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Black Cohosh: Benefits, Side Effects, Uses, Dosage, Warnings?

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BLACK COHOSH: Benefits, Side Effects, Uses, Dosage, Warnings?

Cimicifuga is effective for menopausal symptoms?

Extracts of black cohosh (Cimicifuga racemosa) in the treatment of menopausal symptoms such as hot flushes and sweats - effective or ineffective?

Background
The black cohosh (Cimicifuga racemosa) is a plant in the genus Actaea. Used the underground parts of plants, especially the roots.

As drug is Cimicifuga application for correction imposed by the menopausal symptoms.

Link: summarized the essence
- Cimicifuga succinctly

Menopause can cause a number of health problems in women from 40 under including hot flashes, night sweats, insomnia and irritability. Hot flashes and sweats belong to the group of vasomotor symptoms. This refers to symptoms associated with a constriction or dilation of blood vessels. Hot flashes are paroxysmal ascending or descending heat waves (hot flush), extending from the neck, head or chest. At the same time, a wave-like blushing (flushing) may occur. About one to two thirds of women have during menopause hot flashes and sweats. The majority of women the symptoms are not very pronounced. In some women, however, hot flashes and sweats can be so pronounced that it affects the quality of life significantly.

What treatment options are available?
Standard treatment of menopausal symptoms is hormone replacement therapy. Among the alternative therapies, menopausal symptoms include herbal ingredients such as Cimicifuga racemosa, Rhapontikrhabarber and red clover (Trifoliumpratense), which are offered as non-prescription drugs, or dietary supplements you use.

According to the medical societies are all alternative treatment options in their effectiveness not with hormone replacement therapy. For mild hot flashes and sweats, a therapeutic trial with Cimicifuga racemosa is still possible. However, the effect could not be individually predicted. With strong vasodilatation was not expected according to experts at a sufficient therapeutic effect of Cimicifuga racemosa.

Hormone replacement therapy in menopause is increasingly critical. Reasons for this include the increased risk of stroke and breast cancer, but also the increased risk of thrombosis (5). Therefore, many women resort to alternative herbal preparations.

Evaluation of the quality of Cimicifuga preparations regardless of the effectiveness
The Öko-Test magazine had herbal medicines and dietary supplements for the treatment of menopausal symptoms, including extracts of black cohosh recently reviewed (4). It is noteworthy that had played only a minor role in this assessment questions of effectiveness. All 14 tested extracts of black cohosh (Cimicifuga racemosa) received top marks in the pharmacological evaluation. Ten of these drugs cut with Eco-test with a total of "very good" - including, among other preparations of STADApharm, Ratiopharm and Bionorica. Two received a rating of "good". "Satisfactory" only with cut example Remifemin tablets from (4).

however, we examine the scientific literature on the effectiveness of extracts of black cohosh (Cimicifuga racemosa) for menopausal symptoms, the result is less clear.

Studies of the effectiveness of Cimicifuga
Already in 2008, was a review article on the effectiveness of Cimicifuga racemosa appeared (1). Six studies with a total of 1,112 peri-and postmenopausal women then met the inclusion criteria. The data from these controlled studies show no consistent effect of Cimicifuga extracts on menopausal symptoms. A positive effect on menopausal symptoms could not be excluded in the opinion of the authors. In summary, it was said in 2008: The efficacy of black cohosh extracts for the treatment of menopausal symptoms is uncertain and further methodologically well-designed studies are needed in order to make definite statements.

In a meta-analysis from the year 2010 a total of nine placebo-controlled were randomized, studies included (2). Among these six studies showed a significant improvement in the Cimicifuga group compared with the placebo group. Using data from seven studies was to estimate how pronounced is the effect of Cimicifuga on the vasomotor symptoms associated with menopause. Improve preparations of black cohosh extract the symptoms by 26% (95% confidence interval 11% - 40%), however, there were remarkable differences, partly contradictory results in different studies. Therefore, general statements about the effectiveness of Cimicifuga racemosa on the basis of this study, data were not possible.

further evaluation from the year 2011 is also no fundamentally different conclusion on the effectiveness of Cimicifuga: The present studies provided no convincing data for the effectiveness of alternative or counter products such as phytoestrogens and black cohosh extracts. In addition, their long-term safety largely unknown (3) is.

these statements are also confirmed by a recent survey from the year 2012, in which the efficacy of various herbal drugs had been tested for the relief of menopausal symptoms (8).

