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Black Cohosh

Black Cohosh. By: Stephanie Russell. Background Info. Historical Uses Reported Benefits Phytoestrogens Estrogenic effects. Research Harmful effects Conclusion. Overview. Learning Objectives. 1.What are the historical uses of black cohosh?

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Black Cohosh

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  1. Black Cohosh By: Stephanie Russell

  2. Background Info. Historical Uses Reported Benefits Phytoestrogens Estrogenic effects Research Harmful effects Conclusion Overview

  3. Learning Objectives • 1.What are the historical uses of black cohosh? • 2. Name the common symptoms associated with menopause. • 3. What are the physiological changes that occur during menopause? • 4. What are phytoestrogens? What specific foods are they found in?

  4. Learning Objectives • 5. What does current research say about the possibility that the isoflavone formononetin is found in black cohosh? • 6. What are some of the potential side effects/warnings that should be considered before using black cohosh?

  5. Background Information • Belongs to the buttercup family • Latin names: Actaea racemosa, Cimicifuga racemosa • Common names: black snakeroot, macrotys,bugbane, bugwort, rattleroot, rattleweed • Root is black in color when harvested from the wild • Cohosh = Algonquin Indian word meaning “rough” - refers to the plants gnarly root structure

  6. Shrub-like Plant Native to eastern deciduous forests of North America Flowers of plant have a strong odor, which acts as an insect repellant (bugbane) Background Information

  7. Underground Root/rhizome Used to make tea Liquid Extracts Pills/Capsules Sold as a dietary supplement in U.S. Background Info.

  8. Triterpene Glycosides actein related compounds, cimigoside Other ingredients tannins, fatty acids, phytoesterols Isoflavones formononetin very controversial Notable Ingredients

  9. Historical Uses • Native Americans • Ceremonial treatment of snakebites • Rheumatism • Kidney Disease • Respiratory Illnesses • Skin Problems • Used root to make a tonic • Poultices were made by pounding leaves

  10. Historical Uses • 19th Century American Physicians • Fever • Menstrual Cramps • Arthritis • Insomnia

  11. Reported Benefits • Treat menopause symptoms • Hot Flashes • Night Sweats • Vaginal Dryness • Bone Loss • Mood Swings • Rheumatoid Arthritis • Premenstrual Syndrome

  12. Asthma Back Pain Muscle Spasms Sleep Disorders Depression Induce labor Diarrhea Dizziness Edema Fever High Blood Pressure Other Reported Benefits...

  13. Menopause • Natural process that occurs in women • Marked by cessation of menstrual cycle • Physiological changes occur • Decreased production of estrogen/progesterone • Higher levels of luteinizing hormone/follicle-stimulating hormone • In some women, these hormonal imbalances cause undesirable symptoms (climacteric) • LH/FSH oppose the action of estrogen • If high levels of LH/FSH = low levels of estrogen

  14. Hormone Therapy • Until recent years, was the “gold standard” treatment for symptoms associated with menopause • Uses estrogen, progesterone, or combination of both to increase hormone levels • Due to recent safety concerns, many women are seeking alternative remedies • Increases risk for: stroke, breast cancer, heart attack, blood clots, gall bladder disease

  15. Alternative remedies forsymptoms of menopuse • Phytoestrogens • Plant-derived compounds w/ weak estrogenic activity - similar in structure to estrogen • isoflavones, lignans, coumestans • found in legumes, soybeans, vegetables, cereals • Isoflavones (found in soy) • genistein, daidzein (most studies) • can bind to estrogen receptors • may enhance estrogen’s beneficial effects, or block negative effects

  16. Structures Estradiol (major estrogen in humans) Genistein

  17. Estrogenic effects ofBlack Cohosh • Is black cohosh estrogenic? • Evidence is conflicting • formononetin - estrogenic isoflavone • mainly found in red clover - some in soy • some research suggests it is a constituent of Black Cohosh • recent studies say it is not • older studies may have been compromised by adulteration of plant materials, or misidentification of formononetin • has not been found in commercial extracts

  18. Estrogenic effects ofBlack Cohosh • Suppresses secretion of luteinizing hormone • Studies are conflicting • No single chemical component has been identified for this action • Possibly through synergetic effect of several chemical fractions

