Black cohosh research articles: abstracts and links to the original sources

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Research Abstracts and Links to Original Sources

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12609557&dopt=Abstract Ref: Maturitas 2003 Mar 14;44 Suppl 1:S31-8

In vitro effects of the Cimicifuga racemosa extract BNO 1055.

Jarry H, Metten M, Spengler B, Christoffel V, Wuttke W.

Division of Clinical and Experimental Endocrinology, Department of Obstetrics and Gynecology, University of Gottingen, Robert-Koch-Strasse 40, 37075, Gottingen, Germany

OBJECTIVES: Extracts of Black cohosh (Cimicifuga racemosa or CR) have been used for the treatment of climacteric complaints since decades. Efficacy, particularly concerning neurovegetative and psychic symptoms, has been proven in clinical trials. As active principle yet unknown substances with selective estrogen receptor modulator (SERM) activity are assumed. Recently, evidence arose that CR may also contain dopaminergic compounds, which may contribute to the therapeutic activity of the extract. METHODS: Two subtypes of the estrogen receptor (ERalpha and ERbeta) are known. To examine, whether active substances of CR extract BNO 1055 (which is contained in Klimadynon(R) and Menofem(R)) bind to either of the two estrogen receptors, subtype-specific estrogen receptor ligand-binding assays with recombinant ERalpha or ERbeta were conducted. A ligand-binding assay with recombinant dopamine D(2)-receptor protein was employed to assess possible dopaminergic activity in the CR extract BNO 1055. RESULTS: While a displacement of radiolabeled estradiol from binding sites of a cytosol preparation from procine and human endometrium by CR extract BNO 1055 was shown no such displacement was achieved when either ERalpha or ERbeta protein was used as ligands for tracer. Dopaminergic activity in the CR extract BNO 1055 could be demonstrated with the D(2)-receptor assay. A countercurrent chromatography resulted in a separation of estrogenic and dopaminergic activity in two distinct fractions. CONCLUSIONS: It is suggested that not yet identified substances in the CR extract BNO 1055 bind to a yet unknown estrogen-binding site in the endometrium. Also, yet unknown dopaminergic compounds may contribute to the pharmacological profile of CR extract BNO 1055.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12562054&dopt=Abstract Ref: Dis Mon 2002 Oct;48(10):671-96

Herbs commonly used by women: an evidence-based review.

Tesch BJ.

OBJECTIVE: To review the evidence of herbs commonly used by women. DATA SOURCES: Articles were located by searching Medline, Cochrane Database of Systemic Reviews, and the Combined Health Information Database and by hand searching the reference lists of recent systematic reviews. The databases were searched in January 2000 and October 2000 by using the Latin and common name of each herb. METHODS OF STUDY SELECTION: Preference was given to randomized, placebo-controlled trials. When available, English language studies were reviewed. If not, data are presented from review articles that summarize the foreign study. RESULTS: Many women use herbal therapies. In the United States, herbs are considered dietary supplements. The Food and Drug Administration (FDA) cannot remove them from the market unless they are proven unsafe. The herb industry plans to improve monitoring. Many prospective randomized controlled trials are being funded. Gingko biloba seems to slow the progression of dementia but increases the risk of bleeding. St John's Wort is efficacious for treating mild to moderate depression but has many drug interactions. Ginseng seems to improve well being in perimenopausal women, but it is often impure and has side effects and drug interactions. Garlic slightly lowers blood pressure and lipids. Echinacea slightly decreases the duration of colds but does not prevent them. Valerian is beneficial for insomnia, but there is no long-term safety data. Black cohosh may help the symptoms of perimenopause, and chasteberry may improve premenstrual syndrome. More study is needed on both herbs. CONCLUSION: Some herbs are medically useful, but the American public would benefit from increased regulation. Manufacturers should be able to ensure that herbs contain pure ingredients. Side effects and drug interactions should be listed. Well-designed studies are being conducted. The results will be helpful to physicians and patients when the clinical evidence becomes available.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12557811&dopt=Abstract Ref: Nutr Clin Care 2002 Nov-Dec;5(6):283-9

Black cohosh: an alternative therapy for menopause?

Mahady GB, Fabricant D, Chadwick LR, Dietz B.

UIC/NIH Center for Botanical Dietary Supplements Research, Program for Collaborative Research in the Pharmaceutical Sciences, University of Illinois, Chicago, Illinois, USA.

Due to the long-term health risks now associated with hormone replacement therapy, many menopausal women are actively seeking alternative treatments. One such alternative is black cohosh (Actaea racemosa, syn. Cimicifuga racemosa), which has been used in the United States for the treatment of gynecologic complaints for more than 100 years. Review of the published clinical data suggests that black cohosh may be useful for the treatment of menopausal symptoms, such as hot flashes, profuse sweating, insomnia, and anxiety. Results from the most recently published trial, however, indicate that black cohosh is not effective for the treatment of menopausal symptoms in breast cancer survivors being treated with tamoxifen. Because the overall quality of the published clinical trials is low, two new randomized, double-blind, placebo-controlled clinical trials are currently underway in the United States. To date, only one standardized black cohosh extract has been tested clinically; the current recommended dose is 40-80 mg per day. At least 4-12 weeks of treatment may be required before any therapeutic benefits may be apparent. Adverse reactions such as nausea, vomiting, headaches, dizziness, mastalgia, and weight gain have been observed in clinical trials. No drug interactions are reported in the medical literature. The estrogenic effects of black cohosh are controversial, and the more recent data indicate that black cohosh extracts may have an anti-estrogenic activity. Owing to potential effects on sex hormones, however, black cohosh should not be administered to children or during pregnancy and lactation.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12544679&dopt=Abstract Ref: Menopause 2003 Jan-Feb;10(1):65-72

Botanical dietary supplement use in peri- and postmenopausal women.

Mahady GB, Parrot J, Lee C, Yun GS, Dan A.

University of Illinois at Chicago/National Institutes of Health Center for Botanical Dietary Supplements Research, Department of Pharmacy Practice, Center for Excellence in Women's Health, Chicago, Illinois, USA.

OBJECTIVE: To determine use of botanical dietary supplements (BDS) in women between the ages of 40 and 60 years at the University of Illinois at Chicago (UIC) clinics, including information about commonly used BDS, the reason for use, information resources used, and the overall perception of safety and efficacy of BDS. DESIGN: Five hundred female outpatients at UIC clinics were interviewed by healthcare practitioners using a botanical/drug history questionnaire. Respondents were 46.8% African American, 39.6% Caucasian, 11.7% Hispanic, and 1.5% Asian, with a mean age of 50.34 years. RESULTS: BDS were used by 79% of respondents ( = 395), of which 36.5% used BDS daily. Of the positive respondents, 51.7% used one or two BDS, whereas 48.4% used three or more. Commonly used botanicals included soy (42%), green tea (34.68%), chamomile (20.76%), gingko (20.51%), ginseng (17.97%), Echinacea (15.44%), and St. John's wort (7.34%). Black cohosh, garlic, red clover, kava, valerian, evening primrose, and ephedra were used by less than 15% of respondents. Efficacy ratings were high for BDS, and 68% claimed to have no side effects. Only 3% of respondents obtained BDS information from healthcare professionals, and 70% of respondents were not informing their physician of BDS use. CONCLUSIONS: A high percentage of women at UIC clinics were using multiple BDS. The respondents believed that these products were both safe and effective for the treatment of common ailments. Concomitant BDS use with prescription and over-the-counter medications was commonplace, often without a physician's knowledge. Consumer education about the possible benefits and risks associated with BDS use is urgently needed.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12544678&dopt=Abstract Ref: Menopause 2003 Jan-Feb;10(1):58-64

A systematic review of the safety of black cohosh.

