Treatment Options

Black Cohosh

Possible Harm/No Value

Black cohosh is an herb found in North America. It is known by several names including Cimicifuga racemosa and Actaea racemosa. Black cohosh is used as a complementary and alternative treatment. 

 

Black cohosh is sometimes called a “woman’s remedy” because it has been recommended for relief of premenstrual pain, menstrual cramps, menopausal hot flashes, breast pain, ovarian pain and pain associated with childbirth. Chemicals in the black cohosh herb are said to provide beneficial effects similar to the female hormone estrogen. There are significant scientific studies that show black cohosh has relieved the symptoms of hot flashes and other symptoms associated with menopausal women.

 

Black cohosh has also been used for treatment of rheumatism, high blood pressure, bronchial infections, diarrhea, whooping cough and inflammatory conditions. However, no scientific studies were found to support black cohosh as an effective treatment for these conditions.

Things to Consider

  • The World Health Organization has identified the possibility that black cohosh may contribute to liver injury.
  • Seek the advice of your physician when considering any kind of complementary and alternative treatment choice.
  • Scientific evidence regarding the long-term safety of taking black cohosh is not available.

 

Results

Possible Harm/No Value

Will I live longer if I take black cohosh?

 

There is no scientific evidence to indicate that taking black cohosh will help you live longer.

 

Will taking black cohosh improve my quality of life?

 

There are several scientific studies with evidence that black cohosh can relieve hot flashes and other symptoms associated with menopause, which can improve your quality of life.

 

Will taking black cohosh make my symptoms better?

 

There are several scientific studies with evidence that black cohosh can relieve hot flashes and other symptoms associated with menopause, which can make your symptoms better.

Safety

How safe is this for me?

Possible Harm/No Value

The FDA has issued a letter to distributors of black cohosh that the product is not generally recognized as safe (GRAS) and effective for the treatment of high blood pressure, high cholesterol and cardiovascular and circulatory disorders. 

 

The World Health Organization has identified four cases where the initiation of treatment with black cohosh may have contributed to temporary liver injury. Liver injury is defined as elevated liver enzymes. Symptoms of liver injury include nausea, vomiting, abdominal pain, loss of appetite, diarrhea, feeling tired or weak and yellow skin. Individuals are asked to discontinue black cohosh and consult their physician if they suspect symptoms of liver injury. Physicians are asked to report any suspected hepatic reactions.

 

Although limited, the evidence does suggest that adverse effects are rare, mild and reversible.

 

Individuals with high blood pressure should use caution and seek the advice of their physician before taking black cohosh.

 

Safe use by women who are pregnant or breast feeding has not been established.

 

Reported minor complications:

 

  • Dizziness
  • Headaches
  • Rash
  • Stiffness
  • Stomach discomfort
  • Trembling

 

Reported major complications:

 

There is a potential for temporary liver injury with the initiation of treatment

Comparison

Possible Harm/No Value

More studies need to be performed before a comparison can be made including studies that compare black cohosh with known medical treatments.

Cost

Little Value

Cost is dependant on the manufacturer and the dose and method of administration.

 

Seek the advice of your physician when considering any kind of complementary and alternative treatment choice.

The cost may or may not be covered by insurance.

Sources

The following are off-site links off-site link :

  • Barnes, J., Anderson, L. A., & Phillipson, J. D. (2002). Herbal Medicines (2nd ed., pp. 141-146). Grayslake: Pharmaceutical press.
  • Bauer, B., Frye, C., Wallevand, K., Dietman, R., & Kaufman, K. (Eds.). (2007). Mayo Clinic: Book of Alternative Medicine (pp. 168-169, 172-173). New York: Time Inc.
  • Frei-Kleiner, S., Schaffner, W., Rahlfs, V.W., Bodmer, Ch., & Birkhauser, M. (2005). Cimicifuga racemosa dried ethanolic extract in menopausal disorders: A double-blind placebo-controlled clinical trial. Maturitas, 51(4), 397-404. Abstract retrieved September 28, 2007 from PubMed database.
  • 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 flashes among women with a history of breast cancer. Journal of Clinical Oncology, 19 (10), 2739-2745.  Abstract retrieved September 27, 2007 from PubMed database.
  • Liske, E., Hanggi, W., Henneicke-von Zepelin, H.H., Boblitz, N., Wustenberg, P., & Rahlfs, V.W. (2002). Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosai rhizome): A 6-month clinical study demonstrates no systemic estrogenic effect. Journal of Women’s Health and Gender-Based Medicine. 11 (2), 163-174. Abstract retrieved September 27, 2007 from PubMed database.
  • 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. Obstetrics and Gynecology. 105 (5 Pt 1), 1074-1083. Abstract retrieved September 27, 2007 from PubMed database.
  • Packaj, B.A., Gallagher, J.G., Loprinzi, C.L., Stella, P.J., Barton, D.L., Sloan, J.A., et al. (2006). Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial No1CC1. Journal of Clinical Oncology. 24 (18), 2836-2841. Abstract retrieved September 27, 2007 from PubMed database.
  • Rosenthal, D. S. (2000). Complementary and Alternative Cancer Methods (pp. 176-177). Atlanta: American Cancer Society.
  • Rotblatt, M., & Ziment, I. (2002). Evidence-Based Herbal Medicine (pp. 98-103). Philadelphia: Hanley & Belfus, Inc.
  • Spangler, L., Newton, K.M., Grothaus, L.C., Reed, S.D., Ehrlich, K., & LaCroix, A.Z. (2007). The effects of black cohosh therapies on lipids, fibrinogen, glucose, and insulin. Maturitas. 57 (2), 195-204. Abstract retrieved September 27, 2007 from PubMed database.
  • The Body. (2005, May). Hepatotoxicity. Retrieved October 1, 2007 from http://www.thebody.com/content/art12772.html.
  • The Database of Abstracts of Reviews of Effectiveness. In The Cochrane Library, Issue 3, 2007. Oxford: Update Software. Updated quarterly.
  • Uebelhack, R., Blohmer, J.U., Graubaum, H.J., Busch, R., Gruenwald, J., & Wernecke, K.D. (2006). Black Cohosh and St. John’s wort for climacteric complaints: A randomized trial. Obstetrics and Gynecology. 107 (2 Pt 1), 247-255. Abstract retrieved September 28, 2007 from PubMed database.
  • U.S. Food and Drug Administration. (2004, April). Cyber warning letter to MTE Nutrition. Retrieved September 28, 2007 from http://www.fda.gov/cder/warn/cyber/2004/CFSAN2004MTEnutrition.htm.
  • Wikipedia® Foundation Inc. (2007, September). Hepatotoxicity. Retrieved October 1, 2007 from http://en.wikipedia.org/wiki/Hepatotoxicity.
  • World Health Organization Pharmaceuticals Newsletter. (2006, No. 4). Cimicifuga racemosa (black cohosh). Concerns of liver injury. Retrieved October 1, 2007 from http://www.who.int/medicines/publications/newsletter/PN2006_4.pdf.

 

Next Review Date

10/24/2008

This document has been classified as public information.

Table of Findings

results:  possible harm / no value

safety:  possible harm / no value

comparison:  possible harm / no value

cost: little value


total: possible harm / no value

legend

scale

Page modified:February 14, 2008