establish a little lesson that the present data will not reinforce the relationship between increasing the risk of cancer on grdat and using it on cheren cohosh.

To find out that there is enough evidence in support for the cohosh, which is effective treatment for the preparation of grief for patients with cancer on the gardat. Please report back if additional research is needed due to inconsistent results and security problems.

Ima is clearly a lipstick on the investigation of the black cohosh and how it is connected specifically with weakness or pressure on the teglo. Online you can and intend to get feedback from consumers for cheren cohosh, coito seklnat in him for managing the tegloto during menopause.

Interactions with cheren cohosh

Kogato stava duma for interactions with cheren cohosh, the risk of interactions with cheren cohosh and medications that can be biologically consumed by malc. NCCIH is a financier of the study, so please teach me more about how you can interact.

Clinic in Cleveland Pisch, which interacts with cheren cohosh can be found in fertility treatments, such as drugs, the limes of cato atorvastatin and cisplatin. It is important that you inform your doctor about any medications, over-the-counter medications, supplements and bills you are using for treatment.

Tryabva eat taka da gi notify if you push, drink alcohol or crawl illegal medicine, protection from tyakh can cause some kind of interaction with cohosh hack and can add or add black coffee to the coffee shop page.

Page efects on black cohosh include:

• Allergic reactions, especially allergic reactions to peperudi
• Problems with dischaneto
• viené on saint

for black fractions. Ako will feel dark or kafiava urine, light effusions, a lip for appetite or pozhltyavane on a skin or ochita, an additive from black cohosh, you can harm blackened shot and rag unforgettable and use medical help.

.