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. 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 symptoms of menopause. If you wish to lose weight with natural herbs, consider Diet Rx.

Black Cohosh Extract , 40 mg, 90 Capsules - Natural Factors
Natural Support for Menopause Symptoms
Standardized Potency • Women's Formula

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 and St. John's wort for Menopause
The combination of black cohosh and St-Johns-Wort reduces the physical and psychological symptoms of menopause. St. John's wort is used to treat mild to moderate depression, while women have taken black cohosh for menopausal complaints. To see if a fixed combination of the herbal medicines could benefit women with depression and menopausal symptoms, researchers studied 300 women. Of these women, half took the St. John's wort and black cohosh combination, while the other half took placebo pills. After four months, women who took the two-herb combination showed a 50 percent reduction in symptoms such as hot flashes and sweating, compared to 20 percent for those on placebo. The women who were on the herbs also had much better mood. There was no significant difference between the groups in the number of side effects. The improvement in menopausal symptoms was similar to that seen among women taking hormone therapy for three months. Source: Obstetrics & Gynecology, February 2006.
    Comments: Treating menopausal symptoms effectively with few side effects is not easy. Estrogen works but it has potential long term side effects. Only half of the women benefited from the herbal combination, but that's better than nothing. If women are interested in taking black cohosh and St. John's wort, I would suggest they discuss with their doctor first who may agree to this dosage. Two capsules of black cohosh in the morning along with one capsule of St. John's wort 300 mg. There may be women who respond to half this dosage while others may need more. You can experiment for yourself and take more or less depending on your symptoms. Be a little careful with St. John's wort since the effects can accumulate after several days and you may need to take less with time. If you get insomnia, you may be taking too much.

Black cohosh and cancer risk
Dr. Timothy R. Rebbeck of the University of Pennsylvania School of Medicine in Philadelphia compared 949 women with breast cancer to 1,524 healthy controls. Women who reported taking black cohosh (5 percent of blacks and 2 percent of whites) were at 61 percent lower risk of breast cancer. Also, those who took an herbal preparation derived from black cohosh called Remifemin had a 53 percent lower risk of the disease. Previous studies have shown that black cohosh can block cell growth. The herb is also an antioxidant, and has been shown to have anti-estrogen effects as well. International Journal of Cancer, April 1, 2007.

Black Cohosh additional study
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.

Black Cohosh: What is the opinion of the medical establishment?
The field of hormone or herbal therapy during or after menopause is very complicated and there is no consensus within the medical community regarding the best option for long term therapy. The medical community seems to be shifting its viewpoint on hormone replacement. It appears that most traditional doctors now prefer using low doses of hormones for a brief period of time to treat menopausal symptoms, but prefer not to continue hormone replacement therapy indefinitely as in the past. Black cohosh is not well known in the medical community.

Black Cohosh info
Black cohosh, also known by either its scientific names (Actaea racemosa and Cimicifuga racemosa) is a member of the buttercup family (Ranunculaceae) and is native to the Eastern United States. The roots and rhizomes (lateral roots) of the herb have a long history of traditional use by native American tribes to deal with genitourinary complaints in women. An isopropanolic extract of black cohosh ( Remifemin ) has been used in German clinical practice since the mid-1950s with safe and effective results, and black cohosh preparations have been approved by the German government as safe and effective nonprescription medications for treatment of menopausal symptoms. In the past few years black cohosh has become increasingly popular as the most widely-used natural alternative to hormone replacement therapy. The herb’s popularity with middle-aged women and gynecologists grew significantly after the summer of 2002 when a large-scale government-sponsored clinical trial on HRT was halted prematurely after evidence that HRT was responsible for an increase in cancer and cardiovascular disease in menopausal women. Black cohosh preparations ranked eighth of all single-herb supplements sold in mainstream retail outlets in 2005.

Black Cohosh study
The Cimicifuga (black cohosh) preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers.
Wuttke W, 2003 Mar 14;44 Suppl 1:S67-77. University of Gottingen, Robert-Koch-Strasse 40, 37075 Gottingen, Germany.
In the present study, therapeutic effects of the Cimicifuga racemosa (black cohosh) preparation CR BNO 1055 (Klimadynon/Menofem) on climacteric complaints, bone metabolism and endometrium will be compared with those of conjugated estrogens (CE) and placebo. The question whether black cohosh contains substances with selective estrogen receptor modulator (SERM) activity will be investigated. METHODS: Sixty-two evaluable postmenopausal women were included in the double-blind, randomized, multicentre study, and treated either with (black cohsoh (daily dose corresponding to 40 mg herbal drug), 0.6 mg CE, or matching placebo, for 3 months. Menopausal symptoms were assessed by the menopause rating scale (MRS) and a diary. Levels of CrossLaps (marker of bone degradation) were determined by ELECSYS system and bone-specific alkaline phosphatase (marker of bone formation) by an enzymatic assay. Endometrial thickness was measured via transvaginal ultrasound; vaginal cytology was also studied. The primary efficacy criterion was the change from baseline to end point in the MRS. Change from baseline was analyzed for the secondary variables too. RESULTS: black cohosh proved to be equipotent to CE and superior to placebo in reducing climacteric complaints. Under both verum preparations, beneficial effects on bone metabolism have been observed in the serum. Black cohosh had no effect on endometrial thickness, which was significantly increased by CE. Vaginal superficial cells were increased under CE and black cohosh treatment. CONCLUSION: The results concerning climacteric complaints and on bone metabolism indicate an equipotent effect of black cohosh in comparison to 0.6 mg CE per day. It is proposed that black cohosh contains substances with SERM activity, i.e. with desired effects in the brain/hypothalamus, in the bone and in the vagina, but without exerting uterotrophic effects.

Cimicifuga racemosa (black cohosh) for the treatment of hot flushes in women surviving breast cancer.
Hernandez Munoz G, Pluchino S. Maturitas. 2003 Mar 14;44 Suppl 1:S59-65. Parque Humboldt, Prados del Este, Caracas, Venezuela.
To examine the effect of Cimicifuga racemosa black cohosh (CR BNO 1055) on hot flushes caused by tamoxifen adjuvant therapy in young premenopausal breast cancer survivors. This treatment presents an off-label use of black cohosh. Between May 1999 and December 2001, we accrued 136 breast cancer survivors aged 35-52 years. After treatment with segmental or total mastectomy, radiation therapy and adjuvant chemotherapy, participants were in open-label randomly assigned (1-2) to receive tamoxifen 20 mg per day orally (usual-care group; n=46) or tamoxifen (same dose and posology) plus black cohosh (Menofem/Klimadynon, corresponding to 20 mg of herbal drug; intervention group n=90). Duration of treatment was 5 years for tamoxifen, according to international standards for adjuvant therapies, and 12 months for black cohosh. Follow-up included clinical assessment every 2 months; the primary endpoint was to record the number and intensity of hot flushes. Comparing patients assigned to usual-care group with those assigned to intervention group, the number and severity of hot flushes were reduced after intervention. Almost half of the patients of the intervention group were free of hot flushes, while severe hot flushes were reported by 24.4% of patients of intervention group and 73.9% of the usual-care group. Hot flushes were the most frequent adverse reaction to tamoxifen adjuvant therapy in breast cancer survivors. The combined administration of tamoxifen plus black cohosh for a period of 12 months allowed satisfactory reduction in the number and severity of hot flushes.

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