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Black Cohosh: Herbal Medications, What Works

Black cohosh (Cimicifuga racemosa), a plant native to eastern North America, was used by Native Americans to treat general malaise, kidney ailments, malaria, rheumatism, sore throat, and especially menstrual irregularities. One of black cohosh's popular names is squaw root, because it was used to treat female disorders. Early settlers used it for rheumatism, and it was used in early patent medicines such as Lydia Pinkham's famed "Vegetable Compound," which women drank for menstrual distress.

Black cohosh contains triterpene glycosides, isoflavones, and aromatic acids, and affects the endocrine system, producing effects similar to those of estriol, a form of estrogen. Estriol is an antagonist of estradiol, the estrogen that is given in synthetic form to treat menopausal symptoms, and which is associated with an increased risk of ovarian, breast, and endometrial cancers. According to Murray in 1997, estriol, and perhaps also black cohosh, seems to afford some protection against these cancers.

Commission E in Germany approves black cohosh for premenstrual discomfort, dysmenorrhea, and menopausal ailments, and notes no contraindications or significant side effects (except for occasional gastric discomfort). Commission E recommends the use of black cohosh for no more than six months.

Remifeminċ, a black cohosh extract manufactured in Germany, is the most widely used natural alternative to hormone replacement therapy. More than 1.5 million women in Germany have used Remifemin since 1956 for menopausal symptoms with remarkable effectiveness. Nearly 10 million monthly units of the extract were sold in Germany, Australia, and the United States in 1996.

Mark Blumenthal, executive director of the American Botanical Council, cites at least eight clinical studies that have been published on the therapeutic effects of Remifemin in treating menopausal symptoms.

  • In a 1983 open study by Daiber, 36 women noted highly significant decreases in menopausal symptoms. Vorberg, in a 1984 open study, treated 50 women for twelve weeks with Remifemin for menopausal complaints, yielding significant to highly significant improvements in menopausal symptoms.

  • Four studies have compared Remifemin with placebo, hormones, and/or diazepam (Valium) drugs. In a study by Warnecke in 1985, black cohosh showed a clear advantage over both of the other drugs in controlling menopausal symptoms. A 1987 study by Stoll compared Remifemin with conjugated estrogens and found that black cohosh produced better results. Researchers commented that the black cohosh extract produced such a great improvement in the vaginal lining that it should be the drug of first choice to treat menopausal symptoms.


Studies have also explored the feasibility of switching from hormone replacement therapy to black cohosh extract.

  • In a study involving 131 doctors and 629 women, in which Remifemin produced a clear improvement in menopausal symptoms in more than 80 percent of the women, researchers noted advantages of Remifemin therapy over preceding hormone treatment in 72 percent of the cases.


Although much of the research reported on black cohosh has not met the gold standard of RCTs, the benefits of the herb are well documented for treating premenstrual and menopausal conditions. Additional research with improved design will help to substantiate these findings.




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Copyright © 2000 by Dr. Kenneth R. Pelletier, Inc.
Reprinted by permission of Simon & Schuster, Inc., New York, New York.

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