A Storm in a Teacup?

By Tracey Karele – AIM Nutritionist

Black cohosh (Cimicifuga racemosa or Actaea racemosa) is a herbal remedy that has been used worldwide for many years for the relief of menopausal and premenstrual complaints. Black cohosh root is also an important ingredient in AIM’s Revitafem product. Studies have confirmed that black cohosh can mimic oestrogen in the body, and this herb has received official recognition in Germany. Nonetheless, there have been a few reports of adverse effects associated with the consumption of black cohosh. Read on to discover more about this herb and the truth behind the claims. 

What Is Black Cohosh?

Black cohosh is a member of the buttercup family, and is a perennial plant that is native to North America. Other common names include black snakeroot, bugbane, bugwort, rattleroot, rattletop, rattleweed and macrotys. Insects tend to avoid it, which accounts for some of these common names. The underground stems and roots of black cohosh are commonly used fresh or dried to make infusions, capsules, solid extracts used in pills or liquid extracts (tinctures). Black cohosh is a useful herbal remedy because it is said to have an oestrogen-like action with the ability to bind to oestrogen receptors in the body.

Relief From Menopausal Symptoms

Black cohosh is a popular remedy for the symptoms of menopause. This has been especially true since the risks of hormone therapy, a standard treatment for menopause, were publicised in 2002. Black cohosh possesses anti-spasmodic, diuretic and cooling properties. It is useful for hot flushes, vaginal dryness and night sweats – all common menopausal symptoms. It is also known for its sedative properties and has a calming effect useful for anxiety, nervousness and muscular spasms and the depression associated with menopause. It can also relieve menstrual cramps and back pain.

Quite a few clinical studies confirm that the use of black cohosh is effective for improving menopausal symptoms, although some have found no improvement. Early German studies found black cohosh improved physical and psychological menopausal symptoms, including anxiety, hot flushes, night sweats and vaginal dryness.

In a clinical study of 120 women with menopausal symptoms, black cohosh was more effective in relieving hot flushes and night sweats than a common antidepressant medication. Given the results of most clinical studies, many experts conclude that black cohosh may be a safe and effective alternative for women who cannot or will not take hormonal replacement therapy (HRT) for menopause. However, in a recent review of six studies, researchers concluded that the evidence does not consistently demonstrate an effect of black cohosh on menopausal symptoms.

The American College of Obstetricians and Gynaecologists (ACOG) reports that many of the early studies were poorly designed and did not evaluate the safety and effectiveness of black cohosh beyond 6 months of use. A study in the December 2006 Annals of Internal Medicine, moreover, reported that black cohosh did not relieve hot flushes. Still, the ACOG recognizes the value of black cohosh for menopausal symptoms. Until further studies are conducted, some doctors recommend only short term (less than 6 months) use of this herb for the relief of hot flushes.

What Else Is It Used For?

According to the USA Office of Dietary Supplements, black cohosh was used in North American Indian medicine for malaise (depression), gynaecological disorders, kidney disorders, malaria, rheumatism and sore throats. It was also used for colds, cough, constipation, hives, backache and to induce lactation. In 19th-century America, black cohosh was a home remedy used for rheumatism and fever, as a diuretic and to bring on menstruation. It was extremely popular among a group of alternative practitioners who called black cohosh “macrotys” and prescribed it for rheumatism, lung conditions, neurological conditions and conditions that affected women’s reproductive organs (including menstrual problems, inflammation of the uterus or ovaries, infertility, threatened miscarriage and relief of labour pains).

According to Prescription for Nutritional Healing (Balch & Balch 2000: 90), black cohosh induces labour and aids in childbirth and morning sickness, and many herbalists recommend taking small amounts for 2 weeks before expected delivery. However, AIM does not recommend using black cohosh root products or Revitafem during pregnancy or breastfeeding.

What Is The Concern And Why?

In mid-2009, an episode of Carte Blanche on MNET featured an insert entitled “Snake Oil,” which focused on Complementary and Alternative Medicines (CAMS) and the regulation of natural ingredients. Black cohosh was used as an example, and it was stated that black cohosh may have possible hepatotoxic (toxic to the liver) effects, and that some cases have even required liver transplants.

Dr Tomlinson of the Health Products Association stated that this issue is a “storm in a teacup,” and AIM tends to agree.

A few years ago, an Australian study reported on a single case where a woman who had apparently been taking black cohosh for a week had to undergo a liver transplant. What was NOT mentioned, however, was the fact that the woman already had acute hepatitis, and was probably going to need that liver transplant regardless! The short time between the intake of the herb and the transplant makes it highly unlikely that the black cohosh could be implicated as the cause of her liver failure. Also, it was never officially ascertained that the product the woman was taking was in fact black cohosh.

According to an article published in Forschende komplementärmedizin (a German complimentary medicine journal), the risk of black cohosh hepatoxicity is small. Every year millions of doses of black cohosh are used worldwide (800 000 packets are sold annually in Italy alone) and so far no fully documented cases of adverse liver reactions have been reported. In fact, the safety of black cohosh can be regarded as sufficiently established by the fact that clinical trials in a total of more than 2000 participants have not reported any hepatotoxic reactions. Considering the millions of women using black cohosh worldwide, the incidence of suspected liver damage is extremely low.

AIM’s Revitafem – Natural Support For The Symptoms Of Menopause

Revitafem is a combination of eight botanical ingredients that provide natural relief from the characteristic symptoms of menopause like hot flushes, night sweats, mood swings and vaginal atrophy (deterioration). The recommended daily serving of 2 capsules of AIM’s Revitafem contains black cohosh root as 40 mg standardized extract 2.5% triterpene glycosides.