Huntley A, Ernst E.

OBJECTIVE To systematically review the available data relating to the safety of medicinal extracts of black cohosh ( ).DESIGN Systematic literature searches were conducted in seven electronic databases, and the reference lists of all papers located were checked for further relevant publications. Information was also sought from the spontaneous reporting programs of the World Health Organization and national drug safety bodies. Sixteen manufacturers of black cohosh preparations were contacted and asked for data held on file. Finally, our own departmental files were searched. No language restrictions were imposed. Combination products and homeopathic preparations were excluded.RESULTS Data from clinical studies and spontaneous reporting programs suggest that adverse events (AEs) with black cohosh are rare, mild, and reversible. Gastrointestinal upsets and rashes are the most common AEs. The spontaneous reporting programs do contain a few serious AEs, including hepatic and circulatory conditions, but causality cannot be determined. Although there is large amount of data investigating the efficacy of black cohosh, in particular the product Remifemin, safety issues and the monitoring of AEs have not been the focus.CONCLUSION If black cohosh products are taken for a limited length of time, there seems to be a slight risk of mild, transient AEs. More serious AEs seem to be rare, and it is impossible to ascertain causality with black cohosh with the limited data available. Thus, although definitive evidence is not available, it would seem that black cohosh is a safe herbal medicine.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12445983&dopt=Abstract Ref: Int J Gynaecol Obstet 2002 Dec;79(3):195-207

Use of alternative and complementary medicine in menopause.

Kang HJ, Ansbacher R, Hammoud MM.

Division of Reproduction Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA

OBJECTIVES: To review the clinical evidence available for the treatment of menopausal symptoms with alternative and complementary medicine. METHODS: The MEDLINE, PREMEDLINE and COCHRANE electronic databases for the years 1980-2002 were searched for articles concerning soy products, black cohosh, dong quai, acupuncture, ginseng and evening primrose oil. Studies pertaining to menopausal vasomotor symptoms, lipid profiles and bone mineral densities of postmenopausal women were included. The data from clinical trials were reviewed. RESULTS: Soy isoflavones slightly decrease total cholesterol and LDL levels. The clinical significance of this small change is yet to be determined. The synthetic isoflavone derivative ipriflavone increases bone mineral density in healthy peri- and postmenopausal women with moderate bone mineral densities. Although earlier reports have claimed that soy is beneficial for the improvement of vasomotor symptoms, recent data do not support this claim. There are insufficient data on the other alternative therapies for treating menopausal symptoms at this time. CONCLUSION: Alternative and complementary medicine may play a role in the management of menopause, however, well-designed large studies are still needed.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12435217&dopt=Abstract Ref: Ann Intern Med 2002 Nov 19;137(10):805-13

Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials.

Kronenberg F, Fugh-Berman A.

Rosenthal Center for Complementary and Alternative Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, Box 75, New York, NY 10032, USA.

BACKGROUND: Women commonly use soy products, herbs, and other complementary and alternative medicine (CAM) therapies for menopausal symptoms. Randomized, controlled trials have evaluated the efficacy and short-term safety of these therapies. PURPOSE: To review randomized, controlled trials of CAM therapies for menopausal symptoms in order to better inform practice and guide future research. DATA SOURCES: Searches of MEDLINE for articles published from January 1966 through March 2002, of the Alternative and Complementary Database (AMED) of the British Library for articles published from January 1985 through December 2000, and of the authors' own extensive files. Search terms were hot flash/flush, menopause, and climacteric, combined with phytoestrogens, alternative medicine, herbal medicine, traditional medicine, Traditional Chinese Medicine (TCM ), Ayurveda, naturopathy, chiropractic, osteopathy, massage, yoga, relaxation therapy, homeopathy, aromatherapy, and therapeutic touch. STUDY SELECTION: 29 randomized, controlled clinical trials of CAM therapies for hot flashes and other menopausal symptoms were identified; of these, 12 dealt with soy or soy extracts, 10 with herbs, and 7 with other CAM therapies. DATA EXTRACTION: Each author extracted information from half of the studies on the number of patients, study design, outcome measures, and results; the other author then checked these results. DATA SYNTHESIS: Soy seems to have modest benefit for hot flashes, but studies are not conclusive. Isoflavone preparations seem to be less effective than soy foods. Black cohosh may be effective for menopausal symptoms, especially hot flashes, but the lack of adequate long-term safety data (mainly on estrogenic stimulation of the breast or endometrium) precludes recommending long-term use. Single clinical trials have found that dong quai, evening primrose oil, a Chinese herb mixture, vitamin E, and acupuncture do not affect hot flashes; two trials have shown that red clover has no benefit for treating hot flashes. CONCLUSIONS: Black cohosh and foods that contain phytoestrogens show promise for the treatment of menopausal symptoms. Clinical trials do not support the use of other herbs or CAM therapies. Long-term safety data on individual isoflavones or isoflavone concentrates are not available.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12428954&dopt=Abstract Ref: J Agric Food Chem 2002 Nov 20;50(24):7022-8

Black cohosh (Cimicifuga racemosa L.) protects against menadione-induced DNA damage through scavenging of reactive oxygen species: bioassay-directed isolation and characterization of active principles.

Burdette JE, Chen SN, Lu ZZ, Xu H, White BE, Fabricant DS, Liu J, Fong HH, Farnsworth NR, Constantinou AI, Van Breemen RB, Pezzuto JM, Bolton JL.

Department of Medicinal Chemistry and Pharmacognosy and UIC/NIH Center for Botanical and Dietary Supplements Research, College of Pharmacy, 833 South Wood Street, University of Illinois at Chicago, Chicago, Illinois 60612, USA.

The roots/rhizomes of Cimicifuga racemosa L. (Nutt.) (black cohosh) have traditionally been used to treat menopausal symptoms through an unknown mechanism of action. In an effort to determine if black cohosh had additional health benefits, methanol extracts were investigated for their potential to scavenge reactive oxygen species and to protect against menadione-induced DNA damage. These extracts effectively scavenged 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radicals. In addition, the extracts showed dose-dependent decreases in DNA single-strand breaks and oxidized bases induced by the quinone menadione using the comet (single-cell gel electrophoresis assay) and fragment length associated repair enzyme assays, respectively. Bioassay-directed fractionation of the methanolic extracts using the DPPH assay as a monitor led to the isolation of nine antioxidant active compounds: caffeic acid (1), methyl caffeate (2), ferulic acid (3), isoferulic acid (4), fukinolic acid (5), cimicifugic acid A (6), cimicifugic acid B (7), cimicifugic acid F (8), cimiracemate A (9), and cimiracemate B (10). Six of these antioxidants were found to reduce menadione-induced DNA damage in cultured S30 breast cancer cells with the following order of potency: methyl caffeate (2) > caffeic acid (1) > ferulic acid (3) > cimiracemate A (9) > cimiracemate B (10) > fukinolic acid (5). These data suggest that black cohosh can protect against cellular DNA damage caused by reactive oxygen species by acting as antioxidants.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12408370&dopt=Abstract Ref: Breast Cancer Res Treat 2002 Nov;76(1):1-10

Influence of Cimicifuga racemosa on the proliferation of estrogen receptor-positive human breast cancer cells.