  19. Efficacy and Safety of Isopropanolic Black Cohosh Extract for Climacteric SymptomsOsmers, Ruediger MD, PhD; Friede, Michael PhD; Liske, Eckehard PhD; Schnitker, Joerg PhD; Freudenstein, Johannes PhD; Henneicke-von Zepelin, Hans-Heinrich PhD Volume 105(5, part1) May 2005, pp1074-1083 • Objective: To compare the efficacy and tolerability of the isopropanolic black cohosh extract in the treatment of climacteric complaints compared with placebo. • Methods: Randomized, double-blind clinical trial. 304 patients randomly allocated to receive tablets of 40mg drug, or matching placebo daily for 12 weeks. • Drug contained 2.5mg isopropanolic extract corresponding to 20mg root stock • Placebo corresponded to the active medication w/out isopropanolic extract

  20. Efficacy and Safety of Isopropanolic Black Cohosh Extract for Climacteric SymptomsOsmers, Ruediger MD, PhD; Friede, Michael PhD; Liske, Eckehard PhD; Schnitker, Joerg PhD; Freudenstein, Johannes PhD; Henneicke-von Zepelin, Hans-Heinrich PhD Volume 105(5, part1) May 2005, pp1074-1083 • Inclusion criteria: • Postmenopausal women (>12 months since last regular menstruation), or >6 months since the last regular menstruation plus FSH >50 U/L • 45 years and older • Climacteric complaints as defined by menopause rating scale (MRS) - >0.4 in at least 3 items • MRS is used to measure intensity of menopausal symptoms * Includes 10 items, each ranging from 0 (no complaints), to 1 (severe symptoms), in increments of 0.1

  21. Efficacy and Safety of Isopropanolic Black Cohosh Extract for Climacteric SymptomsOsmers, Ruediger MD, PhD; Friede, Michael PhD; Liske, Eckehard PhD; Schnitker, Joerg PhD; Freudenstein, Johannes PhD; Henneicke-von Zepelin, Hans-Heinrich PhD Volume 105(5, part1) May 2005, pp1074-1083 • Exclusion Criteria: • Cancer - diseases that could interfere w/ the assessment of climacteric symptoms • Drug abuse • Women taking hormone replacement therapy • Women taking supplements such as: soy/red clover

  22. Efficacy and Safety of Isopropanolic Black Cohosh Extract for Climacteric SymptomsOsmers, Ruediger MD, PhD; Friede, Michael PhD; Liske, Eckehard PhD; Schnitker, Joerg PhD; Freudenstein, Johannes PhD; Henneicke-von Zepelin, Hans-Heinrich PhD Volume 105(5, part1) May 2005, pp1074-1083 • Clinical examinations and interviews were performed before treatment began, and 4, 12 weeks after • Intensity of symptoms were assessed according to MRS ratings

  23. Efficacy and Safety of Isopropanolic Black Cohosh Extract for Climacteric SymptomsOsmers, Ruediger MD, PhD; Friede, Michael PhD; Liske, Eckehard PhD; Schnitker, Joerg PhD; Freudenstein, Johannes PhD; Henneicke-von Zepelin, Hans-Heinrich PhD Volume 105(5, part1) May 2005, pp1074-1083 • Findings: • The isopropanolic black cohosh extract was more effective than placebo • Difference was 0.03-0.05 on MRS units • Hot flashes, “atrophy,” and “psyche” decreased statistically significantly in the Black Cohosh extract compared w/ placebo • Most effective in relieving symptoms in early climacteric women

  24. Effects of black cohosh on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal womenWuttke, Wolfgang MD; Gorkow, Christoph DVM; Seidlova-Wuttke, Dana MD: The North American Menopause Society; 13(2) April 2006 pp 185-196 • Objective: To analyze the effects of Cimicifuga racemosa (CR) preparation on markers of bone metabolism, hormones, sex hormone-binding globulin, lipometabolism, and vaginal maturity • Design: Double blind, placebo-controlled, and conjugated estrogens (CE) controlled study. Included 62 postmenopausal women given a daily dose of 40mg herbal drug(CR), 0.6mg CE, or placebo for 12 weeks.

