About two thirds of women at the climacteric age of 45 to 60 years will experience various complaints. This is the phase in the aging of a woman which marks the transition from a reproductive phase to a non-reproductive phase of life. It’s commonly caused the menopause and with it comes a number of symptoms.

Experiencing hot flushes are a common phenomenon associated with the menopause or breast cancer therapy as a result of reduced ovarian function. To counter this, hormone replacement therapy (HRT) has been the backbone treatment for hot flushes, but is contraindicated in women with breast cancer or at high risk for the development of breast cancer (Goss, 2001). HRT therapy is important for preventing bone loss (NAPS, 2004).

Alternative therapies have been sought though because of issues surrounding HRT on heart health and an increased risk of breast cancer.

The medicinal use of Black Cohosh (Cimicifuga racemosa (L.) Nutt., syn. Actaea racemosa L.)  has a long tradition in treating manifestations of the menopause (Krochmal and Krochmal, 1975; Goodenough, 1982). It was historically referred to as “black snakeroot”, and a Native American botanical, for which a monograph was written and included in the first U.S. Pharmacopoeia in 1820. During the 19th century, the plant emerged as an important treatment for a variety of female-related health conditions.  It is also used for temporary changes in mood, such as irritability and restlessness.

Black cohosh has other names including macrotys, bugbane, bugwort, rattleroot, rattleweed, rattlesnake root or squawroot.  

The effects of black cohosh are believed to be the result of complex synergistic actions between  triterpene glycosides such as actein, 2,7-deoxyactein,  cimicifugoside and cinnamic acid esters. Black cohosh does not exert any oestrogenic effects on mammary tissue and even augments the anti-proliferative effect of tamoxifen, both  in vitro and in vivo (Nisslein and Freudenstein, 2003).

A few clinical studies have assessed the effect of black cohosh in climacteric women. Several of these studies involving over 770 women were properly randomized and controlled trials (Borrelli and Ernst, 2002; Liske et al., 2002; Amato and Marcus, 2003; Huntley and Ernst, 2003). Six studies used the drug Remifemin (Schaper & Brűmmer GmbH & Co. KG, Salzgitter, Germany) in dosages of 40–127 mg for comparison (Warnecke, 1985; Stoll, 1997; Osmers, 2005) and another used a different Cimicifuga racemosa preparation (CR BNO 1055) (Wuttke et al., 2001).

Climacteric symptoms are assessed using the Menopause Rating Scale and is an extraneous assessment scale that consists of 10 items, which themselves represent clusters of related symptoms.

To date, the clinical evidence still does not categorically support the use of black cohosh for treating menopause. However, the evidence is developing to support its use.

One of the issues afflicting the use of Black Cohosh as can be the case with many herbal drugs is that it is associated with liver complaints  according to statements made by the Medicines and Healthcare Products Regulatory Agency (MHRA). The situation arose as a result of likely adulteration from Chinese sources. Simply, Black Cohosh comes from the USA rather than China hence the dispute.

References

Amato, P., Marcus, D.M. (2003) Review of alternative therapies for treatment of menopausal symptoms. Climacteric 6: 278–84.

Borrelli, F., Ernst, E. (2002) Cimicifuga racemosa: a systematic review of its clinical efficacy. Eur. J. Clin. Pharmacol. 58: 235–41

Clemons, M., Goss, P. (2001) Estrogen and the risk of breast cancer. N Engl J Med 344: 276-285

Goodenough,  J. (1982) editor. Dr. Goodenough’s home cures and herbal remedies. New York (NY): Avenal Books.

Huntley, A.L., Ernst, E. (2003) A systematic review of herbal medicinal products for the treatment of menopausal symptoms. Menopause 10: 465–76.

Jacobson, J.S., Troxel, A.B., Evans, J., Klaus, L., Vahdat, L., Kinne, D., et al. (2001) Randomized trial of black cohosh for the treatment of hot flushes among women with a history of breast cancer. J. Clin. Oncol. 19: 2739–45.

Krochmal, A., Krochmal, C. (1975) A Guide To The Medicinal Plants Of The United States. New York (NY): Quadrangle.

Lehmann-Willenbrock, E., Riedel, H.H. (1988)  Clinical and endocrinologic studies of the treatment of ovarian insufficiency manifestations following hysterectomy with intact adnexa [in German]. Zentralbl. Gynakol. 110: 611–8.

Liske, E., Hanggi, W., Henneicke von Zepelin, H.H., Boblitz, N.,Wustenberg, P., Rahlfs, V.W. (2002) Physiological investigation of a zoma): a 6-month clinical study demonstrates no systemic estrogenic effect. J. Womens Health Gend. Based Med. 11: 163–74.

Nisslein, T., Freudenstein, J. (2003) Synergistic effects of black cohosh and tamoxifen in an animal model of mammary carcinoma. Maturitas 44 suppl: 128

North American Menopause Society (2004) Recommendations for estrogen and progestogen use in peri-and postmenopausal women: October 2004 position statement of The North American Menopause Society. Menopause 11:589-600

Osmers, R., Friede, M., Liske, E., Schnitker, J., Freudenstein, J., Henneicke von Zepelin, H.H. (2005) Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms [published erratum appears in Obstet. Gynecol. 2005; 106: 644]. Obstet. Gynecol. 105: 1074-83.

Stoll, W. (1997) Phytotherapeutikum beeinflusst atropisches Vaginalepithel–Doppelblindversuch Cimicifuga vs. Őstrogenpraparat. Therapeutikon 1: 23–31.

Warnecke, G. (1985) Beeinflussung klimakterischer Beschwerden durch ein Phytotherapeutikum: erfolgreiche Therapie mit Cimicifuga-Monoextrakt. Med Welt  36: 871–4.

Wuttke, W., Seidlova-Wuttke, D., Gorkow, C. (2003) The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a doubleblind placebo-controlled study: effects on menopause symptoms and bone markers. Maturitas  44 :S67–77.