Written by Jianping Liu, Xun Li and the CAM-Cancer Consortium.
Updated August 14, 2009

Black cohosh (Actaea racemosa)

What is Black cohosh?

Definition

Black cohosh (Actaea racemosa, synonym: Cimicifuga racemosa) is a medicinal plant originating from eastern North America, which has been used by native American Indians and Europeans for women’s conditions such as chronic ovaritis and amenorrhea1. Most recently, black cohosh has been used as a therapy for menopausal symptoms such as hot flushes. The characteristic chemical constituents of the roots and rhizomes of black cohosh include cycloartenol-type triterpenoids and cimicifugoside, as well as cinnamic acid derivatives2. The commonly used dosage for black cohosh is 40 to 80 mg of dried rhizome (root) daily.

Prevalence of use

Black cohosh was first listed in the U.S. Pharmacopoeia in 1830 under the name “black snakeroot”. 3 It has been widely used for more than 40 years in Europe and was introduced in Germany in the 1940s for the treatment of menopausal discomfort, dysmenorrhoea, and climacteric neurovegetative complaints.

Theory

Systemic breast cancer treatment can cause premature menopause, which results in hot flushes before the physiological menopause. Hot flushes are also the main adverse effect of the common anti-breast cancer treatment tamoxifen. Hormone replacement therapy (HRT) for hot flushes in breast cancer patients may not be appropriate because of evidence of a relationship between long-term use of HRT and increased risk of breast cancer and cardiovascular disease 5, and potential stimulation of cancer growth by HRT 6. There is therefore an increasing interest in finding safe and effective alternatives to HRT for the treatment of menopausal symptoms in breast cancer patients. Herbal preparations such as black cohosh are used as alternatives to HRT in the treatment of hot flushes 7. The mechanism of action was proposed as being mediated by an inhibitory effect on the hypothalamus, or an effect on neurotransmitters 8, or a possible oestrogenic effect from the phyto-oestrogens 9.

Providers

Black cohosh products are commercially available on the market such as Remifemin® (manufactured by Schaper & Brümmer, Salzgitter, Germany) which is an isopropanolic extract of black cohosh standardised to contain 1 mg of triterpenes per 20 mg of extract 10. Another standardised ethanolic extract of black cohosh is BNO 1055 (Menofem®/Klimadynon®), BIONORICA, Neumarkt, Germany) 11.

Legal issues

In most European countries and the US, plant-based preparations including herbal remedies are regulated as dietary supplements. However, the European Directive on traditional herbal medicinal products allows herbal medicines to be registered as drugs if they have been used medicinally for at least 30 years (including at least 15 years within EU countries) 12.

Citation Jianping Liu, Xun Li, CAM-Cancer Consortium. Black cohosh (Actaea racemosa) [online document]. http://www.cam-cancer.org/CAM-Summaries/Herbal-products/Black-cohosh-Actaea-racemosa. August 14, 2009.

