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Black cohosh

Black cohosh

Black cohosh is a perennial plant that grows to an average height of 1 m to 1.50 m and can reach a maximum height of over 2 m. The above-ground parts die back in autumn. The above-ground parts die back in the fall. The roots and the rhizome, which increases in size from the 3rd year of life, serve as the overwintering organ. The stem is upright and leafy. The leaves are relatively large and tripinnate, the leaflets are pointed and deeply serrated. Depending on the age of the plant, the upper part of the stem branches out into single to numerous inflorescences. These are narrow, long, candle-like racemes (origin of the German name) with numerous white flowers. The perianth consists of a four-petaled calyx and small petals that fall off immediately after flowering. For this reason, only the numerous stamens with their equally white filaments and anthers can be found in full bloom. There is only one ovary with a sessile stigma, from which ovoid capsules develop containing numerous flat seeds.

Synonymous drug names

German: Cimicifuga rootstock, women's root, North American snake root, bugweed root. English: Black cohosh, Rattleroot. Latin: Radix (Rhizoma) Actaeae racemosae, Radix Christophorianae americanae, Radix Cimicifugae racemosae, Radix Cimicifugae serpentariae, Radix Serpentariae racemosae, Rhizoma Cimicifugae.

Effects

Black cohosh rhizome has an overall estrogen-like effect and thus improves menopausal symptoms. The drug has been intensively studied in recent years. The results currently available indicate that the effect is not caused by a direct attack on oestrogen receptors but by a so-called selective oestrogen receptor modulation (SERM), whereby the interaction with the tissue-specific co-effectors of the receptors is of decisive importance. This theory also explains why black cohosh extracts only produce individual estrogen-like effects and why the wide range of side effects of estrogens are not to be expected. In this respect, black cohosh differs from the so-called phytoestrogens contained in plants such as red clover and soy, which from a chemical point of view are mostly isoflavones and which have the same side effect potential as the synthetically produced estrogens due to their direct attack on the estrogen receptors at comparable doses. The drug is also said to help with hair loss. According to the results of a recent report, the number of hairs that grow is increased and the number of hairs that fall out is reduced. A slight increase in hair thickness was also observed. The latter effect has not yet been used therapeutically and undoubtedly requires further investigation.

Areas of application

Premenstrual and dysmenorrheal as well as menopausal neurovegetative complaints. However, the drug has its main significance in the latter indication. Its effectiveness in the treatment of menopausal symptoms has been proven in several clinical studies. These studies have shown that hot flushes, which are perceived as particularly stressful, as well as sweating, sleep disorders and the psychological symptoms of depression, nervousness, irritability, general performance and memory loss are significantly improved. The drug does not appear to have any significant effect on somatic and atrophic complaints.

Side effects

Triterpene glycosides generally have mucosal irritant properties. Therefore, gastric complaints may occasionally occur. Surveys of patients in clinical studies show that tolerability is rated as very good.

Safety and side effects

Black cohosh products are potentially safe and harmless for adults if taken appropriately for up to one year. Black cohosh products may cause some mild side effects such as stomach discomfort, cramps, headaches, skin rashes, a feeling of heaviness, vaginal bleeding and weight gain. Triterpene glycosides generally have mucous membrane irritating properties. Therefore, stomach complaints may occur in isolated cases. Surveys of patients as part of the clinical studies show that tolerability is considered to be very good. There are also concerns that black cohosh products may be associated with liver damage. However, it is not known with certainty whether grape silver candle products can actually cause liver damage. This is still being investigated by scientists. Until more is known, people who use black cohosh products should watch for symptoms of liver damage. Symptoms suggesting liver damage include yellowing of the skin and eyes (jaundice), unusual fatigue or dark urine. If these symptoms occur, the use of black cohosh products should be discontinued and a doctor contacted. People using black cohosh products should talk to their doctor about tests to make sure their liver is functioning well.

Precautions and warnings

Pregnancy and breastfeeding: Black cohosh products may not be safe to use during pregnancy and breastfeeding. Because black cohosh products can act like estrogen in some ways, they may increase the risk of miscarriage.

