Overview

Why use black cohosh?
Excellent results:

Black cohosh relieves the discomfort of hot flashes, night sweats, mood swings and irritability.†

Time-tested support:

Women have used black cohosh for hundreds of years to relieve menopausal symptoms, and black cohosh has been clinically studied for more than 40 years for its ability to reduce menopausal discomfort.†

Why use our Black Cohosh?
It provides natural control for menopausal symptoms:†

Contains hormone-free, standardized black cohosh extract for consistent benefits.†

Provides reliable, reputable relief from menopausal symptoms, including hot flashes, night sweats and mood swings.†

Directions

One tablet in the morning and one tablet in the evening. Do not chew.

Pill Size

Interactions and Depletions

Technical Data

Description

Black Cohosh is a standardized herbal extract of Cimicifuga racemosa (black cohosh). Black cohosh has been clinically studied for more than 40 years for its ability to reduce the symptoms of menopause.† Black Cohosh provides relief of menopausal symptoms, including hot flashes, night sweats, and mood swings.† Black Cohosh is hormone-free.

Introduction

Menopause
Menopause is defined as “permanent cessation of menstruation.”¹ It results when the ovaries decrease production of the sex hormones estrogen and progesterone, and it signals the end of a woman's reproductive ability.²

It is estimated that over 5,400 women enter menopause daily in North America.² For most women, menopause occurs as part of the natural aging process, usually between the ages of 35 and 58.¹ This hormonal change is influenced by many factors, including genetics, diet, lifestyle, and environmental stresses.^2-5 Premature menopause is sometimes linked to other physical or hormonal disorders.⁴ However, some women may experience induced menopause as a result of surgical removal of the ovaries.^1,2,4

Menopause-related changes are unique for each woman, and may range from mild to severe. In early menopause, some women may experience mood swings, panic attacks, sleep disturbances, depression, changes in tolerance to heat or cold, joint and muscle pain, allergies, and headaches. As production of estrogen decreases, additional menopause-related changes may include irregular menstrual patterns, night sweats, fatigue, vaginal dryness, fluctuations in sexual desire or response, forgetfulness, hot flashes, and weight fluctuations.^2-5

The natural decline in estrogen is often described in four stages:

1. Premenopause⁴ is marked by hormonal fluctuations associated with early menopause-related changes while maintaining regular menstrual cycles. Some women experience premenopause in their late thirties to early forties.⁴
2. Perimenopause,² the transition between the premenopausal phase and menopause, is characterized by changes in estrogen levels, irregular menstrual cycles, and increased menopausal symptoms.²
3. Menopause² is the lack of spontaneous menstruation for twelve consecutive months with no identifiable biological cause.²
4. Postmenopause² is the period of life that follows the last menstrual period when a woman's natural levels of estrogen are at their lowest.²




How Does It Work?


Black Cohosh and Menopause
Black cohosh (Cimicifuga racemosa) is a perennial herb in the Ranunculaceae (buttercup) family. This herb has traditionally been used to support women's health. Its approved monograph in The Complete German Commission E Monographs discusses the well-documented use of Cimicifuga racemosa for the relief of menopausal complaints.†^6-8

The primary constituents in Cimicifuga racemosa extract are glycosides, specifically triterpene glycosides which include cimicifugoside, actein and 27-deoxyactein. The Cimicifuga racemosa extract used in Black Cohosh is standardized to these triterpene glycosides measured as 27-deoxyactein.^6,9,10

The exact mechanism of action for the effects of black cohosh has not been fully elucidated. Early research hypothesized that black cohosh exerted estrogen-like effects.¹⁰ Recent animal research shows that black cohosh binds to the estrogen receptor; however, it does not affect the luteinizing hormone level and does not exhibit estrogen-like effects.†^6,11 Thus, there is currently no consensus as to the biological effect of this binding.^11,12,13 Research indicates that Cimicifuga racemosa does not alter estrogen levels and does not change the thickening of the lining of the uterus.¹³

How black cohosh works at the cellular level is currently being studied in several ongoing research projects.⁶ To date, there is no definitive published data available to clearly describe the process; however, forty years of clinical studies on a standardized black cohosh extract have shown efficacy in the relief of hot flashes, profuse sweating, insomnia and depressive moods associated with menopause, with few adverse effects.†^10,14

