Black Cohosh (Cimicifuga Racemosa) as Treatment of Menopause-Related Symptoms: A Mini Review Shoeb Qureshi - Juniper publishers
Journal of Trends in Technical and Scientific Research
Abstract
Black
cohosh belongs to the family Cimicifuga racemosa. Root and rhizome are
the medicinal parts of the herb. Black cohosh is used against the treatment of
Menopause symptoms (including vasomotor); Premenstrual Syndrome (PMS);
depression (mild); arthritis and migraine. It is often used as an alternative
to estrogen-based replacement therapies to treat hot flushes that frequently
accompany the transition to menopause.
Keywords: Black cohosh; Cimicifuga racemose;
Menopause; Chemical constituents; Adverse effects
Introduction
Black
cohosh belongs to the family Cimicifuga racemosa. Root and rhizome are
the medicinal parts of the herb. Black cohosh is used against the treatment of
Menopause symptoms (including vasomotor); premenstrual syndrome; depression
(mild); arthritis and migraine [1-5]. It is often used as an alternative to
estrogen-based replacement therapies to treat hot flushes that frequently
accompany the transition to menopause [6,7]. However, definitive clinical data
about efficacy have been equivocal [8]. Trials conducted by Pockaj et al. [8]
found no evidence that black cohosh reduced hot flashes more than the placebo.
As a constituent to Avlimil (a dietary supplement advertised to ameliorate
female sexual dysfunction), black cohosh is suggested to have estrogenic,
anti-estrogenic, or androgenic potential for relieving menopausal symptoms.
Furthermore, DMSO extract of Avlimil was found to increase cell proliferation
and cytotoxicity in MCF-7 (in vitro) at low and high concentrations,
respectively Ju, et al. [9].
Materials and Methods
To
accomplish the target on Black cohosh as treatment of menopause related systems
and associated adverse effects, peer-reviewed English language articles
published during 2 decades were selected from Pub Med, Pub Med Central,
Science direct, Up-to-date, Med Line, comprehensive data base, Cochrane library
and the internet (Google, Yahoo).
Chemical constituents
The main constituents
of Black cohosh are triterpenoids, phenolic compounds [9], phytoestrogens,
isoflavones cimicifugoside, formononetin and salicylic acid [10].
Toxicity
Black cohosh
significantly increased the incidence of lung metastases in tumor-bearing
animals compared with mice fed the isoflavone-free control diet [6], and is
reported to cause liver toxicity and induce micronuclei [11].
Contraindications
Contraindicated in
individuals with a history of estrogen-dependent tumors or endometrial cancer.
Black cohosh may cause nausea, vomiting, headache, and hypotension at higher
dosages. Use with caution in individuals allergic to salicylates; it is not
known whether the amount of salicylic acid is likely to affect platelet
aggregation or have other effects associated with salicylates. Use with caution
in individuals with hypotension or those taking antihypertensive medications.
Use with caution in
individuals receiving anticoagulant medications. Monitoring of serum hormone
levels is recommended after 6 months of use with black cohosh. Use with caution
in in dividuals with liver disease due to cases of liver
damage [12-14]. Use with caution in patients with seizure disorder [15]. Contraindicated
in pregnancy (based on in vitro or animal studies, may stimulate uterine
contractions) and lactation [16].
To date, phytoestrogen-containing herbs
have not been associated with the negative health effects seen with synthetic
estrogen. However, use with caution in individuals on hormone replacement
therapy or oral contraceptives, or a history of thromboembolic disease or
stroke [17-21].
Theoretical interactions
Oral
contraceptives, hormonal replacement therapy, NSAIDs, anticoagulants,
antihypertensives, drugs that lower the seizure threshold, hepatoxic drugs;
cytochrome P450, 3A4, and 2D6 substrates.
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