Bodinet C, Freudenstein J.

Research and Development Department, Schaper & Brummer GmbH & Co. KG, Salzgitter, Germany.

Hormone replacement therapy, which is a common menopausal treatment, is contraindicated in women with breast cancers due to concerns regarding the potential for breast cell proliferation. As such, there is a need for alternative methods for treating menopausal symptoms. To determine the influence of one such alternative, black cohosh (Cimicifuga racemosa [CR]), on estrogen-dependent mammary cancers, we conducted an in vitro investigation of the effect of an isopropanolic CR-extract on the proliferation of estrogen receptor-positive breast cancer cells. The experiments were performed using the human breast adenocarcinoma (MCF-7) cell test system, an established in vitro model for estrogen-dependent tumors. The influence of CR-extract on the proliferation of the MCF-7 cells was determined by measuring the incorporation of radioactively labeled thymidine. Under estrogen-deprived conditions, the CR-extract (10(-3)-10(-5) dilutions) significantly inhibited MCF-7 cell proliferation. Additionally, application of the CR-extract inhibited estrogen-induced proliferation of MCF-7 cells. Moreover, the proliferation-inhibiting effect of tamoxifen was enhanced by the CR-extract. Such data that suggest a non-estrogenic, or estrogen-antagonistic effect of CR on human breast cancer cells lead to the conclusion that CR treatment may be a safe, natural remedy for menopausal symptoms in breast cancer.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12391713&dopt=Abstract Ref: Prim Care 2002 Jun;29(2):297-321, vi

Gynecology: select topics.

Sidani M, Campbell J.

Department of Family Medicine, LSU School of Medicine-New Orleans, 200 West Esplanade, Suite 510, Kenner, LA 70065, USA.

Menopause, premenstrual syndrome, dysmenorrhea, female fertility, and mastalgia are common problems not easily treated by conventional medicine. Women often seek alternative therapies to help address these conditions. Some evidence points to the efficacy of black cohosh, exercise, and possibly Kava and St. John's wort, in the treatment of menopausal symptoms. Clinical trials indicate that symptoms of premenstrual syndrome may be alleviated with calcium, magnesium, vitamin E. Thiamine, omega-3 fatty acids, the Japanese herbal concoction, TSS, and calcium have proved useful in treating women with dysmenorrhea. Symptoms of mastalgia may be attenuated by evening primrose oil, chaste tree and flaxseed oil may be helpful.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12391555&dopt=Abstract Ref: Planta Med 2002 Oct;68(10):912-5

In vitro plant regeneration from leaf-derived callus of Cimicifuga racemosa.

Lata H, Bedir E, Hosick A, Ganzera M, Khan I, Moraes RM.

National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, 38677, USA.

Cimicifuga racemosa (L.) Nutt., also known as Black Cohosh, is among the top 10 selling medicinal herbs in the United States. The rhizomes have been used to relieve menopausal discomfort. This plant is wild crafted and conservationists have expressed concerns with the sustainability of C. racemosa. Excised tissues from young leaves of C. racemosa were cultured on Murashige and Skoog's medium (MS) supplemented with various concentrations of NAA and TDZ for production of callus. The optimum callus growth and maintenance was in 1.0 microM NAA plus 0.5 microM TDZ. Two-month-old calli were sub-cultured on different concentrations of cytokinins (BA, kinetin, 2ip, TDZ) or in combination with GA(3) for shoot induction. The rate of shoot induction and proliferation was higher in MS media supplemented with 2.0 or 4.0 microM of TDZ. Concentrations of TDZ greater than 4.0 microM suppressed shoot growth. Adding 3.5 microM of GA(3) into media containing BA increased shoot growth. The presence of GA(3) with kinetin or TDZ did not affect shoot production. For rooting, shoots were transferred to MS medium with activated charcoal supplemented with various auxins (IAA, IBA and NAA), roots were noticed 20 days after transference. Activated charcoal was an essential component for vigorous rooting formation. Our results suggest that conservation of C. racemosa is possible through in vitro multiplication of leaf-derived callus.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12385490&dopt=Abstract Ref: Am J Med Sci 2002 Oct;324(4):185-8

Phytoestrogens: a viable option?

Russell L, Hicks GS, Low AK, Shepherd JM, Brown CA.

Department of Medicine, University of Mississippi Medical Center, Jackson 39216-4505, USA.

Estrogen replacement therapy is one of the most commonly prescribed medicines in the United States by traditional medical professionals. Over the past decade, the market for complementary/ alternative therapies for hormone replacement has dramatically increased. Women are seeking more "natural" alternatives to treat menopausal symptoms. Well-designed randomized clinical trials are often lacking, as is the information on efficacy and safety. This article will review several popular herbal therapies for menopausal symptoms including phytoestrogens, black cohosh (Cimicifuga racemosa), dong quai (Angelica sinensis), chast tree (Vitex agnus-castus), and wild Mexican yam. Their use, mechanism of action, and adverse effects are outlined.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12381254&dopt=Abstract Ref: Med J Aust 2002 Oct 21;177(8):440-3

Black cohosh and other herbal remedies associated with acute hepatitis.

Whiting PW, Clouston A, Kerlin P.

Princess Alexandra Hospital, Woolloongabba, QLD, Australia.

Six patients presented with clinical, biochemical and histological evidence of severe hepatitis after taking herbal remedies. One patient required urgent liver transplantation for fulminant hepatic failure after the brief use of black cohosh. Five patients took a combination of herbs and presented with jaundice, fatigue and pruritus. Healthcare providers and members of the public should be aware of the potential adverse effects of these remedies.

http://www.mja.com.au/public/issues/177_08_211002/whi10119_fm.html
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Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12224599&dopt=Abstract Ref: Biomed Pharmacother 2002 Aug;56(6):283-8

Randomized, controlled trial of phytoestrogen in the prophylactic treatment of menstrual migraine.

Burke BE, Olson RD, Cusack BJ.

Research Service, Department of Veterans Affairs Medical Center, Boise, ID 83702, USA.

