Black Cohosh for Menopause

Black cohosh (Cimicifuga racemosa) is a perennial herb native to North America, traditionally used for its potential benefits in alleviating menopausal symptoms. Its active components—primarily triterpene glycosides—are thought to help reduce neurovegetative and psychological symptoms like hot flashes, night sweats, palpitations, and depression. Although extraction methods vary, black cohosh is often used alone or in combination with other natural compounds to improve sleep quality and overall menopausal symptom relief.

Protocols Studied in Research

Hot Flashes Management in Postmenopausal Women

• Protocol: Administration of black cohosh (20 mg BID) and a proprietary combination of soy isoflavone, black cohosh, chasteberry, and evening primrose oil extracts.
• Outcome from Publication [1]: Black cohosh did not significantly reduce hot flashes compared to placebo, with a 20% decrease in hot flash score for black cohosh vs. 27% for placebo.
• Outcome from Publication [2]: The nutraceutical combination significantly reduced the frequency of hot flushes and sweating (p < 0.0001) compared to placebo, showing effectiveness in managing hot flashes.

Sleep Disturbance in Postmenopausal Women

• Protocol: Daily administration of black cohosh vs. placebo, with monitoring using polysomnography and the Pittsburgh Sleep Quality Index.
• Outcome: Black cohosh significantly improved objective sleep parameters, including increased sleep efficiency and decreased wake after sleep onset (WASO) duration. Subjective sleep quality tended to improve with black cohosh, showing its potential effectiveness in managing sleep disturbances during menopause (p < 0.01) [3].

Overall Menopausal Symptom Relief

• Protocol: Administration of a nutraceutical combination for 12 weeks to post-menopausal women.
• Outcome: Significant improvement in a range of menopausal symptoms including sleep problems, depressed mood, and irritability, alongside beneficial effects on general health indicators such as reduced levels of C-reactive protein, LDL-C, and triglycerides, with no reported adverse effects [2].

Research Interpretation: Summary and Conclusion

Studies on black cohosh have produced mixed results. Some trials show that, when used alone, black cohosh may not significantly reduce hot flashes compared to a placebo. However, when combined with other natural extracts (like soy isoflavones, chasteberry, and evening primrose oil), the nutraceutical formulations have significantly decreased the frequency of hot flashes and sweating. Additionally, black cohosh has demonstrated effectiveness in improving sleep quality by increasing sleep efficiency and reducing the time spent awake.

Overall, while black cohosh shows promise in managing menopausal symptoms—especially sleep disturbances—the results are variable, and its benefits may be enhanced when used as part of a combined natural therapy.

Publications

[1] Pockaj BA, Gallagher JG, Loprinzi CL, Stella PJ, Barton DL, Sloan JA, Lavasseur BI, Rao RM, Fitch TR, Rowland KM, Novotny PJ, Flynn PJ, Richelson E, Fauq AH. Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1. J Clin Oncol. 2006 Jun 20;24(18):2836-41. doi: 10.1200/JCO.2005.05.4296. PMID: 16782922.

[2] Rattanatantikul T, Maiprasert M, Sugkraroek P, Bumrungpert A. Efficacy and Safety of Nutraceutical on Menopausal Symptoms in Post-Menopausal Women: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J Diet Suppl. 2022;19(2):168-183. doi: 10.1080/19390211.2020.1853648. Epub 2020 Dec 17. PMID: 33331798.

[3] Jiang K, Jin Y, Huang L, Feng S, Hou X, Du B, Zheng J, Li L. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric. 2015;18(4):559-67. doi: 10.3109/13697137.2015.1042450. Epub 2015 May 22. PMID: 26000551.

[4] Castelo-Branco, C., et al. Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms–an update on the evidence. Climacteric 24.2 (2021): 109-119.

[5] Jacobson JS, Troxel AB, Evans J, Klaus L, Vahdat L, Kinne D, Lo KM, Moore A, Rosenman PJ, Kaufman EL, Neugut AI, Grann VR. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol. 2001 May 15;19(10):2739-45. doi: 10.1200/JCO.2001.19.10.2739. PMID: 11352967.