Black Cohosh

Black cohosh is a herbal remedy that can provide relief of menstrual discomforts such as cramps, bloating, and pain, as well as menopausal distress such as hot flashes, mood swings, night sweats, and insomnia.

Black cohosh, known to botanists as Actaea racemosa (formerly Cimicifuga racemosa), is indigenous to eastern North America and was used historically by First Nations people for relief of various ailments such as depression, gynecological disorders, kidney disorders, rheumatism, and sore throat. It was also used for colds, cough, constipation, hives, and backache and to induce lactation, as well as to relieve menstrual and menopausal distress.

The word “cohosh” is derived from the Algonquian word meaning “rough” and refers to the plant rhizome (fleshy, underground stems that grow horizontally), which is black, knobby, and irregular. Black cohosh is a perennial herb that grows 3.5 metres (8 feet) tall and has long plumes of white flowers. It is not to be confused with blue cohosh (Caulophyllum thalictroides), which is used as a stimulant to induce labour and childbirth.

Many women have turned to black cohosh as a safe alternative treatment for menopausal symptoms since July 2002, when the US Women’s Health Initiative determined that hormone and estrogen replacement therapies (HRT and ERT) increased risk of heart disease, blood clots, and breast cancer. The Data Safety Monitoring Board also indicated that the risks of HRT and ERT exceeded the benefits. Black cohosh is worth considering as an alternative to HRT and ERT. It succeeds in alleviating menopausal symptoms for many women.

The Jury is Out

In a 2002 physiological investigation of a unique extract of black cohosh, a six-month clinical study published in the Journal of Women’s Health and Gender-Based Medicine demonstrated no systemic estrogenic effect. Further, an article in the American Family Physician in 2003 reviewed recent studies on black cohosh, noting that little or no estrogenic effect exists and that the herb may even block some of the effects of estrogen. If so, black cohosh must work in some other way to relieve menopausal symptoms, but that process is not known. Until more scientific studies are completed, women with estrogen-sensitive cancers may still not want to take black cohosh, regardless of the herb’s relaxant and antispasmodic effect on nerves and muscles.

Black cohosh treats the unpleasant symptoms of PMS and menopause such as depression and minor aches and pains, serving as a mild anti-inflammatory. Research has also shown that black cohosh acts as a mild sedative and decongestant.

Cohosh Essentials

In capsule or tablet form, look for black cohosh products that have been standardized to contain 2.5 percent triterpenes glycosides–the herb’s active ingredient. This percentage has shown to be most effective in clinical trials. Freeze-dried black cohosh root in capsule form is another choice. For liquid forms of black cohosh, seek out products that have been standardized to a higher percentage, around 5 percent triterpenes glycosides, and follow the manufacturer’s recommended dosage. Allow six to eight weeks to see an effect.

A Few Provisos

Dr. Stanley M. Cohen, assistant professor of medicine at the University of Chicago, reported in the journal Menopause (September, 2004) a case of autoimmune hepatitis likely triggered by the use of black cohosh. According to Dr. Stanley, women with compromised liver health should tell their doctors if they are taking black cohosh, and ask for a liver function test. Also, black cohosh may interfere with oral contraceptives and other medications, and unless directed by a health care professional, Health Canada advises women who are pregnant or nursing not to take black cohosh.

Many women, for whom estrogen therapy or estrogen and progestin therapy is contraindicated, can find relief from symptoms of premenstrual syndrome, menstrual dysfunction, and menopause by using black cohosh. For women who find black cohosh ineffective, other herbal alternatives may provide relief. Ask your health care professional, or visit your local health food store to find alternatives.

Bone Health, Too

In a double-blind, placebo-controlled study that compared conjugated estrogen and black cohosh in a sample of postmenopausal women, Dr. Wolfgang Wuttke and colleagues at the University of G?ngen in Germany found black cohosh to have comparable effects on serum markers of bone metabolism as estrogen. Data on alkaline phosphatase (a marker for bone formation) or Cross Laps (a serum marker of bone degradation) indicate that black cohosh may protect bone health due to increased bone formation.