Approximately 30% of women afflicted with migraine have menstrually associated attacks. These migraines are often refractory to treatment. Evidence suggests estrogen and progestin fluctuations may influence menstrual migraine. Phytoestrogens have demonstrated estrogenic effects in some tissues, but are without stimulation of the endometrium, suggesting decreased risk with long-term use. This study was undertaken to assess the efficacy of a phytoestrogen combination in the prophylactic treatment of menstrual migraine. Forty-nine patients were randomized to receive either placebo, or a daily combination of 60 mg soy isoflavones, 100 mg dong quai, and 50 mg black cohosh, with each component standardized to its primary alkaloid. Patients received study medication for 24 weeks. Average frequency of menstrually associated migraine attacks during weeks 9-24 was reduced from 10.3 +/- 2.4 (mean +/- s.e.m.) in placebo treated patients to 4.7 +/- 1.8 (P < 0.01) in patients treated with the phytoestrogen preparation.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12222669&dopt=Abstract Ref: Phytomedicine 2002 Jul;9(5):461-7

Analysis of thirteen populations of black cohosh for formononetin.

Kennelly EJ, Baggett S, Nuntanakorn P, Ososki AL, Mori SA, Duke J, Coleton M, Kronenberg F.

Department of Biological Sciences, Lehman College and The Center for Graduate Studies, The City University of New York, Bronx, NY 10468, USA.

Black cohosh (Actaea racemosa L. syn. Cimicifuga racemosa (L.) Nutt.), a North American perennial plant, is a promising natural alternative to hormone replacement therapy for treating menopausal symptoms, but the mechanism of action is not understood. The clinical actions of this plant have been attributed to the isoflavonone formononetin since 1985, when its presence was reported in a black cohosh extract. Others have since looked for formononetin, but have not detected it. We looked for formononetin in extracts of black cohosh roots and rhizomes collected in thirteen locations in the eastern United States, including Maryland, New Jersey, New York, North Carolina, Pennsylvania, Virginia, and Tennessee. The rhizome samples were extracted using 80% methanol, and the extracts were partially purified using solid-phase extraction to concentrate any isoflavonoids that might be present. We tested for formononetin in these partially purified samples using thin-layer chromatography and high-performance liquid chromatography with a photodiode array detector and a mass spectrometer. Formononetin was not detected in any of the thirteen plant populations examined. Remifemin, a German product now on the United States market, and CimiPure, a commercially available black cohosh rhizome extract, were also analyzed. We did not detect formononetin, or ononin (formononetin-7-glucoside), in any sample tested by the above-mentioned chemical analyses. Therefore, the clinically observed estrogen-like actions of black cohosh, such as reduction of hot flashes, are likely due to a compound, or combination of compounds, other than formononetin.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12126027&dopt=Abstract Ref: Am Fam Physician 2002 Jul 1;66(1):129-34

Alternative therapies for traditional disease states: menopause.

Morelli V, Naquin C.

Family Practice Residency Program, Louisiana State University Health Sciences Center, Kenner 70065, USA.

With growing concern about the use of hormone replacement therapy, some women are looking for alternative treatments for menopausal symptoms and preventing postmenopausal cardiovascular disease and osteoporosis. In observational trials, exercise has been associated with decreased vasomotor symptoms. One trial suggested that black cohosh may reduce menopausal symptoms. Soy has been shown to decrease vasomotor symptoms, lower lipid levels, and increase bone density. However, large amounts of soy must be consumed, and it is not clear whether soy consumption causes a decrease in cardiovascular events or fractures. The evidence for St. John's wort is equivocal. Fish oil is helpful for secondary prevention of coronary artery disease.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12119629&dopt=Abstract Ref: Holist Nurs Pract 2000 Apr;14(3):59-68

Therapeutic use of selected herbs.

Cohen SM, Rousseau ME, Robinson EH.

Yale University School of Nursing, New Haven, Connecticut, USA.

An increasing number of people in the United States are using herbs for health promotion and specific symptom management. Herbs are used to initiate healing through synergistic responses unlike the specific properties of pharmaceuticals. Anecdotal data comprise much of the popular information available about herbs. Scientific studies of the efficacy and safety of herbs, although on the rise, are less available than other drug trials. Clinicians need an appropriate knowledge base for dealing with patients who take herbal preparations as well as the ability to confidently include herbal preparations in their formulary. In this article, five common herbs are reviewed. The effects, clinical studies, side effects, and dosing regimens for aloe vera, arnica, black cohosh, evening primrose oil, and saw palmetto are described.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11975864&dopt=Abstract Ref: J Womens Health Gend Based Med 2002 Mar;11(2):163-74

Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect.

Liske E, Hanggi W, Henneicke-von Zepelin HH, Boblitz N, Wustenberg P, Rahlfs VW.

Schaper & Brummer GmbH & Co. KG, Salzgitter, Germany.

OBJECTIVE: This study sought to confirm the efficacy and safety of the currently recognized dose of Cimicifugae racemosae rhizoma (40 mg/day) and to evaluate a higher dose and its associated physiological effects. METHODS: We conducted a controlled, randomized, double-blinded parallel group study of perimenopausal and postmenopausal women treated with two different doses (39 mg and 127.3 mg) of a unique C. racemosa preparation over a 24-week period. Efficacy and tolerability were determined by the Kupperman Menopause Index, Self-Rating Depression Scale (SDS), a global assessment of tolerability, adverse events, routine hematology, and biochemical tests. To determine if the unique C. racemosa preparation exerts its effect through an estrogen-identical mode of action, we investigated vaginal cytology and gynecologically relevant hormones. RESULTS: Both perimenopausal and postmenopausal patients tolerated the treatment well, and menopausal symptoms decreased regardless of dose (responder rate 70% and 72%, respectively). The lack of change in vaginal cytology measures indicates a nonestrogenic effect of the tested extract in this critical organ. Likewise, the lack of significant changes in the levels of gynecologically relevant hormones does not indicate an overall estrogenic effect. CONCLUSIONS: The higher dose did not exert a significantly greater effect on any end point. Thus, the currently recognized standard dose of the isopropanolic aqueous C. racemosa extract should be preferred over the higher dose. Despite the absence of a placebo group, this study suggests that C. racemosa extract is associated with improvement in menopause symptoms without evidence of estrogenlike effects.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11937433&dopt=Abstract Ref: Urology 2002 Apr;59(4 Suppl 1):20-33

Complementary/alternative therapies for reducing hot flashes in prostate cancer patients: reevaluating the existing indirect data from studies of breast cancer and postmenopausal women.

Moyad MA.

Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0330, USA.

