Written by Jianping Liu, Xun Li and the CAM-Cancer Consortium.
Updated March 9, 2017

Black cohosh (Actaea racemosa)

What is it?

Description

Black cohosh (Actaea racemosa, synonym: Cimicifuga racemosa) is a medicinal plant originating from eastern North America. Black cohosh products are commercially available on the market such as Remifemin® (manufactured by Schaper & Brümmer, Salzgitter, Germany) which is an isopropanolic extract of black cohosh standardised to contain 1 mg of triterpenes per 20 mg of extract 1. Another standardised ethanolic extract of black cohosh is BNO 1055 (Menofem®/Klimadynon®), BIONORICA, Neumarkt, Germany) 2.

Ingredients

The characteristic chemical constituents of the roots and rhizomes of black cohosh include cycloartenol-type triterpenoids and cimicifugoside, as well as cinnamic acid derivatives 3.

Application and dosage

Black cohosh is a dietary supplement, usually available as tablets. The commonly used dosage for black cohosh is 40 to 80 mg of dried rhizome (root) daily.

History/providers

Black cohosh has been used by native American Indians and Europeans for women’s conditions such as chronic ovaritis and amenorrhea 4. It was first listed in the U.S. Pharmacopoeia in 1830 under the name “black snakeroot” 5. It has been widely used for more than 40 years in Europe and was introduced in Germany in the 1940s for the treatment of menopausal discomfort, dysmenorrhoea, and climacteric neurovegetative complaints. More recently, black cohosh has been used as a therapy for menopausal symptoms such as hot flushes.

Claims of efficacy and alleged indications

Systemic breast cancer treatment can cause premature menopause, which results in hot flushes before the physiological menopause. Hot flushes are also the main adverse effect of the common anti-breast cancer treatment tamoxifen. Hormone replacement therapy (HRT) for hot flushes in breast cancer patients may not be appropriate because of evidence of a relationship between long-term use of HRT and increased risk of breast cancer and cardiovascular disease 6, and potential stimulation of cancer growth by HRT 7. There is therefore an increasing interest in finding safe and effective alternatives to HRT for the treatment of menopausal symptoms in breast cancer patients. Herbal preparations such as black cohosh are used as alternatives to HRT in the treatment of hot flushes 8.

Mechanism of action

The mechanism of action was proposed as being mediated by an inhibitory effect on the hypothalamus, or an effect on neurotransmitters 9, or a possible oestrogenic effect from the phyto-oestrogens 10.

A systematic review including 21 pre-clinical studies concluded that there is a potential antiproliferative effect on breast and prostate tumour cells as well as a theoretical beneficial use in prostate cancer patients.[14] This is, however, not likely to be due to an estrogenic component of the herb as preclinical studies consistently conclude a lack of specific estrogenic activity. The antiproliferative effects, which are observed in in vitro and/or in vivo models for both breast and prostate cancer, are likely to be causally impacted by the favourable disruption of anti/pro-apoptotic cellular machinery.

An in vitro study investigating 9 herbal extracts and 23 isoflavonoids found strong inhibitory effect in extract of black cohosh on breast cancer resistance protein-mediated transport of methotrexate 15. One animal study found that black cohosh presented some beneficial effect for breast cancer prevention and therapy, such as downregulating mitochondrial oxidative phosphorylation genes, but these findings were not consistent 16. Another recent animal study found chemopreventive potentials for mammary cancer, as black cohosh was found reduce Ki-67 and cyclin D1 protein expression in fibroadenomas by immunohistochemistry 17.

Prevalence of use

Specific prevalence data for the use of black cohosh by cancer patients are not available.

Legal issues

In most European countries and the US, plant-based preparations including herbal remedies are regulated as dietary supplements. However, the European Directive on traditional herbal medicinal products allows herbal medicines to be registered as drugs if they have been used medicinally for at least 30 years (including at least 15 years within EU countries) 11. Black cohosh has been granted a traditional herbal registration by the Medicines and Healthcare products Regulatory Agency for the relief of symptoms of the menopause, such as hot flushes, night sweats, and temporary changes in mood 12.

Cost(s) and expenditure

The average monthly cost of e.g. Remifemin is about US$20 or EUR11.

Citation Jianping Liu, Xun Li, CAM-Cancer Consortium. Black cohosh (Actaea racemosa) [online document]. http://ws.cam-cancer.org/The-Summaries/Herbal-products/Black-cohosh-Actaea-racemosa. March 9, 2017.

References

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  2. Popp M, Schenk R, Abel G. Cultivation of Cimicifuga racemosa (L.) nuttal and quality of CR extract BNO 1055. Maturitas 2003; 44 (Suppl 1):S1-7.
  3. Mahady GB, Fabricant D, Chadwick LR, Dietz B. Black cohosh: an alternative therapy for menopause? Nutr Clin Care 2002;5(6):283-9
  4. Anonymous. Cimicifuga racemosa. Monograph. Alternative Medicine Review 2003; 8(2):186-9.
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