Cimicifuga racemosa Black Cohosh

What is Cimicifuga racemosa Black Cohosh

Cimicifuga racemosa is commonly known as black cohosh, and is sometimes referred to as black snakeroot, squaw root, or bugbane.

In herbal lore, Cimicifuga racemosa is described as an ’emmenagogue’, an agent used to stimulate menstrual and uterine flow, tone, and activity. It has several historical uses in women’s health.

Native Americans used black cohosh dried rhizome and roots to aid childbirth, and treat female complaints and snakebites; black cohosh was an official drug in the U.S. Pharmacopoeia from 1830 to 1926.

Black cohosh was one of the ingredients in the combination herb product known as Lydia E. Pinkham’s Vegetable Compound of the late 1800’s and early 1900’s; the product claimed to treat a multitude of female health problems, including infertility.

In February 2000, the FDA released a warning letter to dietary supplement manufacturers that advised against making any claims related to uses of black cohosh during pregnancy; the letter was released following concerns of the potential for birth defects from the use of untested products.

Modern marketed preparations are marketed as dietary supplements in the U.S., and are promoted for the relief of symptoms related to menopause and perimenopause.

Estroven is a combination product containing black cohosh, soy isoflavones, kava kava, vitamins, and minerals.

Remifemin contains only black cohosh, and has been marketed in Germany since the 1960’s; Germany’s Commission E found this extract of black cohosh effective for the treatment of dysmenorrhea, premenstrual syndrome, and climacteric neurovegetative ailments.

The 2015 North American Menopause Society Guidelines has refrained from recommending black cohosh in the non-hormonal management of vasomotor symptoms related to menopause, due to apparent lack of efficacy in decreasing hot flash frequency per meta-analyses of available data versus placebo.

However, a 2017 review of a black cohosh standardized extract, including data from 60-years of medicinal use in Europe and many clinical studies with this extract since the 1980’s, has supported the use of black cohosh for menopausal symptoms such as hot flashes and sleep disturbances.

There are some data suggesting positive effects on bone density maintenance in menopausal women.

The FDA does not recognize black cohosh as a “GRAS” (generally safe and effective) dietary ingredient. Reports of possible hepatotoxicity due to black cohosh products started to appear with popular use of these products.

After examining all reported cases, the U.S. Pharmacopeial Convention’s Dietary Supplements- Botanicals Expert Committee found only 30 reports possibly related to black cohosh; however, patients are advised to discontinue use and consult a healthcare practitioner if a patient develops symptoms of liver dysfunction, such as abdominal pain, dark urine, or jaundice while taking products containing this herb.

Data from 60-years of use of a standardized extract in over 12,000 women in clinical trials have revealed no evidence of hepatotoxicity, and emphasize the need to select a black cohosh product that is standardized and that adheres to good manufacturing practices (GMPs).

Indications

  1. dysmenorrhea
  2. hot flashes
  3. menopause
  4. premenstrual syndrome (PMS)

For the support of symptoms associated with menopause† (e.g., hot flashes or other symptoms according to global symptom rating scales like the Kupperman Menopausal Index)

Side Effects

  1. anaphylactoid reactions
  2. anemia
  3. bradycardia
  4. bronchospasm
  5. dizziness
  6. dyspepsia
  7. elevated hepatic enzymes
  8. headache
  9. heart failure
  10. hepatic failure
  11. hepatitis
  12. hypertension
  13. hypotension
  14. infection
  15. jaundice
  16. mastalgia
  17. menorrhagia
  18. nausea
  19. neonatal respiratory depression
  20. palpitations
  21. peripheral edema
  22. rash
  23. seizures
  24. sinus tachycardia
  25. spontaneous fetal abortion
  26. tetany
  27. thrombocytopenia
  28. uterine contractions
  29. vaginal bleeding
  30. vasculitis

Monitoring Parameters

  • pelvic exam

Contraindications

  • abnormal fetal position
  • asthma
  • breast cancer
  • breast-feeding
  • cardiac disease
  • cervical cancer
  • children
  • eclampsia
  • fetal distress
  • fetal prematurity
  • hepatic disease
  • hepatotoxicity
  • hypertension
  • incomplete abortion
  • infants
  • infertility
  • intrauterine fetal death
  • jaundice
  • labor
  • multiparity
  • neonates
  • ovarian cancer
  • placenta previa
  • preeclampsia
  • pregnancy
  • premature rupture of membranes (PROM)
  • salicylate hypersensitivity
  • soya lecithin hypersensitivity
  • surgery
  • tartrazine dye hypersensitivity
  • uterine cancer

Interactions

There are no drug interactions associated with Black Cohosh, Cimicifuga racemosa products.

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