Vasomotor hot flashes are a common problem in women who are postmenopausal or receiving antiestrogen treatment for breast cancer. Hot flashes are also a common problem after orchiectomy/luteinizing hormone-releasing hormone therapy, occurring generally in 50% to 66% of these men. Prescribed treatments for hot flashes for men on hormonal ablation treatment for prostate cancer are well documented. These conventional agents have shown good results, but their long-term efficacy, safety, and cost are still questioned. Therefore, the search for other viable agents, including nontraditional treatments, continues. Complementary/alternative treatments to alleviate hot flashes in women have generated an enormous amount of interest. However, these options have received little attention in men with hot flashes. Research with vitamin E, soy, black cohosh, red clover, and numerous other alternative treatments in women may provide some indirect but valuable insight on their potential effectiveness in men. Many of these alternatives have been a disappointment in recent randomized trials of women, and it is likely that there will be similar results with men. However, numerous supplements have yet to be tested in a clinical trial against a placebo, and clinicians should become aware of this ever-increasing list. Patients should be made aware of the primary importance of lifestyle interventions that could partially affect hot flashes and immediately affect overall health, especially during the period of androgen suppression, when it is not uncommon to observe accelerated weight changes and insulin insensitivity. Otherwise, recent research with older and newer conventional agents, such as antidepressants or estrogen/progesterone, should be emphasized at this time for moderate-to-severe hot flashes that profoundly affect daily activities and/or sleep. Antidepressant supplements (St. John's wort) or acupuncture could also be an attractive option in future investigations. Low-dose estrogen seems particularly attractive, because it is inexpensive and may simultaneously reduce hot flashes and the risk of osteoporosis in men receiving long-term androgen suppression therapy; however, the potential for cardiovascular complications must be further investigated. Ultimately, adequate research (vs placebo) should determine the fate of the alternative supplements proposed for hot flash reduction.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11884218&dopt=Abstract Ref: Pharmacol Res 2002 Mar;45(3):213-220

Inhibitory effect of herbal remedies on 12-o-tetradecanoylphorbol-13-acetate-promoted Epstein--Barr virus early antigen activation.

Kapadia GJ, Azuine MA, Tokuda H, Hang E, Mukainaka T, Nishino H, Sridhar R.

Laboratory of Natural Drug Products, Department of Pharmaceutical Sciences, School of Pharmacy, Howard University, 2300 4 thStreet, NW, Washington, DC 20059, USA

For the past several years we have been evaluating natural products as potential cancer chemopreventive agents in a short term in vitroassay involving Epstein--Barr virus early antigen (EBV-EA) activation in Raji cells promoted by phorbol ester, 12-O-tetradecanoylphorbol-13-acetate (TPA). Because of the current interest in the use of herbal remedies, we considered examining them for their cancer chemopreventive activities, using their extracts with a view to uncovering such benefits (if any) these remedies might possess. Thirty-six extracts of 32 herbs belonging to 27 families in use as herbal remedies including those of gingko, black cohosh, echinacea, kava-kava, saw palmetto, turmeric, angelica, wild yam, cat's claw, passion flower, muira puama, feverfew, blueberry, chasteberry, licorice, nettle, golden seal, pygeum, ginger, valerian and hops were prepared and evaluated. Turmeric at a concentration of 10 &mgr;g ml (minus sign1)exhibited the most potent anti-EBV-EA activity, which is ten times more than passionflower, that is next in the order of activity. At the concentration level of 100 &mgr;g ml (minus sign1), several of the herbal remedies tested inhibited the EBV-EA in Raji cells exposed to the tumor promoter TPA (32 pM) by more than 90%. We also report for the first time the activities of 16 new medicinal plants as potential cancer chemopreventive agents. Since inhibitors of EBV-EA promoted by TPA in vitrohave been shown to be effective anti-tumor promoting agents in laboratory animal models, our results indicate new and potential applications of these herbal remedies as cancer chemopreventive agents since they are already in clinical use in the human population.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11875334&dopt=Abstract Ref: Menopause 2002 Mar-Apr;9(2):145-50

Estrogenic activity of herbs commonly used as remedies for menopausal symptoms.

Amato P, Christophe S, Mellon PL.

Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas 77030, USA.

OBJECTIVE: Women are increasingly turning to herbal therapies in an effort to manage their menopausal symptoms. In this study, we investigate the estrogenic activity of four selected herbs commonly used in menopause, namely dong quai, ginseng, black cohosh, and licorice root. DESIGN: We investigated the effect of these selected herbs on cell proliferation of MCF-7 cells, a human breast cancer cell line. We also assessed their estrogenic activity in a transient gene expression assay system using HeLa cells co-transfected with an estrogen-dependent reporter plasmid in the presence of human estrogen receptor ER alpha or ER beta cDNA. Finally, we investigated the estrogenic activity of these herbs using a bioassay in mice. RESULTS: Dong quai and ginseng both significantly induced the growth of MCF-7 cells by 16- and 27-fold, respectively, over that of untreated control cells, while black cohosh and licorice root did not. The herbs tested failed to show transactivation of either hER alpha or hER beta and had no effect on uterine weight in vivo when administered orally to mice for a period of 4 days. CONCLUSIONS: Our studies show that dong quai and ginseng stimulate the growth of MCF-7 cells independent of estrogenic activity. Because of the lack of efficacy and the potential for adverse effects, use of these herbs in humans warrants caution pending further study.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11874595&dopt=Abstract Ref: Semin Dial 2002 Jan-Feb;15(1):53-9

Herbs, menopause, and dialysis.

Roemheld-Hamm B, Dahl NV.

Department of Family Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08901, USA.

Women with chronic kidney disease (CKD) are at increased risk for menstrual disorders, early menopause, and osteoporosis, and rarely discuss gynecologic and reproductive issues with their nephrologist. Various complementary and alternative medicine (CAM) products are of interest to women with end-stage renal disease (ESRD) who have these disorders. However, very little is known about the specifics of using herbal medicines in patients on chronic dialysis, resulting in numerous problems when patients and providers try to ascertain the safety and efficacy of these products. This article reviews evidence regarding the safety and efficacy of black cohosh, ginseng, chastetree, dong quai, evening primrose oil, soy products, and the so-called natural hormones. Pharmacologic parameters important to evaluating the quality of botanical products are discussed, along with recommendations and information resources.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11867271&dopt=Abstract Ref: J Steroid Biochem Mol Biol 2002 Jan;80(1):125-30

Antiestrogenic activities of Cimicifuga racemosa extracts.

Zierau O, Bodinet C, Kolba S, Wulf M, Vollmer G.

Molecular Cell Physiology and Endocrinology, Technical University Dresden, Mommsen street 13, 01062 Dresden, Germany.

Despite the wide use of extracts from the rhizome of black cohosh (Cimicifuga racemosa) for the treatment of menopausal complaints, surprisingly little is known on their potential estrogenic properties, e.g. on estrogen dependent gene transcription. In addition, available informations on the effects on cell proliferation are contradictory. We therefore, tested for estrogenic and antiestrogenic effects of Cimicifuga racemosa extracts on proliferation of MCF-7 cells and on gene expression using ethanolic and iso-propanolic extracts of this medical plant. Estrogenic properties of plant extracts could neither be detected in proliferation assays, nor on gene expression using an estradiol-inducible yeast assay or the estrogen-inducible MVLN cells. In contrast, in all three experimental systems Cimicifuga racemosa antagonized estradiol induced activities. Estradiol induced stimulation of proliferation was inhibited by a dosage >1 microg/ml of extract concentration, gene expression was suppressed by doses of 100-1000 microg/ml of Cimicifuga racemosa extracts. From these results we conclude, that extracts from the rhizome of Cimicifuga racemosa contain compounds with antiestrogenic properties.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11791089&dopt=Abstract Ref: Menopause 2002 Jan-Feb;9(1):72-8

Dietary supplement use among menopausal women attending a San Francisco health conference.