RESULTS: In most of the studies to Comparison of Cimicifuga with placebo, no significant effect of Cimicifuga be detected on menopausal symptoms. The combination of Cimicifuga and St. John's wort, however, shows an improvement in menopausal symptoms compared to placebo. In a direct comparison of Cimicifuga with hormone therapy showed a significantly stronger under the hormonal symptom reduction than under the Cimicifuga-taking. In summary, this review article concludes that the sole treatment of climacteric complaints with Cimicifuga was not very promising, but that a combination of Cimicifuga and St. John's wort may be effective.

Update 2013
The Cochrane Collaboration is an international nonprofit organization that has set itself the goal to create independent, systematic reviews. In the fall of 2012 was a first Cochrane review on the effectiveness of black cohosh (Cimicifuga racemosa) published (9):

Sixteen randomized controlled trials with a total of 2,027 peri-or postmenopausal women were included in this analysis. Cimicifuga has been applied in the studies considered in an average daily dose of 40 mg, with a mean treatment duration of 23 weeks.

Result: There was no significant difference between black cohosh and placebo in the incidence of hot flashes or the menopause symptom score. When comparing Cimicifuga with hormone replacement therapy, significant advantages in the frequency of hot flashes during menopause and symptom score showed the benefit of hormone therapy.

striking were the significant differences in the results of individual studies. For health-related quality of life, the influence on bone density or the frequency of night sweats inadequately were data before, so no evaluation was possible here.

The conclusion of the authors of the effectiveness of Cimicifuga fell accordingly from negative:
Currently there are no adequate effectiveness evidence the use of black cohosh for menopausal symptoms justify (9).

Contrary to previous findings of a study published in late 2012 placebo-controlled study to very positive results in terms of the effectiveness of Cimicifuga for menopausal symptoms (10). Possible explanations may lie in the use of another Cimicifuga extract at higher doses.

In a three-arm, double-blind study, a newly developed Cimicifuga dry extract was compared at the doses of 6.5 and 13 mg with placebo administration. 12 weeks a total of 180 women with menopausal complaints received one of three treatments. The primary study objective was to improve the clinical symptom profile, which was evaluated by the Kupperman index.

RESULTS: Compared to placebo was seen in the patients treated with Cimicifuga a significant decrease in the severity of menopausal symptoms. In the primary endpoint of the study (Kupperman index) a significant superiority of both Cimicifuga groups arose after twelve weeks of therapy compared to placebo (13 mg: p <0.0001; 6.5 mg <0.001). The result in the 13-mg group was the in the 6.5-mg group also significantly superior (p <0.01).

Over time it became apparent that the symptoms hot flashes and sweats after six weeks, a dose-dependent improvement revealed. There were few side effects that were (10) for dose without reference.

, the these study results, underlying dry extract Ze 450, from Cimicifuga racemosa (black cohosh) -Wurzelstock differs from those used in previous studies Cimicifuga extracts. This extract is only by the Swiss company Zeller Medical in product Cimifemin® uno / - offered forte.

Safety and tolerability of Cimicifuga
The tolerability of Cimicifuga extracts can not yet be assessed to conclude with. In 2009 there had been a result of numerous suspected cases of liver damage associated with the use of Cimicifuga extracts changes in the information leaflets of medicinal products (5). A subsequent meta-analysis of five studies could not confirm (7) impairment of liver function by Cimicifuga extracts. Nonetheless, it is pointed out that Cimicifuga-containing preparations without medical advice should be taken for more than three months.

Conclusion
The data published so far indicate a moderately strong effect of Cimicifuga extracts on menopausal symptoms such as hot flushes and sweats. The magnitude of improvement seems very individual. Whether in general a significant, clinically relevant improvement in vasomotor symptoms may be achieved with Cimicifuga remains questionable. The compatibility with brief application is well studied and is known as well. For use over a period of 3 months beyond are insufficient data before. An impairment of liver function during long-term use of Cimicifuga can not be excluded.

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asked Aug 13, 2014 by Lancomega Level (10,245 points)
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