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Black cohosh (Cimicifuga racemosa, Actaea racemosa)

Synonyms/Common Names/Related Substances:

  • 5-HT(7) ligand, Actaea macrotys, Actaeapachypoda, Actaeapodocarpa, Actaea racemosa L., Actaearubra, actaealactone, actée à grappes (French), Amerikanisches Wanzenkraut (German), Appalachian bugbane, baneberry, BCE, black bugbane, black cohosh root extract Cr 99, black cohosh roots, black snakeroot, Botrophis serpentaria, bugbane, bugwort, caffeic acid, Cimicifuga, Cimicifuga racemosa, Cimicifugae racemosae rhizoma, Cimicifugawurzelstock (German), cimicifugic acid A, cimicifugic acid B, cimicifugic acid D, cimicifugic acid E, cimicifugic acid F, cimicifugic acid G, cohosh bugbane, CR, CR BNO 1055, CR extract, ferulic acid, fukinolic acid, herbe au punaise (French), ICR, isoferulic acid, isopropanolic black cohosh extract, isopropanolic extract, macrotys, Macrotys actaeoides, methyl caffeate, mountain bugbane, N-omega-methylserotonin, p-coumaric acid, phytoestrogen, protocatechualdehyde, protocatechuic acid, Ranunculaceae (family), rattle root, rattle snakeroot, rattle top, rattle weed, rattlesnake root, rattleweed, Remifemin®, rhizoma Actaeae, rich weed, richweed, schwarze Schlangenwurzel (German), snakeroot, solvlys, squaw root, squawroot, Thalictrodes racemosa, Traubensilberkerze (German), triterpene glycosides, Wanzenkraut, Ze 450.
  • Combination product examples: GYNO-Plus (black cohosh and St. John's wort), PNC (pennyroyal, red raspberry, lobelia, blue cohosh, black cohosh, blessed thistle), Phyto-Female Complex (standardized extracts of black cohosh, dong quai, milk thistle, red clover, American ginseng, chaste-tree berry), Reumalex® (contains 35mg of black cohosh, 100mg of white willow bark, 25mg of sarsaparilla (4:1), 17mg of poplar bark (7:1), and 40mg of guaiacum resin).
  • Note: Black cohosh (Cimicifuga racemosa) is not to be confused with blue cohosh (Caulophyllum thalictroides) , which contains potentially cardiotoxic or vasoconstrictive chemicals. Black cohosh (Cimicifuga racemosa) is also not to be confused with Cimicifuga foetida, bugbane, fairy candles, or sheng ma; these are species from the same family (Ranunculaceae) with different therapeutic effects.

Clinical Bottom Line/Effectiveness

Brief Background:

  • Black cohosh, a perennial plant from the buttercup family, is one of the best-selling supplements in the United States and is popular as an alternative to hormonal therapy in the treatment of menopausal (climacteric) symptoms such as hot flashes, mood disturbances, diaphoresis, palpitations, and vaginal dryness (1;2;3;4;5;6;7). With the exception of formononetin, extracts from black cohosh are not considered phytoestrogens (8). Several controlled trials and case series have reported black cohosh to improve menopausal symptoms for up to one year. Systematic reviews and meta-analyses report a mixed result for the effectiveness of black cohosh on climacteric symptoms. Black cohosh has been traditionally used for menstruation problems (5;9).
  • The mechanism of action of black cohosh remains unclear, and the effects on estrogen receptors or hormonal levels (if any) have not been fully elucidated. Studies suggest that there may be no direct effects on estrogen receptors, although this is an area of active controversy (10;11;12;13;14;15;16;17). Safety and efficacy data beyond one year are lacking, although reports suggest safety with short-term use, including in women experiencing menopausal symptoms for whom estrogen replacement therapy is contraindicated (18;19;20). Use of black cohosh in high-risk populations (such as in women with a history of breast cancer) should be under the supervision of a licensed healthcare professional.
  • Since the Women's Health Initiative Trial was halted early due to an excess risk of stroke and other adverse outcomes, millions fewer women are using prescription hormone replacement therapy. However, a 2005 survey showed a lack of appreciable increase in alternative therapies, including black cohosh (21).
  • Studies and reports of liver damage due to the use of black cohosh has led to the development of recommendations from several regulatory agencies to help promote safety and a better understanding of black cohosh (22;23;24;25;26;27;28). A true causal relationship is considered questionable by several researchers in the field due to confounding factors (29;30;31;32;33;34;35;36;37).
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Dosing/Toxicology

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Precautions/Contraindications

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Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

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Mechanism of Action

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History

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Evidence Table

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Evidence Discussion

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Products Studied

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Author Information

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References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.