Kam IW, Dennehy CE, Tsourounis C.

Department of Clinical Pharmacy, University of California-San Francisco, San Francisco, CA, USA.

OBJECTIVE: This study examined the usage patterns of dietary supplements during menopause, providing information about type, prevalence, and rationale for use. METHODS: A survey instrument was distributed to self-identified peri- or postmenopausal women at a San Francisco women's health conference in March 2000. RESULTS: Of the 100 eligible women, 29% used hormone replacement therapy (HRT) alone, 16% used HRT with dietary supplements (Combo group), 32% used dietary supplements alone, and 13% used no product or used supplements excluded in this survey. The most common dietary supplements were soy (29%), ginkgo biloba (16%), and black cohosh (10%). Only 54% of women using dietary supplements reported such usage to their primary care providers. Women using HRT alone reported relief of hot flashes significantly more often than those using dietary supplements alone (63% vs. 30%; p = 0.016). Women using combination therapy reported enhanced improvement in vaginal dryness, libido, and mood compared with those using HRT alone. Perceived quality of life and overall control of menopausal symptoms were highest among women using dietary supplements alone and women using combination therapy, respectively. Satisfaction with menopausal counseling from a primary care provider was significantly greater in women receiving HRT alone ( p = 0.02) and combination therapy ( p = 0.006) compared with women receiving dietary supplements alone. CONCLUSIONS: Dietary supplements were frequently used during menopause. Combined use of dietary supplements and HRT seemed to be associated with enhanced relief of certain menopausal symptoms. Women using dietary supplements alone seemed particularly dissatisfied with the menopausal counseling provided by a primary care provider.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11605850&dopt=Abstract Ref: Anal Chem 2001 Oct 1;73(19):4704-10

Evaluation of triterpene glycoside estrogenic activity using LC/MS and immunoaffinity extraction.

Onorato J, Henion JD.

Analytical Toxicology, Cornell University, Ithaca, New York 14850, USA.

We present a study on the mass spectral as well as the binding properties of three triterpene glycosides (cimicifugoside, cimiracemoside F, 27-deoxyactein) contained in black cohosh to the ligand binding domain of estrogen receptor beta (ER-beta). Using affinity ultrafiltration and LC/ MS detection, initial experiments using estradiol and the phytoestrogens daidzein and genistein (compounds known to bind ER-beta) were performed to serve as positive controls. The same affinity techniques and LC/MS procedures were then employed to show that neither the triterpene glycosides nor their enzymatically prepared aglycons bound significantly to ER-beta, except for 27-deoxyactein aglycon, which showed weak binding affinity (4%). Additionally, metabolites of the aglycons were prepared by incubation with female human liver microsomes and subjected to binding experiments with ER-beta. No significant binding of the metabolites to the receptor was observed. Further studies are needed to fully characterize whether these triterpene glycosides as well as other components of black cohosh in this plant extract bind to the estrogen receptor alpha (ER-alpha).

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11368622&dopt=Abstract Ref: J Agric Food Chem 2001 May;49(5):2472-9

Evaluation of estrogenic activity of plant extracts for the potential treatment of menopausal symptoms.

Liu J, Burdette JE, Xu H, Gu C, van Breemen RB, Bhat KP, Booth N, Constantinou AI, Pezzuto JM, Fong HH, Farnsworth NR, Bolton JL.

Department of Medicinal Chemistry and Pharmacognosy, UIC/NIH Center for Botanical Dietary Supplements Research, College of Pharmacy, M/C 781, University of Illinois at Chicago, 833 South Wood Street, Chicago, Illinois 60612, USA.

Eight botanical preparations that are commonly used for the treatment of menopausal symptoms were tested for estrogenic activity. Methanol extracts of red clover (Trifolium pratense L.), chasteberry (Vitex agnus-castus L.), and hops (Humulus lupulus L.) showed significant competitive binding to estrogen receptors alpha (ER alpha) and beta (ER beta). With cultured Ishikawa (endometrial) cells, red clover and hops exhibited estrogenic activity as indicated by induction of alkaline phosphatase (AP) activity and up-regulation of progesterone receptor (PR) mRNA. Chasteberry also stimulated PR expression, but no induction of AP activity was observed. In S30 breast cancer cells, pS2 (presenelin-2), another estrogen-inducible gene, was up-regulated in the presence of red clover, hops, and chasteberry. Interestingly, extracts of Asian ginseng (Panax ginseng C.A. Meyer) and North American ginseng (Panax quinquefolius L.) induced pS2 mRNA expression in S30 cells, but no significant ER binding affinity, AP induction, or PR expression was noted in Ishikawa cells. Dong quai [Angelica sinensis (Oliv.) Diels] and licorice (Glycyrrhiza glabra L.) showed only weak ER binding and PR and pS2 mRNA induction. Black cohosh [Cimicifuga racemosa (L.) Nutt.] showed no activity in any of the above in vitro assays. Bioassay-guided isolation utilizing ER competitive binding as a monitor and screening using ultrafiltration LC-MS revealed that genistein was the most active component of red clover. Consistent with this observation, genistein was found to be the most effective of four red clover isoflavones tested in the above in vitro assays. Therefore, estrogenic components of plant extracts can be identified using assays for estrogenic activity along with screening and identification of the active components using ultrafiltration LC-MS. These data suggest a potential use for some dietary supplements, ingested by human beings, in the treatment of menopausal symptoms.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11352967&dopt=Abstract Ref: J Clin Oncol 2001 May 15;19(10):2739-45

Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer.

Jacobson JS, Troxel AB, Evans J, Klaus L, Vahdat L, Kinne D, Lo KM, Moore A, Rosenman PJ, Kaufman EL, Neugut AI, Grann VR.

Herbert Irving Comprehensive Cancer Center and Joseph L. Mailman School of Public Health, Columbia University, and Weill-Cornell Medical College, New York, NY 10032, USA.

PURPOSE: Most breast cancer survivors experience hot flashes; many use complementary or alternative remedies for these symptoms. We undertook a randomized clinical trial of black cohosh, a widely used herbal remedy for menopausal symptoms, among breast cancer patients. PATIENTS AND METHODS: Patients diagnosed with breast cancer who had completed their primary treatment were randomly assigned to black cohosh or placebo, stratified on tamoxifen use. At enrollment, patients completed a questionnaire about demographic factors and menopausal symptoms. Before starting to take the pills and at 30 and 60 days, they completed a 4-day hot flash diary. At the final visit, they completed another menopausal symptom questionnaire. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were measured in a subset of patients at the first and final visits. RESULTS: Of 85 patients (59 on tamoxifen, 26 not on tamoxifen) enrolled in the study, 42 were assigned to treatment and 43 were assigned to placebo; 69 completed all three hot flash diaries. Both treatment and placebo groups reported declines in number and intensity of hot flashes; the differences between the groups were not statistically significant. Both groups also reported improvements in menopausal symptoms that were, for the most part, not significantly different. Changes in blood levels of FSH and LH also did not differ in the two groups. CONCLUSION: Black cohosh was not significantly more efficacious than placebo against most menopausal symptoms, including number and intensity of hot flashes. Our study illustrates the feasibility and value of standard clinical trial methodology in assessing the efficacy and safety of herbal agents.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11347288&dopt=Abstract Ref: Altern Ther Health Med 2001 May-Jun;7(3):93-100

Black cohosh: efficacy, safety, and use in clinical and preclinical applications.

