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The Importance of Black Cohosh & Benefits
Black
cohosh also has a long history of treating menstrual cramps in a drug
free way. The antispasmodic properties of black cohosh may be
responsible for its effectiveness at treating the discomforts of
menstrual cramps. In addition, black cohosh is thought to
increase the blood flow to the uterus, and to reduce the intensity of
painful cramping. Black cohosh is even thought to benefit those
suffering from premenstrual syndrome (PMS).
Black cohosh is
available in a number of different preparations, including tinctures,
tablets, capsules, and dried herbs. These dried black cohosh
herbs are often used to prepare soothing teas.
Modern uses of black cohosh
For
many years, the use of black cohosh fell out of favor, but this popular
root is once again being used as an herbal treatment for such symptoms
as hot flashes which are commonly associated with menopause. When
traditional hormone replacement therapy was found to carry significant
health risks, many doctors recommended that their patients treat their
menopausal symptoms instead with black cohosh.
Black cohosh is
also thought to be an excellent anti-inflammatory medication, a relief
for muscle aches and even a mild sedative. In addition, black
cohosh has been used to clear stopped up mucous membranes and to help
lessen congestion and coughing.
What clinical studies have been done on black cohosh and its effect on menopausal symptoms?
Black
cohosh is used primarily for hot flashes and other menopausal symptoms.
A number of studies using various designs have been conducted to
determine whether black cohosh affects menopausal symptoms. Few studies
were placebo controlled, and most assessed symptoms by using the
Kupperman index-a scale that combines measures of hot flashes,
insomnia, and depression but not vaginal dryness. Those with the best
study designs are described below.
A randomized, double-blind,
placebo-controlled trial was done in breast cancer survivors because
most of these women experience hot flashes and many use complementary
or alternative remedies [6]. The women were over age 18 and had
completed breast cancer treatment at least 2 months before the trial;
85 women (69 of whom completed the trial) took one tablet of placebo or
40 mg/day of black cohosh (as 20 mg twice daily) for 2 months to
determine the effect on hot flashes, excessive sweating, palpitations,
headaches, poor sleep, depression, and irritability [J.S. Jacobson,
Columbia University, written communication, 2002]. Fifty-nine subjects
were using tamoxifen (an antiestrogen treatment for breast cancer);
tamoxifen users were distributed almost equally between the treatment
and control groups.
The frequency and intensity of hot
flashes decreased in both groups, with no statistical difference
between the groups; excessive sweating decreased significantly more in
the treatment group than the placebo group. Other symptoms improved
equally in both groups, and scores on a health and well-being scale did
not change significantly in either group.
A 24-week study in 60
women who had undergone hysterectomy but retained at least one ovary
compared the effects of 8 mg/day of a black cohosh extract (as four
2-mg tablets daily; isopropanol extract version of Remifemin) with
three estrogen regimens: estriol (1 mg/day), conjugated estrogens (1.25
mg/day), and estrogen-progestin therapy (one daily Trisequens® tablet
containing 2 mg estradiol and 1 mg norethisterone acetate) . In all
groups a modified Kupperman index measuring additional physical
symptoms was significantly lower 4, 8, 12, and 24 weeks after treatment
began. Black cohosh decreased symptoms similarly to the other
treatments, but this study was not placebo controlled.
A
randomized, double-blind, placebo-controlled trial in 80 menopausal
women compared 8 mg/day of a black cohosh extract (as two 2-mg tablets
of Remifemin twice daily) with placebo or conjugated estrogens (0.625
mg/day) . At 12 weeks, scores on the Kupperman index and the Hamilton
anxiety scale were significantly lower in the treated groups than in
the placebo group; the scores of participants using black cohosh were
somewhat better than the scores of those receiving the estrogen
treatment.
This is one of the few studies in which hot flashes
were scored separately from other symptoms. Daily hot flashes decreased
from 4.9 to 0.7 in the black cohosh group, 5.2 to 3.2 in the estrogen
group, and 5.1 to 3.1 in the placebo group.
A randomized,
12-week study of 55 menopausal women compared an ethanolic extract of
black cohosh (40 drops twice daily) with conjugated estrogens (0.6
mg/day) or diazepam (2 mg/day) . Regardless of the treatment, all
symptoms improved as measured by the Kupperman index, a depression
scale, and an anxiety scale. However, this was not a blinded,
placebo-controlled trial and diazepam is not a usual treatment for
menopausal symptoms.
Although some study results suggest that
black cohosh may help relieve menopausal symptoms, other study results
do not. Studies of black cohosh have yielded conflicting data, in part
because of lack of rigor in study design and short study duration (6
months or less). In addition, interpretation of these studies is
complicated by the fact that different amounts of black cohosh from
different sources were used in the various studies and their outcome
measures were different.
To provide more definitive evidence
on the effects of black cohosh on menopausal symptoms, NCCAM is funding
a 12-month, randomized, placebo-controlled study to determine whether
treatment with black cohosh is effective in reducing the frequency and
intensity of menopausal hot flashes. The study will also assess whether
black cohosh reduces the frequency of other menopausal symptoms and
improves quality of life. The study will examine the possible
mechanisms of action of black cohos
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