Black cohosh (cimicifuga racemosa), also known as snakeroot, bugbane and rattle weed, is native to eastern North America, and has historically been used by Native Americans for a variety of female conditions. Black cohosh contains a variety of phytoestrogens. The German Comminssion E has approved black cohosh for the treatment of menopausal symptoms, premenstrual syndrome, and dysmenorrhea, however they recommend treatment be limited to 6 months. You can find Hot-Flash with black cohosh here.
     Studies with black cohosh root have shown inconsistent results in reducing hot flashes in postmenopausal women. However, a survey of women done at the University of San Francisco published in Feb 2002 indicated that women who use a combination of herbal remedies and estrogen were more satisfied in the outcome of their symptoms compared to women who used estrogen alone or herbs alone. The supplements used were black cohosh, ginkgo, and soy.
     At this time there is debate in the herbal community on the role and effectiveness of black cohosh in treating female conditions. However, historically black cohosh has been used to treat some symptoms of menopause. For more up to date information on black cohosh.

Black Cohosh Extract , 40 mg, 90 Capsules - Natural Factors
Natural Support for Menopause Symptoms


Natural Factors Black Cohosh Extract capsules contain extract standardized to 2.5% triterpene glycosides. Containing valuable phytoestrogen, Black Cohosh has been used for a number of feminine conditions and recently been recognized for its ability to support menopause symptoms naturally.

Suggested Usage:  1 black cohosh capsule, 1- 2 times per day preferably before meals or as directed by a health care professional.

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Black Cohosh active ingredients
Black cohosh root contains triterine glycosides such as cimifugaside, 27-deoxyactein and actein.

Black Cohosh for the treatment of hot flashes
Hot flashes cause significant disturbances in postmenopausal women, including women with breast cancer. A pilot study was undertaken to evaluate the effectiveness of black cohosh in reducing hot flashes. Women who reported significant hot flashes (greater than 14 per week) were enrolled. The first week was a no-treatment baseline period, and therapy was given for the subsequent 4 weeks. Patients reported an average of 8 hot flashes per day during the baseline week. The reduction in mean daily hot flash frequency was 50%, while weekly hot flash scores were reduced 56% at completion of the study. Overall, patients reported less trouble with sleeping, less fatigue, and less abnormal sweating. No patients stopped therapy because of adverse effects. Conclusion: black cohosh appeared to reduce hot flashes and had a low toxicity.
    The results of studies evaluating black cohosh in the therapy of menopausal symptoms have not been consistent, but the majority of studies lean towards this herbal extract providing some sort of benefit, but certainly not in any way as powerful as estrogen itself. But estrogen has its risks, and, if needed, should be used at the lowest effective dose and hopefully not for very extended periods.

Black cohosh, estrogen activity and as a phytoestrogen
Research with substances in black cohosh has not provided to us a complete understanding on what kind of estrogenic or anti-estrogenic activity this herb has.

Ethanolic extracts of black cohosh (Actaea racemosa) inhibit growth and estradiol synthesis from estrone sulphate in breast cancer cells.
Maturitas. 2006 Nov 22; Developmental and Endocrine Signalling, Division of Basic Medical Sciences, St. George's University of London, Cranmer Terrace, London SW17 0RE, UK.
Extracts of black cohosh (Actaea racemosa) and soy are used as 'natural' alternatives to conventional hormone replacement therapy (HRT) and there is some evidence that soy may protect against breast cancer by inhibiting the production of active oestrogens. This study compares the action of ethanolic extracts of black cohosh and genistein on growth and enzyme activity in MCF-7 and MDA-MB-123 breast cancer cells. Black cohosh inhibited growth at the two highest doses tested, i.e. 50 and 100mug/ml, whilst genistein stimulated growth in the estrogen receptor positive  MCF-7 cells, but at high doses it inhibited growth in both cell lines. Black cohosh did not affect the conversion of androstenedione to estradiol and only the highest doses (50 and 100mug/ml) significantly inhibited the conversion of estrone to estradiol in MDA cells. In contrast, black cohosh induced a dose-dependent inhibition of the conversion of estrone sulphate to estradiol in both cell lines, whilst in human granulosa lutein (GL) cells enzyme activity was only inhibited at the highest dose of black cohosh. Genistein had no significant effect on enzyme activity in breast cancer cells and like black cohosh only the highest doses (10 and 50muM) inhibited enzyme activity in human GL cells. In vivo genistein may have growth stimulatory effects on breast tissue but black cohosh not only inhibits growth but inhibits the conversion of estrone sulphate to active estradiol, considered by some, to be the preferred pathway of estradiol synthesis in breast tissue.

