FACTS ABOUT BLACK COHOSH

FACTS ABOUT BLACK COHOSH

Black cohosh is an herb sold as a dietary supplement in the United States.

Black cohosh is used for hot flashes and other menopausal symptoms. Although preliminary evidence is encouraging, the currently available data are not sufficient to support a recommendation on the use of black cohosh for menopausal symptoms. The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health is funding a rigorous scientific study to determine whether treatment with black cohosh reduces the frequency and intensity of hot flashes, and other menopausal symptoms.

What is black cohosh?

Black cohosh (known as both Actaea racemosa and Cimicifuga racemosa), a member of the buttercup family, is a perennial plant that is native to North America. Other common names include black snakeroot, bugbane, bugwort, rattleroot, rattletop, rattleweed, and macrotys. Insects avoid it, which accounts for some of these common names.

What are common black cohosh preparations?

Preparations of black cohosh are made from its roots and rhizomes (underground stems). One commercial standardized black cohosh preparation is Remifemin®, which contains black cohosh extract equivalent to 20 mg of root per tablet. The manufacturer changed the formulation of this preparation from a solution (root extracted with ethanol, 60% by volume) to tablets (root extracted with isopropyl alcohol, 40% by volume), complicating the comparison of research results. Other preparations of black cohosh have been less well studied than Remifemin.

What are the historical uses of black cohosh?

Black cohosh was used in North American Indian medicine for malaise, gynecological disorders, kidney disorders, malaria, rheumatism, and sore throat. It was also used for colds, cough, constipation, hives, and backache and to induce lactation. In 19th-century America, black cohosh was a home remedy used for rheumatism and fever, as a diuretic, and to bring on menstruation. It was extremely popular among a group of alternative practitioners who called black cohosh "macrotys" and prescribed it for rheumatism, lung conditions, neurological conditions, and conditions that affected women's reproductive organs (including menstrual problems, inflammation of the uterus or ovaries, infertility, threatened miscarriage, and relief of labor pains).

Black cohosh and its effect on menopausal symptoms.

Black cohosh is used primarily for hot flashes and other menopausal symptoms. A number of studies using various designs have been conducted to determine whether black cohosh affects menopausal symptoms. Few studies were placebo controlled, and most assessed symptoms by using the Kupperman index-a scale that combines measures of hot flashes, insomnia, and depression but not vaginal dryness.

Although some study results suggest that black cohosh may help relieve menopausal symptoms, other study results do not. Studies of black cohosh have yielded conflicting data, in part because of lack of rigor in study design and short study duration (6 months or less). In addition, interpretation of these studies is complicated by the fact that different amounts of black cohosh from different sources were used in the various studies and their outcome measures were different.

To provide more definitive evidence on the effects of black cohosh on menopausal symptoms, NCCAM is funding a 12-month, randomized, placebo-controlled study to determine whether treatment with black cohosh is effective in reducing the frequency and intensity of menopausal hot flashes. The study will also assess whether black cohosh reduces the frequency of other menopausal symptoms and improves quality of life. The study will examine the possible mechanisms of action of black cohosh. (Women who are interested in participating in the study, which is at Columbia University in New York City, can find out more at www.clinicaltrials.gov or 1-212-342-0110.)

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