The bright side of black cohosh

When it comes to herbs, there's not a whole lot that's new under the sun. The same old plants are still out there soaking up rays. But in some cases, the ancient remedies derived from them are right back in style, this time with scientific underpinnings. Take, for example, black cohosh, the roots and underground stem of the North American forest plant Cimicifuga racemosa.

Although she didn't know it, your great-grandmother may well have taken a daily dose of this venerable herb as one of several ingredients--probably the only active one--in a product called "Lydia Pinkham's Vegetable Compound."
Lydia's elixir

Mrs. Pinkham herself was one of America's most colorful entrepreneurs. Besides turning an old family recipe into a business in the 1870s, she pio-neered the art of personalizing advertising by providing all the newspapers, both large and small, in the entire country with woodcuts of herself to be used to print her likeness alongside her pitch.

Lydia's widely advertised remedy became the most popular turn-of-the-century nostrum for the treatment of a wide variety of "female complaints." These ranged (in today's terminology) from premenstrual syndrome (PMS) to menopausal symptoms. College students and other irreverent types compounded the promotion of Lydia's product with lusty verses, such as:

Widow Brown she had no children,
Though she loved them very dear;
So she took some Vegetable Compound,
Now she has them twice a year!

For years, the activity of Vegetable Compound was attributed to the tranquilizing effect of the 18% (36- proof) alcohol it contained. A detailed review of the formula, however, has shown that 3 teaspoonfuls daily yielded slightly more than the recommended therapeutic dose of black cohosh.
Cohosh science

Recent European studies of this herb have shown that it has several actions on the various symptoms associated with menopause. Certain complex chemicals, especially triterpenes and flavonoids, are believed to be the active constituents. Some of them apparently act on the pituitary gland, which is located at the base of the brain, to suppress the secretion of luteinizing hormone (LH). High levels of LH in the blood are often associated with menopausal symptoms, including hot flashes, night sweats, headaches, heart palpitations and drying and thinning of the vagina. In contrast to standard hormonal ther-apy with estrogens and progestins, however, black cohosh does not seem to affect levels of two other pituitary hormones, follicle-stimulating hormone (FSH) and prolactin. In other words, the action is more selective than with normal hormonal therapy. That's good, because it tends to lessen side effects.

Other constituents in black cohosh bind to estrogen receptors, producing a weak estriol-like effect. Estriol, unlike its more potent cousin estradiol, is not associated with increased risk of breast, ovarian or endometrial cancers. Still other constituents in the plant seem to promote mild relaxation.

A noncontrolled study of 812 women suffering psychological symptoms associated with meno-pause suggests that administration of black-cohosh extract for periods up to 12 weeks produced "very good" results in 41% and "good" results in an additional 41% of the participants. Conditions including irritability, anxiety, concentration difficulties, depression, sleeplessness and hot flashes were all said to improve. The results of two controlled trials tend to confirm the usefulness of black cohosh previously suggested by noncontrolled studies in larger numbers of human patients. One double-blind study in 80 patients compared the effectiveness of black-cohosh extract with both conjugated estrogens (0.625 mg. daily) and a placebo over a 12-week period. Evaluation of both the psychological and physiological symptoms of menopause found the herb to be the superior treatment. The physiological symptoms included hot flashes, headache, joint pain and heart palpitations. These were in addition to sleep disturbances and depressive moods. In another trial with 110 women, black cohosh proved better than placebo in relieving hot flashes and reducing dryness in the vaginal lining. Although additional trials are needed, we have in black cohosh a botanical that appears capable of providing symptomatic relief of menopausal symptoms comparable to that of hormone-replacement therapy (HRT) without the risk of serious side effects. It has been approved by the German Commission E, the scientific body that evaluates herbal therapies there, for treatment of PMS, painful menstruation and menopausal symptoms.
Intelligent use

The effective daily dose of black cohosh (in capsules) is very small, just 40 milligrams--about one-eighth of the weight of a regular aspirin tablet. Other than an occasional stomach upset, side effects are not known, nor have any contraindications or interactions with drugs been reported. Because long-term toxicity information in humans is lacking, experts recommend that black cohosh use be limited to a period no longer than 3 to 6 months.

Similar common names of unrelated plants often cause confusion. Don't mistake blue cohosh, Caulophyllum thalictroides, for the black variety. Blue cohosh is totally different, even though it is reputed to be effective for some female problems, such as delayed menstruation and difficult childbirth. Modern clinical studies needed to establish the safety and efficacy of blue cohosh are lacking. So the herb cannot be recommended.

A final word of caution: Although black cohosh appears quite promising, it remains an unapproved drug in the United States. Before deciding to use it to treat those hot flashes and related symptoms, discuss it with your physician. That professional can evaluate your need and monitor your progress, thus helping determine whether black cohosh is for you or whether some other therapy would be more beneficial.

THE HERB AT A GLANCE

Common name: Black cohosh

Scientific name: Cimicifuga racemosa

Beneficial uses: Treatment of premenstrual syndrome (PMS), painful menstruation and menopausal symptoms

Possible side effects: Occasional stomach upsets have been reported.

Herbal oddity: This showy woodland plant is native to North America. It was introduced to the early settlers by the Indians who valued it for several purposes including--you guessed it--"diseases of women."

PHOTOS (COLOR): Spilled pill bottles; Dr. Varro E. Tyler, PhD, ScD

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By Varro E. Tyler, PhD, ScD

VARRO E. TYLER, PHD, SCD, is America's foremost expert on herbs and plant-derived medicine. He is Dean Emeritus of the Purdue University School of Pharmacy and Pharmacal Sciences, and Distinguished Professor Emeritus of Pharmacognosy. He is also the author of over 270 scientific articles and 18 books, including The Honest Herbal.

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