Evidence for selective estrogen receptor modulator activity in a black cohosh (Cimicifuga racemosa) extract: comparison with estradiol-17beta.
Eur J Endocrinol. 2003 Oct;149(4):351-62. Department of Clinical and Experimental Endocrinology, University of Gottingen, Robert-Koch-Strasse 40, D-37075 Gottingen, Germany.
Some phytoestrogens are believed to have selective estrogen receptor modulator (SERM) activity with no action in the uterus but beneficial effects in the hypothalamo / pituitary unit and in the bone and are presently the focus of clinical interest. In the present experiments, the effects of the clinically used Cimicifuga racemosa ( black cohosh ) extract BNO 1055 in the uterus, in the bone and on serum luteinizing hormone (LH) were compared with the effects of estradiol-17beta (E(2)) under acute and chronic conditions in ovariectomized rats. These data confirm the concept that the black cohosh extract BNO 1055 contains as yet unidentified substances with SERM properties which act in the hypothalamo/pituitary unit and in the bone but not in the uterus.

Estrogenicity of black cohosh (Cimicifuga racemosa) and its effect on estrogen receptor level in human breast cancer MCF-7 cells.
Wei Sheng Yan Jiu. 2001 Mar;30(2):77-80. Institute of Nutrition and Food Hygiene, Chinese Academy of Preventive Medicine, Beijing 100050, China.
The estrogenicity of Black Cohosh (Cimicifuga racemosa, CR) was tested in vivo and in vitro and its effect on estrogen receptor level of human breast cancer MCF-7 cells were investigated. Based on the body weight of animals, 75, 150 and 300 mg/kg of black cohosh were administered by tube feeding to immature female mice for 14 days. Estrus was observed and the uterine and ovary weights of mice were measured. Taking all the results together, black cohosh has an estrogen-like action. The enhancing effect of black cohosh on estrogen receptor level is one of the potential mechanisms involved with its therapeutic role in climacteric syndrome.

No estrogen-like effects of an isopropanolic extract of Rhizoma Cimicifugae racemosae on uterus and vena cava of rats after 17 day treatment.
J Steroid Biochem Mol Biol. 2005 Nov;97(3):271-7. Institut fur Zoologie, Technische Universitat Dresden, Germany.
The effects of black cohosh extracts (Rhizoma Cimicifugae racemosae) on primary estrogen target organs, like mammary gland and endometrium are better described then those on other estrogen-sensitive systems e.g. the vasculature. We therefore treated ovariectomized DA/Han rats for 17 days with an isopropanolic Cimicifuga racemosa rhizoma extract (iCR) alone and in combination with the pure antiestrogen fulvestrant. As control groups vehicle, estradiol, fulvestrant, and estradiol fulvestrant cotreatment were used. Contrary to earlier suggestions black cohosh does not seem to act as an estrogen agonist, but possibly as a weak antiestrogen.

Analysis of thirteen populations of black cohosh for formononetin.
Phytomedicine. 2002 Jul;9(5):461-7. Department of Biological Sciences, Lehman College and The Center for Graduate Studies, The City University of New York, Bronx, NY 10468, USA.
Black cohosh (Actaea racemosa L. syn. Cimicifuga racemosa (L.) Nutt.), a North American perennial plant, is a promising natural alternative to hormone replacement therapy for treating menopausal symptoms, but the mechanism of action is not understood. The clinical actions of this plant have been attributed to the isoflavonone formononetin since 1985, when its presence was reported in a black cohosh extract. Others have since looked for formononetin, but have not detected it. We looked for formononetin in extracts of black cohosh roots and rhizomes collected in thirteen locations in the eastern United States, including Maryland, New Jersey, New York, North Carolina, Pennsylvania, Virginia, and Tennessee. The rhizome samples were extracted using 80% methanol, and the extracts were partially purified using solid-phase extraction to concentrate any isoflavonoids that might be present. We tested for formononetin in these partially purified samples using thin-layer chromatography and high-performance liquid chromatography with a photodiode array detector and a mass spectrometer. Formononetin was not detected in any of the thirteen plant populations examined.

