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Black Cohosh Glycerite Liquid Extract

Also known as: Black Cohosh, Cimicifuga racemosa, Black Snakeroot, Bugbane, Actaea racemosa

Overview

Black Cohosh, scientifically known as Actaea racemosa (formerly Cimicifuga racemosa), is a perennial herb native to North America. The glycerite liquid extract is a non-alcoholic preparation derived from the root and rhizome of the plant, using glycerin as a solvent. This form is often preferred for its ease of administration and better tolerability compared to alcohol-based extracts. Black Cohosh is primarily utilized as an herbal supplement, particularly for alleviating menopausal symptoms such as hot flashes, night sweats, mood disturbances, and other neurovegetative symptoms. It is considered a phytoestrogenic botanical, though its mechanism of action is believed to be non-hormonal, potentially involving selective estrogen receptor modulator-like effects without directly altering hormone levels. Research on Black Cohosh is extensive, with numerous randomized controlled trials, systematic reviews, and meta-analyses supporting its efficacy, especially for vasomotor and psychological symptoms, with better outcomes observed at higher doses or in combination therapies.

Benefits

Black Cohosh has demonstrated significant benefits in alleviating menopausal symptoms. A meta-analysis of 35 clinical studies involving over 43,000 women showed a significant reduction in neurovegetative and psychological menopausal symptoms, with a standardized mean difference (SMD) of -0.694. Higher doses or combination with St. John’s wort further enhanced these effects, yielding SMDs of approximately -1.0. While it effectively reduces vasomotor symptoms like hot flashes, its efficacy is generally less pronounced than hormonal treatments. Another meta-analysis of 22 randomized controlled trials confirmed improvements in menopausal symptoms, hot flashes, and somatic symptoms, though its impact on depressive or anxiety symptoms alone was limited. Secondary benefits include reported improvements in sleep, concentration, and fatigue. Black Cohosh is particularly beneficial for women experiencing natural menopause or iatrogenic climacteric symptoms, including those with hormone-sensitive conditions, due to its non-hormonal profile. The observed moderate effect sizes (0.7 to 1.0 SMD) indicate clinically meaningful symptom relief, comparable to low-dose estradiol or tibolone, with better tolerability. Benefits typically manifest within weeks to a few months of consistent use, with sustained effects reported with continued administration.

How it works

The precise mechanism of action for Black Cohosh is not fully understood, but it does not appear to exert direct estrogenic effects or alter hormone levels. Instead, its therapeutic effects are likely mediated through complex interactions within the body. It is thought to act via serotonergic pathways and selective estrogen receptor modulation, influencing neurovegetative and psychological symptoms without causing systemic hormonal changes. This suggests a potential interaction with serotonin receptors and modulation of neurotransmitter systems involved in thermoregulation and mood. While specific pharmacokinetic data for glycerite extracts are limited, this form may enhance bioavailability and reduce gastrointestinal irritation compared to alcohol-based extracts, potentially improving the delivery and absorption of its active compounds.

Side effects

Black Cohosh is generally well-tolerated, with a safety profile comparable to placebo in clinical trials. Common side effects, though infrequent, include mild gastrointestinal discomfort, headache, and rash. Rare allergic reactions have been reported. While anecdotal reports of hepatotoxicity exist, large clinical trials have not confirmed a direct causal link; however, monitoring liver function is advised during prolonged use as a precautionary measure. Potential drug interactions include those with hepatically metabolized drugs and serotonergic agents, given its possible serotonergic activity, so caution is recommended. Black Cohosh is contraindicated during pregnancy and breastfeeding due to insufficient safety data. It should be used with caution in individuals with pre-existing liver disease. Notably, it is considered safe for women with hormone-dependent diseases due to its lack of estrogenic stimulation.

Dosage

Clinical studies typically utilize standardized isopropanolic Black Cohosh extracts at doses ranging from 40-80 mg per day. However, the exact dosage equivalence for glycerite liquid extracts is less clearly defined. For optimal efficacy, higher doses or combination with St. John’s wort (especially for psychological symptoms) have shown enhanced benefits. There is no clearly established maximum safe dose, but clinical trials have used up to 80 mg/day without significant adverse effects. Black Cohosh is typically taken daily, and benefits usually become apparent after several weeks of consistent use. Glycerite liquid extracts offer an alternative to alcohol-based forms, potentially improving tolerability and absorption. No specific cofactors are identified as necessary for its efficacy.

FAQs

Is black cohosh safe for long-term use?

Limited long-term safety data exist. Short to medium-term use (up to 6 months) appears safe with appropriate monitoring, especially for liver function.

Does black cohosh affect hormone levels?

No significant changes in estrogen or other hormone levels have been observed in studies, indicating a non-hormonal mechanism of action.

Can black cohosh be used with hormone replacement therapy?

It is generally not recommended to combine black cohosh with hormone replacement therapy due to potential overlapping effects. Consult a healthcare provider for personalized advice.

How soon can benefits be expected?

Symptom relief typically begins within 4 to 8 weeks of consistent daily use, with more pronounced effects often seen after a few months.

Are all black cohosh supplements the same?

No, there is variability in extract types and standardization, which can affect efficacy. Isopropanolic extracts have the most robust research backing, but glycerite forms are also used.

Research Sources

https://pubmed.ncbi.nlm.nih.gov/33021111/ – This systematic review and meta-analysis of 35 clinical studies (n=43,759 women) found that isopropanolic black cohosh extract significantly reduced menopausal neurovegetative and psychological symptoms. It reported a standardized mean difference of -0.694 and noted better tolerability compared to tibolone, with no confirmed hepatotoxicity.
https://www.msdmanuals.com/professional/special-subjects/dietary-supplements/black-cohosh – This source, citing a network meta-analysis of 22 RCTs (n=2310), indicates that black cohosh reduces vasomotor and somatic menopausal symptoms. It notes that black cohosh is less effective than hormonal therapy and that its improvement in psychological symptoms alone is limited, highlighting variability in extract standardization.
https://www.medicalnewstoday.com/articles/317530 – This narrative review summarizes findings from multiple RCTs, stating that black cohosh can reduce menopausal symptoms. It cautions about the rare but serious potential for liver injury and notes the wide variability in dosing and product formulations, emphasizing the need for more long-term safety data.
https://www.ncbi.nlm.nih.gov/books/NBK79338/ – This source provides general information on black cohosh, including its traditional uses and some safety considerations. It supports the use of black cohosh for menopausal symptoms and discusses its non-estrogenic mechanisms, aligning with the understanding that it does not significantly alter hormone levels.