Breast cancer: There are concerns that black cohosh products may exacerbate existing breast cancer. Women who suffer from breast cancer, have suffered from breast cancer in the past, or are at increased risk for breast cancer should avoid dextrose products.

Hormone-sensitive conditions such as breast cancer, uterine cancer, ovarian cancer and endometriosis: There is evidence that grape silver candle products may act like estrogen. There are concerns that black cohosh products may exacerbate diseases that are affected by female hormones. For this reason, if you have a condition that could be exacerbated by estrogen, you should not use grape celery products.

Liver disorders: Some reports suggest that black cohosh products may cause liver damage. However, it is not known with certainty whether dextrose products were actually the cause of the liver damage in these cases. Until more is known, people suffering from liver disease should avoid black cohosh products.

Kidney transplants: Ingestion of a product containing black cohosh and alfalfa has been linked to one case of donor kidney rejection. However, it is not known if black cohosh was the cause of this rejection. Until more is known, recipients of donor organs should refrain from using black cohosh products.

Protein S Deficiency: People who suffer from protein S deficiency are at increased risk of developing blood clots. There are concerns that black cohosh products may increase the risk of developing blood clots in these people because they have some of the effects of estrogen. There is one report linking the development of blood clots in a person who was protein S deficient to the use of black cohosh in combination with several other herbal products. Until more is known, people suffering from protein S deficiency should avoid black cohosh products.

Interactions

Care should be taken when combining black cohosh products with the following medications

Medications that are broken down by the liver (cytochrome P450 2D6 (CYP2D6) substrates)

Some drugs are broken down by the liver. Grape silver candle products can reduce the rate at which the liver breaks down certain medications. Taking black cohosh products in conjunction with medications that are broken down by the liver may increase the effects and side effects of some medications. For this reason, you should consult your doctor before taking black cohosh products if you are taking medications that are broken down by the liver.

Medications that can damage the liver

There are concerns that black cohosh products could damage the liver. The use of black cohosh products in combination with medications that could also damage the liver can increase the risk of liver damage. For this reason, you should avoid using black cohosh products if you are taking medications that can damage the liver.

References

  1. Foster S: Black cohosh: Cimicifuga racemosa: a literature review. HerbalGram 45: 35-49, 1999.
  2. Liu J, Burdette JE, Xu H, Gu C, van Breemen RB, Bhat KP, Booth N, Constantinou AI, Pezzuto JM, Fong HH, Farnsworth NR, Bolton JL. Evaluation of estrogenic activity of plant extracts for the potential treatment of menopausal symptoms. J Agric Food Chem. 2001 May;49(5):2472-9.
  3. Zierau O, Bodinet C, Kolba S, Wulf M, Vollmer G. Antiestrogenic activities of Cimicifuga racemosa extracts. J Steroid Biochem Mol Biol. 2002 Jan;80(1):125-30.
  4. McKenna DJ, Jones K, Humphrey S, Hughes K. Black cohosh: efficacy, safety, and use in clinical and preclinical applications. Altern Ther Health Med. 2001 May-Jun;7(3):93-100.
  5. Liu Z, Yang Z, Zhu M, Huo J. Estrogenicity of black cohosh (Cimicifuga racemosa) and its effect on estrogen receptor level in human breast cancer MCF-7 cells. Wei Sheng Yan Jiu. 2001 Mar;30(2):77-80.
  6. Lieberman S. A review of the effectiveness of Cimicifuga racemosa (black cohosh) for the symptoms of menopause. J Womens Health. 1998 Jun;7(5):525-9.
  7. Chen S-N, Li W, Fabricant DS, Santasiero BD, et al: Isolation, structure elucidation, and absolute configuration of 26-deoxyactein from Cimicifuga racemosa and clarification of nomenclature associated with 27-deoxyactein. Journal of Natural Products 65: 601-605, 2001.
  8. Dixon-Shanies D, Shaikh N. Growth inhibition of human breast cancer cells by herbs and phytoestrogens. Oncol Rep. 1999 Nov-Dec;6(6):1383-7.
  9. Bodinet C, Freudenstein J. Influence of marketed herbal menopause preparations on MCF-7 cell proliferation. Menopause. 2004 May-Jun;11(3):281-9.
  10. 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 Medica 65: 763-764, 1999.