Black Cohosh additional research
Black cohosh, when given to mice, did not increase the risk of breast cancer, but in those that did develop it, the herb apparently made it more likely to spread. This study contradicts another study listed below.
Black cohosh has a non-estrogenic, or estrogen-antagonistic effect on human breast cancer cells. This leads to the conclusion that black cohosh treatment may be a safe, natural remedy for menopausal symptoms in breast cancer.
Chemicals within black cohosh can protect against cellular DNA damage caused by reactive oxygen species by acting as antioxidants.

Black Cohosh dosage and availability
Black cohosh is sold either by itself, or combined with other herbs and nutrients. The dosage of black cohosh extract used in the majority of clinical studies has  been based on the level of a key marker, 27-deoxyactein. The recommended dosage for the relief of menopausal symptoms is one tablet of 20 mg taken twice daily, or one 40 mg capsule daily, with benefits hopefully seen in one to three months.

Not All Black Cohosh Is the Same - press release by Enzymatic Therapy, Inc.
GREEN BAY, Wis., Dec 20, 2006 /PRNewswire via COMTEX/ -- Over 90 research papers, 15 published studies and 50 years of usage by women worldwide show that Remifemin black cohosh is effective for alleviating menopausal symptoms including hot flashes, night sweats and occasional mood swings. Although research just published in the Annals of Internal Medicine (Dec 19, 2006;145:869-879) concluded that the type of black cohosh used in this study is ineffective for treating menopause-related symptoms, the study did not use the proprietary Remifemin black cohosh.
"Not all black cohosh is the same," said Dr. Eckehard Liske, Director of the International Medical Department, Shaper & Brummer GmbH, Salzgitter, Germany. "Remifemin is produced using a proprietary isopropanolic extraction method which yields a more complete spectrum of active compounds than other extraction methods. The body of published research on Remifemin demonstrates consistent positive results, unlike other black cohosh extracts." "Multiple randomized controlled trials clearly show the benefits of Remifemin in relieving the symptoms of menopause," explained Dr. Liske. "The most recent study by Osmers (2005) found a statistically relevant effect of Remifemin in relieving menopausal symptoms including hot flashes. This study was reviewed by the North American Menopause Society and given the highest level of validation. Remifemin is a safe and effective intervention for the relief of hot flashes and other vasomotor symptoms associated with menopause." Remifemin comprises a proprietary, standardized extract (uniform dosage) of pure black cohosh root called RemiSure. It is the most OB/GYN-recommended non-prescription menopausal therapy. The German E Commission has approved the use of 40 mg/day of black cohosh (Remifemin brand) for 6 months for relief of menopausal symptoms, as well as for premenstrual syndrome (PMS) and dysmenorrhea. "Remifemin black cohosh is clearly the world's most clinically tested black cohosh product," said Mark Blumenthal, Founder and Executive Director of the American Botanical Council. "At least 15 clinical trials demonstrate the safety and efficacy of the product, manufactured according to the latest GMPs by Shaper & Brummer GmbH, a highly respected German phytomedicine company with over 50 years of experience in manufacturing and testing Remifemin. Most of the scientific literature on black cohosh was conducted on Remifemin including recent clinical trials showing no estrogenic activity of the product," he explained.
   Comments: More research will be needed to figure out whether black cohosh is effective for menopausal symptoms and whether there are differences between different brands.

Black cohosh extract availability by herbal suppliers
Black cohosh extract is sold in a number of concentrations and extract potencies including 2.5 percent triterpene glycosides.

Black Cohosh emails
Q. I came across a web page on black cohosh regarding phytoestrogens. Black Cohosh : by Ray Sahelian, M.D.
" . . . Black cohosh contains a variety of phytoestrogens. . . " I'm wondering what phytoestrogens black cohosh contains. Freddi Kronenberg didn't find any formononetin and Susan Love's newest book says it doesn't have any phytoestrogens. I'm confused.
   A. See the studies above that discuss the ingredients found in black cohosh that have some estrogenic activity.

Q. I wonder if black cohosh has been causing my headaches. I quit taking it a week ago to see if they would go away. How long does black cohosh stay in the system?
   A. The positive or negative effects of black cohosh in most cases are likely to go away within a few days depending on the dosage used and the length of time it was taken.

Q. I've heard that black cohosh can aid in breast growth for males who are involved in crossdressing and are seeking to try to grow breasts. Is there a danger for males in taking black cohosh herb?
   A. We are not aware of any research regarding breast growth in men with the use of black cohosh herb.

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