References

  1. Anonymous. Cimicifuga racemosa. Monograph. Alternative Medicine Review 2003; 8(2):186-9.
  2. Mahady GB, Fabricant D, Chadwick LR, Dietz B. Black cohosh: an alternative therapy for menopause? Nutr Clin Care 2002;5(6):283-9
  3. Blumenthal M, ed. Herbal Medicine: Expanded Commission E Monograph. 1st ed. Newton, Mass: Integrative Medicine Communications; 2000.
  4. DiGianni LM, Garber JE, Winer EP. Complementary and Alternative Medicine Use Among Women With Breast Cancer Journal of Clinical Oncology 2002;20(18S): 34s-38s
  5. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002;288(3):321-33.
  6. Schairer C, Lubin J, Troisi R, Sturgeon S, Brinton L, Hoover R. Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk. JAMA. 2000;283(4):485-91.
  7. Graf MC, Geller PA. Treating hot flushes in breast cancer survivors: a review of alternative treatments to hormone replacement therapy. Clin J Oncol Nurs 2003; 7(6):637-40.
  8. Einer-Jensen N, Zhao J, Andersen KP, Kristoffersen K. Cimicifuga and Melbrosia lack oestrogenic effects in mice and rats. Maturitas 1996; 25:149-53.
  9. Kruse SO, Lohning A, Pauli GF, Winterhoff H, Nahrstedt A. Fukiic and piscidic acid esters from the rhizome of Cimicifuga racemosa and the in vitro estrogenic activity of fukinolic acid. Planta Med 1999; 65(8):763-4.
  10. Piersen CE. Phytoestrogens in botanical dietary supplements: implications for cancer. Integrative Cancer Therapies 2003; 2(2): 120-38.
  11. Popp M, Schenk R, Abel G. Cultivation of Cimicifuga racemosa (L.) nuttal and quality of CR extract BNO 1055. Maturitas 2003; 44 (Suppl 1):S1-7.
  12. De Smet P. Herbal medicine in Europe – relaxing regulatory standards. N Engl J Med 2005;352:1176-8.
  13. Jacobson JS, Troxel AB, Evans J, Klaus L, Vahdat L, Kinne D, et al. Randomised trial of black cohosh for the treatment of hot flushes among women with a history of breast cancer. J Clin Oncol 2001; 19(10):2739-45.
  14. Hernandez Munoz G, Pluchino S. Cimicifuga racemosa for the treatment of hot flushes in women surviving breast cancer. Maturitas 2003; 44(Suppl 1):S59-65.
  15. Wade C, Kronenberg F, Kelly A, Murphy PA. Hormone-modulating herbs: implications for women’s health. J Am Med Women’s Assoc. 1999; 54:181-3.
  16. Zava DT, Dollbaum CM, Blen M. Estrogen and progestin bioactivity of foods, herbs, and spices. Proc Soc Exp Biol Med 1998; 217:369-78.
  17. Liske E. Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders. Adv Ther 1998; 15:45-53.
  18. Pepping J. Black cohosh: Cimicifuga racemosa. Am J Health Syst Pharm 1999; 56:1400-2.
  19. Lieberman S. A review of the effectiveness of Cimicifuga racemosa (black cohosh) for the symptoms of menopause. J Women’s Health 1998; 7:525-9.
  20. Huntley A. The safety of black cohosh (Actaea racemosa, Cimicifuga racemosa). Expert Opin Drug Saf 2004; 3(6):615-23.
  21. Rockwell S, Liu Y, Higgins SA. Alteration of the effects of cancer therapy agents on breast cancer cells by the herbal medicine black cohosh. Breast Cancer Res Treat. 2005; 90(3):233-9.
  22. Pockaj BA, Gallagher JG, Loprinzi CL, Stella PJ, Barton DL, Sloan JA, Lavasseur BI, Rao RM, Fitch TR, Rowland KM, Novotny PJ, Flynn PJ, Richelson E, Fauq AH. Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1. J Clin Oncol. 2006 Jun 20;24(18):2836-41.
  23. Mahady GB. Low Dog T. Barrett ML. Chavez ML. Gardiner P. Ko R. Marles RJ. Pellicore LS. Giancaspro GI. Sarma DN. United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause 2008;15(4 Pt 1):628-38.
  24. Borrelli F. Ernst E. Black cohosh (Cimicifuga racemosa): a systematic review of adverse events. American Journal of Obstetrics & Gynecology 2008;199(5):455-66.
Legal notice
The present documentation has been compiled by the CAM-CANCER Project with all due care and expert knowledge. However, the CAM-CANCER Project provides no assurance, guarantee or promise with regard to the correctness, accuracy, up-to-date status or completeness of the information it contains. This information is designed for health professionals. Readers are strongly advised to discuss the information with their physician. Accordingly, the CAM-CANCER Project shall not be liable for damage or loss caused because anyone relies on the information.