McKenna DJ, Jones K, Humphrey S, Hughes K.

Institute for Natural Products Research in Marine, St. Croix, Minn., USA.

Actaea racemosa L (formerly Cimicifuga racemosa [L] Nutt) (Ranunculaceae), commonly known as black cohosh, is an herb native to Eastern North America. Black cohosh has a history of traditional use among Native Americans for the treatment of a variety of disorders, including various conditions unique to women such as amenorrhea and menopause. Contemporary uses of black cohosh are primarily geared toward the treatment of symptoms of menopause, such as hot flashes, and menopausal anxiety and depression. Extracts also have been shown to be useful for younger women suffering hormonal deficits following ovariectomy or hysterectomy, as well as for juvenile menstrual disorders. A number of clinical studies using Remifemin, a standardized extract, have demonstrated efficacy for the alleviation of menopausal complaints. The safety profile of black cohosh is positive, with low toxicity, few and mild side effects, and good tolerability. In European phytotherapy, Remifemin is commonly prescribed as an effective alternative to hormone replacement therapy for menopause.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11321955&dopt=Abstract Ref: Wei Sheng Yan Jiu 2001 Mar;30(2):77-80

Estrogenicity of black cohosh (Cimicifuga racemosa) and its effect on estrogen receptor level in human breast cancer MCF-7 cells

[Article in Chinese]

Liu Z, Yang Z, Zhu M, Huo J.

Institute of Nutrition and Food Hygiene, Chinese Academy of Preventive Medicine, Beijing 100050, China.

The estrogenicity of Black Cohosh (Cimicifuga racemosa, CR) was tested in vivo and in vitro and its effect on estrogen receptor (ER) level of human breast cancer MCF-7 cells were investigated. Based on the body weight of animals, 75, 150 and 300 mg/kg of CR were administered by tube feeding to immature female mice for 14 days. Estrus was observed and the uterine and ovary weights of mice were measured. The optimal dose of CR for the growth of MCF-7 cells was screened by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromide (MTT) assay. Subsequently, Growth curves of MCF-7 cells in blank control, 4.75 micrograms/L of CR and 0.3 nmol/L of 17 beta-estradiol groups were observed for 5 days. ER level in MCF-7 cells was analyzed by indirect immunofluorescence assay in flow cytometry. The results showed that uterine weight increased with the increasing dosage of CR and the days of estrus was significantly prolonged in the 300 mg/kg group (P < 0.05). The concentration of CR at 4.75 micrograms/L showed the strongest enhancement effects (64.7%). The doubling time (TD) of cell growth in CR group and 17 beta-estradiol group were 32.1 h and 31.7 h respectively, which were shorter than that of blank control (TD = 35.3 h). Additionally, 4.75 micrograms/L of CR significantly increased ER levels compared with the blank control (P < 0.01). Taking all the results together, CR has an estrogen-like action. The enhancing effect of CR on ER level is one of the potential mechanisms involved with its therapeutic role in climacteric syndrome.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11310520&dopt=Abstract Ref: Pharmacotherapy 2001 Apr;21(4):464-80

Urogenital atrophy: prevention and treatment.

Willhite LA, O'Connell MB.

Pharmacy Department, Fairview University Medical Center, University of Minnesota, Minneapolis, USA.

Fifteen percent of premenopausal women, 10-40% of postmenopausal women, and 10-25% of women receiving systemic hormone therapy experience urogenital atrophy. The most common symptoms are dryness, burning, pruritus, irritation, and dyspareunia. Estrogen loss, drugs, and chemical sensitivities are causes. Estrogen or hormone replacement therapy (ERT-HRT) is the treatment of choice in postmenopausal women. Dosages prescribed for menopause symptoms or to prevent osteoporosis (and, potentially, other conditions) can restore the vagina to premenopausal physiology and relieve symptoms. Concomitant progestins are necessary for women with an intact uterus to minimize or eliminate estrogen-induced endometrial cancer. Low-dosage oral and vaginal ERT can relieve urogenital atrophy but might not produce systemic effects. Progestins are not necessary with vaginal rings and vaginal tablets. If ERT is given only to treat urogenital atrophy, estrogen creams 1 or 2 times/week may prevent recurrence after symptoms are resolved. Progestins are not required for occasional estrogen cream use. Vaginal moisturizers provide longer relief by changing the fluid content of endothelium and lowering vaginal pH. Vaginal lubricants provide short-term relief. Women with contraindications to ERT-HRT could use lubricants for intercourse-related dryness or moisturizers for more continuous relief. The lay press promotes agrimony, black cohosh, chaste tree, dong quai, witch hazel, and phytoestrogens for vaginal dryness and dyspareunia; however, no evidence exists to support these specific claims. Pharmacists should be actively involved in identifying, preventing, and treating urogenital atrophy.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11105569&dopt=Abstract Ref: Planta Med 2000 Oct;66(7):635-40

Direct analysis and identification of triterpene glycosides by LC/MS in black cohosh, Cimicifuga racemosa, and in several commercially available black cohosh products.

He K, Zheng B, Kim CH, Rogers L, Zheng Q.

Department of Research & Development, Pure World Botanicals, Inc., South Hackensack, New Jersey, USA.

A method to directly identify triterpene glycosides using reversed-phase liquid chromatography with positive atmospheric pressure chemical ionization mass spectrometry (LC/(+)APCIMS) was developed. Based on the analysis of the molecular weight, fragment ions, selected ion chromatograms, a number of triterpene glycosides, including actein, 27-deoxyactein, cimicfugoside M, and cimicifugoside, from Cimicifuga racemosa were studied. A chromone, cimifugin, from C. foetida was also identified. Cimicifugoside M and cimifugin can specifically serve as indicators for species identification. The method can, therefore, be used to distinguish black cohosh products from among different plant species for quality control purposes.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10730024&dopt=Abstract Ref: J Am Pharm Assoc (Wash) 2000 Mar-Apr;40(2):234-42; quiz 327-9

Herbs of special interest to women.

Hardy ML.

Cedars-Sinai Integrative Medicine Medical Group, Cedars-Sinai Hospital, Los Angeles, CA, USA.

