View
216
Download
0
Category
Tags:
Preview:
Citation preview
Black Cohosh
By: Stephanie By: Stephanie Russell Russell
Overview
Background Info.Historical UsesReported BenefitsPhytoestrogensEstrogenic effects
ResearchHarmful effects Conclusion
Learning Objectives
1.What are the historical uses of black cohosh?
2. Name the common symptoms associated with menopause.
3. What are the physiological changes that occur during menopause?
4. What are phytoestrogens? What specific foods are they found in?
Learning Objectives
5. What does current research say about the possibility that the isoflavone formononetin is found in black cohosh?
6. What are some of the potential side effects/warnings that should be considered before using black cohosh?
Background Information
Belongs to the buttercup familyLatin names: Actaea racemosa, Cimicifuga
racemosaCommon names: black snakeroot, macrotys,
bugbane, bugwort, rattleroot, rattleweed Root is black in color when harvested from the
wild Cohosh = Algonquin Indian word meaning
“rough” - refers to the plants gnarly root structure
Background Information
Shrub-like Plant Native to eastern
deciduous forests of North America
Flowers of plant have a strong odor, which acts as an insect repellant (bugbane)
Background Info.
Underground Root/rhizome Used to make
tea Liquid Extracts Pills/Capsules
Sold as a dietary supplement in U.S.
Notable Ingredients
Triterpene Glycosides actein related
compounds, cimigoside
Other ingredients tannins, fatty
acids, phytoesterols
Isoflavones formononetin
very controversial
Historical Uses
Native Americans Ceremonial treatment of snakebites Rheumatism Kidney Disease Respiratory Illnesses Skin Problems
Used root to make a tonicPoultices were made by pounding leaves
Historical Uses
19th Century American Physicians Fever Menstrual Cramps Arthritis Insomnia
Reported Benefits
Treat menopause symptoms Hot Flashes Night Sweats Vaginal Dryness Bone Loss Mood Swings
Rheumatoid ArthritisPremenstrual Syndrome
Other Reported Benefits...
AsthmaBack PainMuscle SpasmsSleep DisordersDepression Induce labor
DiarrheaDizzinessEdemaFeverHigh Blood
Pressure
Menopause
Natural process that occurs in women Marked by cessation of menstrual cycle
Physiological changes occur• Decreased production of estrogen/progesterone• Higher levels of luteinizing hormone/follicle-
stimulating hormone• In some women, these hormonal imbalances
cause undesirable symptoms (climacteric)• LH/FSH oppose the action of estrogen
– If high levels of LH/FSH = low levels of estrogen
Hormone Therapy
Until recent years, was the “gold standard” treatment for symptoms associated with menopause Uses estrogen, progesterone, or
combination of both to increase hormone levels
Due to recent safety concerns, many women are seeking alternative remediesIncreases risk for: stroke, breast cancer, heart
attack, blood clots, gall bladder disease
Alternative remedies forsymptoms of menopuse
Phytoestrogens Plant-derived compounds w/ weak estrogenic
activity - similar in structure to estrogenisoflavones, lignans, coumestans
• found in legumes, soybeans, vegetables, cereals
Isoflavones (found in soy) genistein, daidzein (most studies)
can bind to estrogen receptors• may enhance estrogen’s beneficial effects, or block
negative effects
Structures
GenisteinGenisteinEstradiolEstradiol(major estrogen in humans)(major estrogen in humans)
Estrogenic effects ofBlack Cohosh
Is black cohosh estrogenic? Evidence is conflicting
formononetin - estrogenic isoflavone• mainly found in red clover - some in soy• some research suggests it is a constituent of
Black Cohosh• recent studies say it is not
– older studies may have been compromised by adulteration of plant materials, or misidentification of formononetin
• has not been found in commercial extracts
Estrogenic effects ofBlack Cohosh
Suppresses secretion of luteinizing hormone Studies are conflicting No single chemical component has been
identified for this action Possibly through synergetic effect of
several chemical fractions
Efficacy and Safety of Isopropanolic Black Cohosh Extract for Climacteric Symptoms
Osmers, Ruediger MD, PhD; Friede, Michael PhD; Liske, Eckehard PhD; Schnitker, Joerg PhD; Freudenstein, Johannes PhD; Henneicke-von Zepelin, Hans-Heinrich PhD
Volume 105(5, part1) May 2005, pp1074-1083
Objective: To compare the efficacy and tolerability of the isopropanolic black cohosh extract in the treatment of climacteric complaints compared with placebo.
