Black Cohosh: Benefits, Dosage, Contraindications
Other name(s)
Actea Racemosa, Black cohosh, cimicifuga, black snakeroot
Scientific name(s)
Cimicifuga racemosa, Actea racemosa
Family or group:
Plants
Active ingredients:
Alkaloids
Salicylic Acid
Indications
Rating methodology
EFSA approval.
Menopause ✪✪✪✪✪
Several studies have shown that black cohosh was effective in reducing vasomotor symptoms (hot flashes, night sweats) associated with menopause. The ESCOP indicates that black cohosh is used for symptoms associated with menopause such as hot flashes, excessive sweating, sleep disturbances, and nervous irritability. More recent studies indicate that the magnitude of these effects is modest when focusing on high-quality studies.
Posologie
Oral route: rhizome, root
5 mg
6 - months
Women
Dry extract
Black cohosh with or without St. John's wort for symptom-specific climacteric treatment--results of a large-scale, controlled, observational study.
European Union herbal monograph on Cimicifuga racemosa (L.) Nutt., rhizoma
Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis.
Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect.
Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol
Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect.
European Union herbal monograph on Cimicifuga racemosa (L.) Nutt., rhizoma
Morning/evening menopausal formula relieves menopausal symptoms: a pilot study.
Cimicifuga BNO 1055 preparation against conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers.
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.
Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial.
A randomized placebo-controlled trial on the effectiveness of an herbal formula to alleviate menopausal vasomotor symptoms.
Premenstrual Syndrome ✪✪✪✪✪
A study suggests that a combination of dong quai (100 mg), soy isoflavones (60 mg), and black cohosh (50 mg) would reduce the frequency of sudden migraines related to premenstrual syndrome.
Posologie
Oral route: rhizome, root
50 mg
24 - weeks
Dry extract
Synergies
Dysmenorrhea ✪✪✪✪✪
Black cohosh is also suggested for relieving painful or irregular periods, as well as premenstrual syndrome.
Posologie
Oral route: rhizome, root
5 mg
Dry extract
Properties
Estrogenic Action
Black cohosh has estrogen-like effects exerted through an unknown mechanism. Studies on animals suggest that black cohosh extracts do not bind to estrogen receptors, do not upregulate estrogen-dependent genes, and do not stimulate the growth of estrogen-dependent tumors. However, animal studies have shown that black cohosh may suppress the pituitary secretion of luteinizing hormone (LH). It is believed that black cohosh may have selective effects on estrogen receptors and therefore exert estrogenic effects on some tissues and anti-estrogenic effects on others.
Usages associés
Anti-inflammatory
Fukinolic acid found in black cohosh is a powerful inhibitor of neutrophil elastase involved in inflammatory reactions. Black cohosh has an anti-inflammatory effect on the entire reproductive system, whether at the ovarian or uterine level: menstrual cramps, pain, and inflammation associated with endometriosis, ovarian or fallopian tube inflammation... In vitro, it has been shown that cimicifugate A, a constituent of black cohosh, inhibits the production of tumor necrosis factor (TNF-alpha) induced by lipopolysaccharides (LPS) in primary blood macrophages. Similarly, it has been demonstrated that isoferrulic acid, a constituent of black cohosh, decreased the release of pro-inflammatory cytokines interleukin (IL)-6, TNF-alpha, and interferon (IFN)-gamma.
Usages associés
Antioxidant
The high antioxidant content in black cohosh extracts allows it to neutralize radicals and protect DNA from oxidative damage.
Usages associés
Neurological
Preliminary research suggests that black cohosh may act as a partial agonist of serotonin receptors. This effect may potentially play a role in reducing menopause symptoms. Other in vitro studies suggest that black cohosh extracts may function as agonists of the mu-opioid receptor (a neurotransmitter receptor widely distributed in the brain). The mu-opioid receptor is essential for temperature and hormonal homeostasis, which may explain black cohosh's effects on alleviating menopause symptoms, such as hot flashes.
Usages associés
Safety dosage
Adult aged 18 years and over: 40 mg - 140 mg (dry extract)
Black cohosh has been safely used in some studies for a period of up to one year. However, black cohosh may cause liver problems in some patients. Indeed, several case reports link black cohosh to liver failure or autoimmune hepatitis. Medical advice is recommended before prolonged consumption of black cohosh.
Interactions
Médicaments
Atorvastatin: moderate interaction
A case has been reported of a patient taking black cohosh who experienced elevated liver enzymes after combining with Atorvastatin. It is unclear whether the elevation in liver enzymes was due to black cohosh or an interaction between Atorvastatin and black cohosh. Until more is known, patients are advised to use black cohosh with caution if they are taking Atorvastatin.
Cisplatin: moderate interaction
An animal study suggests that black cohosh may decrease the cytotoxic effect of cisplatin on breast cancer cells.
Cytochrome P450 substrates: moderate interaction
Some clinical research suggests that black cohosh may inhibit cytochrome P450 2D6 (CYP2D6) and increase levels of drugs metabolized by this enzyme. Medications metabolized by CYP2D6 include amitriptyline (Elavil), codeine, desipramine (Norpramin), flecainide (Tambocor), haloperidol (Haldol), imipramine (Tofranil), metoprolol (Lopressor, Toprol XL), ondansetron (Zofran), risperidone (Risperdal), tramadol (Ultram), venlafaxine (Effexor), among others.
Precautions
Breastfeeding woman: avoid
Black cohosh may have hormonal effects. Theoretically, the intake of black cohosh by the breastfeeding mother may have an adverse effect on the child.
Breast cancer: avoid
Research on animal models suggests that black cohosh could increase the risk of metastases in cases of existing breast cancer. However, other clinical studies suggest that black cohosh does not significantly increase the risk of breast cancer. Until more is known, women with a history of breast cancer or at risk of breast cancer should avoid using black cohosh.
Hormone-sensitive condition: avoid
Black cohosh does not seem to affect estrogen receptors, but it has not been studied for more than 2 months in women with hormone-sensitive conditions. Until more is known, women with hormone-sensitive conditions should avoid black cohosh. These conditions include uterine cancer, ovarian cancer, endometriosis, and uterine fibroids.
Liver disorders: avoid
There is concern that black cohosh is associated with cases of liver failure and autoimmune hepatitis. Until more is known, patients with liver disease are advised to avoid using black cohosh.
Protein S deficiency: avoid
There is concern that black cohosh may increase the risk of thrombosis in patients with protein S deficiency due to its estrogenic activity. A case of retinal vein thrombosis was noted in a patient with protein S deficiency and systemic lupus erythematosus, 3 days after taking a combination product containing black cohosh.
Contraindications
Pregnant woman: prohibited
Black cohosh may have hormonal effects and stimulate uterine contractions. Theoretically, this could increase the risk of miscarriage.