OBJECTIVE: To review the efficacy and safety of specific herbal medications that have been used traditionally to treat common conditions in women. DATA SOURCES: Current literature, with emphasis on more rigorously controlled studies. DATA SYNTHESIS: Herbal medicines have long been used in traditional healing systems to treat conditions of particular interest to women, such as premenstrual syndrome (PMS) and menopausal symptoms. For a select number of phytomedicines, including evening primrose oil, black cohosh root extract, dong quai, and chaste tree berry, scientific investigation is elucidating the pharmacologically active constituents, mechanism of action, and clinical value. CONCLUSION: Based on the available evidence, evening primrose oil and chaste tree berry may be reasonable treatment alternatives for some patients with PMS. Dong quai may have some efficacy for PMS when used in traditional Chinese multiple-herb formulas. For relief of menopausal symptoms, black cohosh root extract and dong quai have good safety profiles, but only black cohosh has demonstrated efficacy for this indication. Safety data, especially during pregnancy and lactation, are still largely lacking for many herbal medications, and recommendations for usage and dosage vary. Pharmacists who wish to recommend herbal products for women's health conditions need to evaluate the scientific literature in order to form their own opinions about appropriate use and safety.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10531758&dopt=Abstract Ref: J Am Med Womens Assoc 1999 Fall;54(4):181-3

Hormone-modulating herbs: implications for women's health.

Wade C, Kronenberg F, Kelly A, Murphy PA.

Department of Rehabilitation Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.

Women in the United States are increasingly turning to botanical medicines to treat conditions throughout their life cycles. Many herbs traditionally used for women's health conditions have been found to contain phytoestrogens. Phytoestrogens and their metabolites can bind estrogen receptors and can have both estrogenic and anti-estrogenic effects. Many women are attracted to the idea of using phytomedicine as an alternative to hormone replacement therapy. It is unclear, however, whether these herbs are safe for women at risk for breast cancer or its recurrence. This paper considers the estrogenicity of herbs such as black cohosh (Cimicifuga racemosa) and the implications for women's health.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10523716&dopt=Abstract Ref: Oncol Rep 1999 Nov-Dec;6(6):1383-7

Growth inhibition of human breast cancer cells by herbs and phytoestrogens.

Dixon-Shanies D, Shaikh N.

The New York College of Osteopathic Medicine of the New York Institute of Technology, Old Westbury, NY 11568-8000, USA.

Epidemiologic studies have suggested that consumption of phytoestrogen-rich foods may protect against breast cancer, and phytoestrogens such as genistein have been reported to both inhibit and stimulate the growth of some human breast cancer cells. The phytoestrogens genistein, daidzein, biochanin A, and coumestrol were tested and found to inhibit serum-stimulated growth in both T-47D and MCF-7 breast cancer cells at 10-100 microM. Extracts of several estrogenic herbs, including hops, black cohosh and vitex, inhibited growth of T-47D cells. These in vitro results suggest that certain herbs and phytoestrogens may have potential in the prevention of breast cancer.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10380441&dopt=Abstract Ref: J Nurse Midwifery 1999 May-Jun;44(3):205-16

A national survey of herbal preparation use by nurse-midwives for labor stimulation. Review of the literature and recommendations for practice.

McFarlin BL, Gibson MH, O'Rear J, Harman P.

West Virginia University School of Medicine, Department of Obstetrics and Gynecology, Morgantown 26506-9186, USA.

To document the use of herbal preparations for cervical ripening, induction, and augmentation of labor by certified nurse-midwives (CNMs) and nurse-midwifery education programs, a national survey of 500 members of the American College of Nurse-Midwives was conducted. Forty eight nurse-midwifery education programs were also surveyed to determine whether they were formally or informally educating students in the use of herbal preparations for cervical ripening, induction, or augmentation of labor. The results of this study, a review of the literature, professional issues, and recommendations for clinical practice are presented in this article. Of 500 questionnaires mailed to ACNM members, 90 were returned from CNMs who used herbal preparations to stimulate labor and 82 were returned from CNMs who did not use herbal preparations to stimulate labor. Three questionnaires were excluded due to incomplete data or blank questionnaires. No significant differences were noted in relations to geographical region, midwifery education, or highest level of education between the CNM respondents who did and those who did not use alternative methods to stimulate labor. Of the CNMs who used herbal preparations to stimulate labor, 64% used blue cohosh, 45% used black cohosh, 63% used red raspberry leaf, 93% used castor oil, and 60% used evening primrose oil. CNMs who used herbal preparations to stimulate labor were younger (43 versus 45 years, P < .01) and more likely to deliver at home or in an in-hospital or out-of-hospital birthing center (P < .0006), than CNMs who never used herbal preparations to stimulate labor. The most cited reason for using herbal preparations to stimulate labor was that they are "natural," whereas the most common reason for not using herbal preparations was the lack of research or experience with the safety of these substances. Sixty-nine percent of CNMs who used herbal preparations to stimulate labor learned about using them from other CNMs, 4% from formal research publications, and none from their formal education programs. Although 78% of the CNMs who used herbal preparations to stimulate labor directly prescribed them and 70% indirectly suggested them to clients, only 22% had included them within their written practice protocols. Seventy-five percent of the CNMs who used herbal preparations to stimulate labor used them first or instead of pitocin. Twenty-one percent reported complications including precipitous labor, tetanic uterine contractions, nausea, and vomiting. Sixty-four percent of the nurse-midwifery education programs included instruction in the use of herbal preparations to stimulate labor in their formal curricula, and 92% included informal discussions on the use of herbal preparations. Evening primrose oil was the most common herbal preparation discussed in nurse-midwifery education programs. Castor oil was the most commonly used herbal preparation used by nurse-midwives in clinical practice.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9650153&dopt=Abstract Ref: J Womens Health 1998 Jun;7(5):525-9

A review of the effectiveness of Cimicifuga racemosa (black cohosh) for the symptoms of menopause.

Lieberman S.

University of Bridgeport, Connecticut, USA.

In this review of eight human studies on the effectiveness of an extract of Cimicifuga racemosa on alleviating menopausal symptoms, it is apparent that it is a safe, effective alternative to estrogen replacement therapy for those patients in whom estrogen replacement therapy is either refused or contraindicated.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10178637&dopt=Abstract Ref: Adv Ther 1998 Jan-Feb;15(1):45-53

Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders.

Liske E.

Schaper & Brummer GmbH & Co. KG, International Sales Division, Salzgitter-Ringelheim, Germany.

The reproducible quality of phytopharmaceuticals--herbal medicines--is an essential prerequisite for good efficacy and tolerability in the treatment of functional disorders. In clinical trials and scientific investigations, standardized assessments (i.e., validated, internationally recognized and accepted scales) provide the basis for establishing clinical efficacy and tolerability. Extracts (ethanolic and isopropanolic aqueous, Remifemin) of the rootstock of the herb Cimicifuga racemosa (black cohosh) are active ingredients developed for the treatment of gynecologic disorders, particularly climacteric symptoms. Drug-monitoring and clinical studies documenting experience with C. racemosa rootstock extracts comprise the database of this herbal treatment for menopausal symptoms (e.g., hot flashes, profuse sweating, sleep disturbances, depressive moods). These studies show good therapeutic efficacy and tolerability profiles for C. racemosa. In addition, clinical and experimental investigations indicate that the rootstock of C. racemosa does not show hormone-like activity, as was originally postulated.

Weight loss herbal formula, made of herbs of woman: black cohosh, dong quai, and blue cohosh

About Black cohosh

About Angelica sinensis, Dong Quai

About menopause and PMS

Black cohosh research articles: abstracts and links to sources

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