Methods: Randomized, double-blind clinical trial. 304 patients randomly allocated to receive tablets of 40mg drug, or matching placebo daily for 12 weeks. Drug contained 2.5mg isopropanolic extract corresponding to
20mg root stock Placebo corresponded to the active medication w/out
isopropanolic extract
Efficacy and Safety of Isopropanolic Black Cohosh Extract for Climacteric Symptoms
Osmers, Ruediger MD, PhD; Friede, Michael PhD; Liske, Eckehard PhD; Schnitker, Joerg PhD; Freudenstein, Johannes PhD; Henneicke-von Zepelin, Hans-Heinrich PhD
Volume 105(5, part1) May 2005, pp1074-1083
Inclusion criteria: Postmenopausal women (>12 months since last
regular menstruation), or >6 months since the last regular menstruation plus FSH >50 U/L
45 years and older Climacteric complaints as defined by menopause
rating scale (MRS) - >0.4 in at least 3 itemsMRS is used to measure intensity of menopausal
symptoms * Includes 10 items, each ranging from 0 (no complaints), to 1 (severe symptoms), in increments of 0.1
Efficacy and Safety of Isopropanolic Black Cohosh Extract for Climacteric Symptoms
Osmers, Ruediger MD, PhD; Friede, Michael PhD; Liske, Eckehard PhD; Schnitker, Joerg PhD; Freudenstein, Johannes PhD; Henneicke-von Zepelin, Hans-Heinrich PhD
Volume 105(5, part1) May 2005, pp1074-1083
Exclusion Criteria: Cancer - diseases that could interfere w/ the
assessment of climacteric symptoms Drug abuse Women taking hormone replacement therapy Women taking supplements such as: soy/red
clover
Efficacy and Safety of Isopropanolic Black Cohosh Extract for Climacteric Symptoms
Osmers, Ruediger MD, PhD; Friede, Michael PhD; Liske, Eckehard PhD; Schnitker, Joerg PhD; Freudenstein, Johannes PhD; Henneicke-von Zepelin, Hans-Heinrich PhD
Volume 105(5, part1) May 2005, pp1074-1083
Clinical examinations and interviews were performed before treatment began, and 4, 12 weeks after
Intensity of symptoms were assessed according to MRS ratings
Efficacy and Safety of Isopropanolic Black Cohosh Extract for Climacteric Symptoms
Osmers, Ruediger MD, PhD; Friede, Michael PhD; Liske, Eckehard PhD; Schnitker, Joerg PhD; Freudenstein, Johannes PhD; Henneicke-von Zepelin, Hans-Heinrich PhD
Volume 105(5, part1) May 2005, pp1074-1083
Findings: The isopropanolic black cohosh extract
was more effective than placeboDifference was 0.03-0.05 on MRS unitsHot flashes, “atrophy,” and “psyche”
decreased statistically significantly in the Black Cohosh extract compared w/ placebo
Most effective in relieving symptoms in early climacteric women
Effects of black cohosh on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women
Wuttke, Wolfgang MD; Gorkow, Christoph DVM; Seidlova-Wuttke, Dana MD: The North American Menopause Society; 13(2) April 2006 pp 185-196
Objective: To analyze the effects of Cimicifuga racemosa (CR) preparation on markers of bone metabolism, hormones, sex hormone-binding globulin, lipometabolism, and vaginal maturity
Design: Double blind, placebo-controlled, and conjugated estrogens (CE) controlled study. Included 62 postmenopausal women given a daily dose of 40mg herbal drug(CR), 0.6mg CE, or placebo for 12 weeks.
