Black cohosh [Actaea racemosa L., formerly Cimicifuga racemosa (L.) Nutt.] is an herbal medicine that has been used in the United States for over 100 years for the treatment of many conditions, including menopausal symptoms. To date the clinical data remain controversial. While there are over 20 positive clinical trials, all of the recent NIH-funded studies are negative, casting doubt on its efficacy. In addition, the cases of hepatoxicity are replete, although direct causality to the ingestion of black cohosh has not been demonstrated. In vitro studies have suggested possible chemopreventative effects; however, the in vivo studies to date do not support this hypothesis and suggest enhanced metastases. Unresolved issues of quality, safety, and efficacy remain and until these issues are resolved, the use of black cohosh products cannot be recommended.
ComptonJACulhamAJurySL. Reclassification of Actaea to include Cimicifuga and Soulica (Ranunculaceae) phylogeny inferred from morphology, nrDNA, ITS and cpDNA trnL-F sequence variation. Taxonomy.1998; 47:593–635.
2.
FosterS.Black cohosh: Cimicifuga racemosa: a literature review. HerbalGram.1999; 45:35–49.
3.
MahadyGBFongHHSFarnsworthNR. Rhizoma Cimicifugae Racemosae. In: WHO Monographs on Selected Medicinal Plants, vol. 2. Geneva: World Health Organization; 2002:57–68.
4.
BrinkerF.Review of Macrotys (black cohosh). Eclectic Med J.1996; 2:2–4.
5.
FosterS.Black cohosh: Cimicifuga racemosa. A literature review. HerbalGram.1999; 45:35–49.
6.
MahadyGBFabricantDChadwickLR. Black cohosh: an alternative therapy for menopause?Nutr Clin Care.2002; 5:282–289.
7.
ChenSNLiWFabricantDSSantarsieroBDIsolation, structure elucidation, and absolute configuration of 26-deoxyactein from Cimicifuga racemosa and clarification of nomenclature associated with 27-deoxyactein. J Nat Prod.2002; 65:601–605.
8.
JiangBLylesJTReynertsonKAKronenbergFKennellyEJ. Stability evaluation of selected polyphenols and triterpene glycosides in black cohosh. J Agric Food Chem.2008; 56:9510–9519.
9.
MahadyGBDoyleBLocklearTCotlerSJ. Guzman-Hartman G, Krishnaraj R. Black cohosh (Actaea racemosa) for the mitigation of menopausal symptoms: recent developments in clinical safety and efficacy. Womens Health (London).2006; 2:773–783.
10.
DogT. LowMenopause: a review of botanical dietary supplements. Am J Med.2005; 19(118 Suppl 12B):98–108.
11.
BorrelliFErnstE.Black cohosh (Cimicifuga racemosa) for menopausal symptoms: a systematic review of its efficacy. Pharmacol Res.2008; 58(1):8–14.
12.
PalacioCMasriGMooradianAD. Black cohosh for the management of menopausal symptoms: a systematic review of clinical trials. Drugs Aging.2009; 26(1):23–36.
13.
GellerSEShulmanLPvan BreemenRBSafety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause.2009; 16:1156–1166.
14.
NewtonKMReedSDGrothausLReprint of the Herbal Alternatives for Menopause (HALT) Study: background and study design. Maturitas.2008; 61(1–2):181–193.
15.
ShamsTSetiaMSHemmingsRMcCuskerJSewitchMCiampiA.Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Altern Ther Health Med.2010; 16:36–44.
16.
BorrelliFErnstE.Black cohosh (Cimicifuga racemosa): a systematic review of adverse events. Am J Obstet Gynecol.2008; 199:455–466.
17.
TeschkeRBahreRGenthnerAFuchsJSchmidt-TaenzerWWolffA.Suspected black cohosh hepatotoxicity—challenges and pitfalls of causality assessment. Maturitas.2009; 63:302–314.
18.
MahadyGBLow DogTBarrettMLUnited States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause.2008; 15(4 Pt 1):628–638.
19.
TeschkeRBahreRFuchsJWolffA.Black cohosh hepatotoxicity: quantitative causality evaluation in nine suspected cases. Menopause.2009; 16:956–965.
20.
ShordSSShahKLukoseA.Drug-botanical interactions: a review of the laboratory, animal, and human data for 8 common botanicals. Integr Cancer Ther.2009; 8:208–227.
21.
LiuJBurdetteJEXuHEvaluation of estrogenic activity of plant extracts for the potential treatment of menopausal symptoms. J Agric Food Chem.2001; 49:2472–2479.
22.
RuhlenRLHaubnerJTracyJKBlack cohosh does not exert an estrogenic effect on the breast. Nutr Cancer.2007; 59:269–277.
23.
FreudensteinJBodinetC.Influence of an isopropanolic aqueous extract of Cimicifugae racemosae rhizoma on the proliferation of MCF-7 cells. Breast Cancer ***Treat.2002; 76:1–10.
24.
LupuRMehmiIAtlasEBlack cohosh, a menopausal remedy, does not have estrogenic activity and does not promote breast cancer cell growth. Int J Oncol.2003; 23:1407–1412.
25.
Al-AkoumMDodinSAkoumA.Synergistic cytotoxic effects of tamoxifen and black cohosh on MCF-7 and MDA-MB-231 human breast cancer cells: an in vitro study. Can J Physiol Pharmacol.2007; 85:1153–1159.
26.
RiceSAmonAWhiteheadSA. Ethanolic extracts of black cohosh (Actaea racemosa) inhibit growth and oestradiol synthesis from oestrone sulphate in breast cancer cells. Maturitas.2007; 56:359–367.
27.
EinbondLSWen-CaiYHeKGrowth inhibitory activity of extracts and compounds from Cimicifuga species on human breast cancer cells. Phytomedicine.2008; ***15:504–511.
28.
FreudensteinJDasenbrockCNissleinT.Lack of promotion of estrogen-dependent mammary gland tumors in vivo by an isopropanolic Cimicifuga racemosa extract. Cancer Res.2002; 62:3448–3452.
29.
NissleinTFreudensteinJ.Concomitant administration of an isopropanolic extract of black cohosh and tamoxifen in the in vivo tumor model of implanted RUCA-I rat endometrial adenocarcinoma cells. Toxicol Lett.2004; 150:271–275.
30.
DavisVLJayoMJHoABlack cohosh increases metastatic mammary cancer in transgenic mice expressing c-erbB2. Cancer Res.2008;15;68:8377–8383.
31.
MinciulloPLSaijaAPatafiMMarottaGFerlazzoBGangemiS.Muscle damage induced by black cohosh (Cimicifuga racemosa). Phytomedicine.2006; 13:115–118.