  25. Effects of black cohosh on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal womenWuttke, Wolfgang MD; Gorkow, Christoph DVM; Seidlova-Wuttke, Dana MD: The North American Menopause Society; 13(2) April 2006 pp 185-196 • Inclusion Criteria: • Postmenopausal, aged 40-60 years • Last menstrual bleeding > 6 months ago • Postmenopausal hormone values (E2 < 40pg/mL, FSH >= 25mU/mL) baseline and wk 2 • at least 3 hot flashes/day • Sum score of MRS >= 1.7 at wk 2 and baseline, sum scores of MRS item 1 (hot flashes) >= 0.3 at wk 2 and baseline

  26. Effects of black cohosh on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal womenWuttke, Wolfgang MD; Gorkow, Christoph DVM; Seidlova-Wuttke, Dana MD: The North American Menopause Society; 13(2) April 2006 pp 185-196 • Exclusion criteria: • Hysterectomy • Endometriosis • Current treatment w/ estrogenic substances • Alcohol/drug abuse • hypertriglyceridemia or hypercholesterolemia

  27. Effects of black cohosh on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal womenWuttke, Wolfgang MD; Gorkow, Christoph DVM; Seidlova-Wuttke, Dana MD: The North American Menopause Society; 13(2) April 2006 pp 185-196 • Methods of assessment • Markers of bone turnover, estradiol, FSH, LH, SHBG, triglycerides, total cholesterol, high density cholesterol, low-density cholesterol, and routine clinical chemistry parameters were determined from blood samples. • Vaginal “maturity index” was determined from vaginal smears • Configured by counting 500 cells and calculating the % of parabasal, intermediary, and superficial cells

  28. Effects of black cohosh on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal womenWuttke, Wolfgang MD; Gorkow, Christoph DVM; Seidlova-Wuttke, Dana MD: The North American Menopause Society; 13(2) April 2006 pp 185-196 • Results: CR has estrogen-like effects on vaginal mucosa (increased number of superficial cells) • Not as strong of an effect as CE, but significantly higher than placebo • CR has beneficial bone-remodeling effects • At wk 12, markers for bone formation significantly increased in CR group, compared w/ placebo • Conclusion:CR has beneficial effects on climacteric symptoms - beneficial bone remodeling and weak estrogenic-like effects on the vaginal mucosa

  29. Liver Toxicity: 1 case of acute liver failure 2 cases of hepatitis Other cases reported in people using multiple herbal remedies No scientific research to support these claims General side effects: Nausea, vomiting, dizziness, stomach discomfort Not recommended for use during pregnancy or breastfeeding Do not take with ER therapy No noted drug interactions Harmful Effects

  30. Conclusion • Black Cohosh may be a relatively safe/effective alternative to HR therapy, but dosage/duration should be monitored by physician to avoid potential harmful effects • However, more studies are needed to understand the active components, and mechanisms of action responsible for the beneficial effects on menopausal symptoms.

  31. References: • The American College of Obstetricians and Gynecologists; Volume 1.5 (5, part 1), May 2005, pp 1074-1083 • The North American Menopause Society; Volume 11 (5), September/October 2004, pp 575-577 • The Medical Journal of Australia; Volume 177 (8) 2002 pp 440-443 • http://www.womenshealth.gov • U.S. Department of Health and Human Services • http://www.nccam.nih.gov/health/blackcohosh/ • The North American Menopause Society; volume 13 (2), March/April 2006 pp 185-196 • http://www.health-care-beauty.com/Amerifit-Estroven-Extra-Strength-60-Caplets-B00014FUTQ.htm • http://www.bodyandfitness.com/Information/Herbal/Research/black.htm • http://www.holisticonline.com/Herbal-Med/_Herbs/h32.htm • http://www.allnatural.net/herbpages/black-cohosh.shtml • http://www.drugdigest.org/DD/PrintablePages/herbMonograph/0,11475,4079,00.html • http://www.healthcentral.com/peoplepharmacy/408/20554.html • http://ods.od.nih.gov/factsheets/BlackCohosh.asp

  32. Questions?

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