Effects of black cohosh on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women
Wuttke, Wolfgang MD; Gorkow, Christoph DVM; Seidlova-Wuttke, Dana MD: The North American Menopause Society; 13(2) April 2006 pp 185-196
Inclusion Criteria: Postmenopausal, aged 40-60 years Last menstrual bleeding > 6 months ago Postmenopausal hormone values (E2 <
40pg/mL, FSH >= 25mU/mL) baseline and wk 2
at least 3 hot flashes/day Sum score of MRS >= 1.7 at wk 2 and
baseline, sum scores of MRS item 1 (hot flashes) >= 0.3 at wk 2 and baseline
Effects of black cohosh on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women
Wuttke, Wolfgang MD; Gorkow, Christoph DVM; Seidlova-Wuttke, Dana MD: The North American Menopause Society; 13(2) April 2006 pp 185-196
Exclusion criteria: Hysterectomy Endometriosis Current treatment w/ estrogenic
substances Alcohol/drug abuse hypertriglyceridemia or
hypercholesterolemia
Effects of black cohosh on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women
Wuttke, Wolfgang MD; Gorkow, Christoph DVM; Seidlova-Wuttke, Dana MD: The North American Menopause Society; 13(2) April 2006 pp 185-196
Methods of assessment Markers of bone turnover, estradiol, FSH, LH,
SHBG, triglycerides, total cholesterol, high density cholesterol, low-density cholesterol, and routine clinical chemistry parameters were determined from blood samples.
Vaginal “maturity index” was determined from vaginal smearsConfigured by counting 500 cells and calculating
the % of parabasal, intermediary, and superficial cells
Effects of black cohosh on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women
Wuttke, Wolfgang MD; Gorkow, Christoph DVM; Seidlova-Wuttke, Dana MD: The North American Menopause Society; 13(2) April 2006 pp 185-196
Results: CR has estrogen-like effects on vaginal mucosa (increased number of superficial cells) Not as strong of an effect as CE, but significantly
higher than placebo CR has beneficial bone-remodeling effects At wk 12, markers for bone formation significantly
increased in CR group, compared w/ placebo
Conclusion: CR has beneficial effects on climacteric symptoms - beneficial bone remodeling and weak estrogenic-like effects on the vaginal mucosa
Harmful Effects
Liver Toxicity: 1 case of acute liver
failure 2 cases of hepatitis Other cases
reported in people using multiple herbal remedies
No scientific research to support these claims
General side effects: Nausea, vomiting,
dizziness, stomach discomfort
Not recommended for use during pregnancy or breastfeeding
Do not take with ER therapy
No noted drug interactions
Conclusion
Black Cohosh may be a relatively safe/effective alternative to HR therapy, but dosage/duration should be monitored by physician to avoid potential harmful effects
However, more studies are needed to understand the active components, and mechanisms of action responsible for the beneficial effects on menopausal symptoms.
References:
The American College of Obstetricians and Gynecologists; Volume 1.5 (5, part 1), May 2005, pp 1074-1083
The North American Menopause Society; Volume 11 (5), September/October 2004, pp 575-577
The Medical Journal of Australia; Volume 177 (8) 2002 pp 440-443 http://www.womenshealth.gov U.S. Department of Health and Human Services http://www.nccam.nih.gov/health/blackcohosh/ The North American Menopause Society; volume 13 (2), March/April 2006 pp 185-
196 http://www.health-care-beauty.com/Amerifit-Estroven-Extra-Strength-60-Caplets-
B00014FUTQ.htm http://www.bodyandfitness.com/Information/Herbal/Research/black.htm http://www.holisticonline.com/Herbal-Med/_Herbs/h32.htm http://www.allnatural.net/herbpages/black-cohosh.shtml http://www.drugdigest.org/DD/PrintablePages/herbMonograph/
0,11475,4079,00.html http://www.healthcentral.com/peoplepharmacy/408/20554.html http://ods.od.nih.gov/factsheets/BlackCohosh.asp
Questions?
Recommended