In a randomized, placebo-controlled, double-blind study, a researcher compared women who took standardized black cohosh extract with women taking a placebo. At the end of the study, the women taking the standardized black cohosh extract showed improvement relative to the placebo as measured by the Kupperman Menopausal Index, the Hamilton Anxiety Scale, and the Maturation Index of vaginal epithelium.† No clear improvement of menopausal complaints was observed in the control (placebo) group. This study demonstrated clinical and statistical improvement of menopausal symptoms by the women taking the standardized black cohosh extract.†^6,15

In a more recent 6-month randomized, open-label trial involving 53 women, significant decreases in unwanted menopause-related symptoms were reported following the administration of Cimicifuga racemosa.†¹⁶

The benefits of Black Cohosh may be first experienced in two to three weeks; however, the full benefits may not be realized until after four to eight weeks of administration.†



Recommendations


One tablet in the morning and one tablet in the evening. Do not chew.





Precautions


In more than 40 years' use in Germany, black cohosh has shown no evidence of serious adverse effects, contraindications, or drug interactions.^6,10 One study showed that 7% of patients who took it experienced minor gastrointestinal upset.^6,10 Studies thus far have shown that the extracts of Cimicifuga racemosa have no toxic or mutagenic properties demonstrated in any human or animal studies.⁶

Because very long-term studies have not been performed, some authorities recommend not using the herb for more than 6 months without supervision of a health care practitioner. However, there have been no reports of the evidence of toxicity or serious side effects to date.^6,9 Historically, black cohosh has been used for longer periods of time. We encourage consumers to consult their healthcare practitioner for further direction if they have questions regarding extended use.

Black Cohosh should be well tolerated when used as directed. However, women who are pregnant or nursing should not use this product.



How Is It Supplied?



• 07906;60 tablets




Storage Recommendations


Store at controlled room temperature, 59° to 86°F (15°-30°C)



References



1. Taber's Cyclopedic Medical Dictionary. 17th ed. Philadelphia, Penn: F.A. Davis Company; 1993:1194.
2. Basic facts about menopause. The North American Menopause Society (NAMS). Available at: http://www.menopause.org/aboutmeno/overview.html. Accessed April 18, 2002.
3. Brunner LS, Suddarth DS, Bare BG, Boyer MJ, O'Connell Smeltzer SC. Management during the reproductive cycle. In: Textbook of Medical-Surgical Nursing. Philadelphia, Penn: J.B. Lippincott Company; 1988:1087.
4. Ford G. Perimenopause and menopause. In: Listening to Your Hormones. 6th ed. Rocklin, Calif: Prima Publishing; 1996: 232-304.
5. Mackay HT. Gynecology. In: Tierney LM Jr, McPhee SJ, Papadais MA, eds. Current Medical Diagnosis and Treatment. 38th ed. Stamford, Conn: Appleton & Lange; 1999:734-736.
6. Liske E. Therapeutic efficacy and safety of Cimicifuga racemosa for gynecological disorders. Adv Ther. 1998;15:45-53.
7. Pettit JL. Alternative Medicine – Black Cohosh. Clinical Reviews. 2000;10:117-121.
8. Black Cohosh Root. In: Blumenthal M., ed. The Complete German Commission E Monographs. Austin, Tex: American Botanical Council; Integrative Medicine Communications; 1998:90.
9. Gruenwald J. Standardized black cohosh (Cimicifuga) extract clinical monograph. Quarterly Rev Nat Med. 1998; Summer:117-125.
10. Lieberman S. A Review of the effectiveness of Cimicifuga racemosa (black cohosh) for the symptoms of menopause. J Womens Health. 1998;7:527-528.
11. Jarry H, Harnischfeger G, Düker EM. Studies on the endocrine effects of the constituents of Cimicifuga racemosa: In vitro binding of constituents to estrogen receptors. Planta Med. 1985; 4:316-319.
12. Kuiper GG, Lemmen JG, Carlsson B, et al. Interaction of estrogenic chemicals and phytoestrogens with estrogen receptor beta. Endocrinology. 1998;139:4252-4263. Abstract.
13. Einer-Jensen N, Zhao J, Andersen KP, Kristoffersen K. Cimicifuga and Melbrosia lack oestrogenic effects in mice and rats. Maturitas. 1996; 25:149-153.
14. Duker EM, Kipanski L, Jarry H, et al. Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats. Planta Med. 1991;57:420-424.
15. Stoll W. Phytopharmacon influences atrophic vaginal epithelium. Double-blind study Cimicifuga vs estrogenic substances.Therapeuticum. 1987;1:23-31.
16. Pepping J. Black cohosh: Cimiciguga racemosa. Am J Health Syst Phar. 1999;56:1400-1402.

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