Menopause and Black Cohosh

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The roots of black cohosh, pictured at left, are used to make an extract that shows promise as an alternative to conventional hormonal replacement therapy and a means to soothe menstrual pain.

Many women are plagued by menstrual cramps, premenstrual syndrome, or hot flashes at some point during their lifetimes. Now they can take a tip from European women, who are increasingly turning to one herb more than any other for relief from these discomforts. Known as black cohosh, the herb has been used by more than one-and-a-half million German women, according to one manufacturer of a black cohosh supplement. And the German Commission E, a government-sponsored panel that evaluates herbal therapies, has given black cohosh its stamp of approval, recommending it for treating PMS, painful menstruation, and menopausal problems.

Some predict that black cohosh (Cimicifuga racemosa) will soon become as popular in the United States as it is in Europe. That would bring history full circle, ­because black cohosh was known in North America long before Europeans dis­covered it.

• Recipe for Menopause Tincture.

Taking A Cue From Native Americans

At the turn of the century, U.S. medical doctors were of three general persuasions: They prescribed drugs, homeopathic remedies, or herbs. Allopaths used substances such as mercury; homeopaths preferred preparations made with highly diluted herbs and minerals.

The herbally oriented doctors were called the Eclectics, who learned about herbs through interactions with their patients. They observed reactions, both good and bad, of botanical medicines that had been used by Native Americans, including black cohosh, echinacea, wild indigo, osha, cramp bark, snakeroot, lobelia, and pokeroot. The Eclectics, taking their cue from Native Americans, prescribed black cohosh to treat “female complaints”, including menstrual problems, hormonal imbalances, fibroid cysts, and false and true labor pains. They also recommended the herb to calm the nervous system, reduce pain after labor, or relieve painful, late menstrual periods. They combined it with cramp bark to ease menstrual cramps, and used it alone to treat neuralgia, rheumatism, arthritis, and headaches.

After the 1930s, pharmaceuticals replaced herbal remedies as the treatment of choice in the United States, but the experience of the Eclectic physicians wasn’t lost. Their knowledge of many Native American herbs made its way to Europe, where German researchers, aware of the clinical effectiveness of some of these remedies, began looking for marketable drugs among them.

Today, black cohosh remains on a European short list of proven remedies for “women’s conditions”. Thanks to the body of evidence that has accumulated during the past century, we now understand much more about the symptoms and syndromes for which black cohosh is proving beneficial and safe. This includes knowledge about its proper dose, the length of time it should be used, and other therapeutic aspects.

Defining its Effectiveness

In the classic reference book Herbal Medicine (Beaconsfield, 1988), Dr. Rudolph Weiss lists black cohosh as a treatment for conditions caused by lack of estrogen, such as depression associated with menopause. Clinical experience of European practitioners backs this up. Scientific studies show that black cohosh has a balancing effect on hormone production, either by acting as a mild estrogen or regulating estrogen’s production in the body. For that reason, black cohosh is often found in herbal formulas for regulating female hormones, especially those prescribed to reduce hot flashes, which can occur when estrogen levels drop too low. Commercial preparations of the herb, available in the United States, are commonly prescribed in Europe and sold in drugstores to reduce hot flashes.

Researchers have conducted many test-tube and animal studies using black cohosh as well as a few human trials. In one controlled double-blind study, 110 meno­pausal women who complained of unpleasant symptoms and who hadn’t taken estrogen replacement therapy for at least six months took a standardized black cohosh extract. According to the researchers, these women felt less depressed and had fewer hot flashes than those in the placebo group. The researchers theorize that black cohosh extract affects estrogen behavior by changing vaginal cells and suppressing the secretion of luteinizing hormone (LH), both indicators of an estrogenic influence. Sudden bursts of LH have been linked to the occurrence of hot flashes, night sweats, heart palpitations, headaches, and the drying and thinning of the vagina.

At the University of Göttingen’s Department of Clinical and Experimental Endocrinology in Germany, researchers report that black cohosh’s impact on sexual hormones can be traced primarily to three compounds (formononetin, triterpenes, and aceteine). The German BGA (the German equivalent of the U. S. Food and Drug Administration, or FDA) considers black cohosh to be safe because so few side effects have been reported. The Botanical Safety Handbook (CRC Press, 1997) states that black cohosh shouldn’t be used during pregnancy.

Promising Future

Although all of the science defining how black cohosh works isn’t in, modern herbalists in North America use the herb in many of the ways their forebears did, and European physicians recommend it for a variety of gynecological complaints. While still unapproved for use as a drug in the United States, black cohosh appears quite promising as an alternative to conventional hormonal replacement therapy, or HRT, without the serious risk of side effects. 8

Christopher Hobbs, an Herbs for Health Editorial Advisory Board member, is the author of many books, including Vitex, the Women’s Herb (Botanica, 1996). He is a fourth-generation herbalist and botanist with more than thirty years’ experience with medicinal herbs.

Additional Reading

Blumenthal, M., et al. Commission E Herbal Monographs. Austin, Texas: American Botanical Council, work in progress.
Bruneton, J. Pharmacognosy, Phytochemistry, Medicinal Plants. New York: Lavoisier, 1995.
Duker, E. M., et al. “Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats.” Planta Medica 1991, 57(5):420-24.
Felter, H. W., and J. U. Lloyd. King’s American Dispensatory. Cincinnati: The Ohio Valley Co., 1876.
Foster, S., and J. Duke. A Field Guide to Medicinal Plants: Eastern and Central North America. Boston: Houghton Mifflin, 1990.
Lehmann-Willenbrock, E., and H. Riedel. “Clinical and endocrinological studies of the treatments of ovarian insufficiency manifestations following hysterectomy with intact adnexa.” Aentralblatt fur Gynakologie 1988, 110(10):611-18.
List, P. H., and L. Horhammer. Hagers Handbuch der Pharmazeutischen Praxis. 7 vols. New York: Springer-Verlag, 1973-1979.
Newall, C. A., et al. “Herbal Medicines” in A Guide for Health-Care Professionals. London: The Pharmaceutical Press, 1996.
Weiss, R. Herbal Medicine. Beaconsfield, England: Beaconsfield, 1988.

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