Black cohosh root supplement benefit and side effects for menopause treatment, herbal extract, 40 mg capsules, influence on pregnancy, labor
October 23 2016 by Ray Sahelian, M.D.

Black cohosh (cimicifuga racemosa), also known as snakeroot, bugbane and rattle weed, is native to eastern North America, and has historically been used by Native Americans for a variety of female conditions. It contains a variety of substances as listed later, but it may not have any significant amount of phytoestrogens. The German Comminssion E has approved black cohosh for the treatment of menopause symptoms, premenstrual syndrome - pms, and dysmenorrhea (painful menstruation typically involving abdominal cramps), however they recommend treatment be limited to 6 months.
   Studies with black cohosh root have shown inconsistent results in reducing hot flashes in postmenopausal women. However, a survey of women done at the University of San Francisco published in 2002 indicated that women who use a combination of herbal remedies and estrogen were more satisfied in the outcome of their symptoms compared to women who used estrogen alone or herbs alone. The supplements used were black cohosh, ginkgo, and soy. A 2006 German study found the combination of St. John's wort and black cohosh to be helpful in women with menopause symptoms and depression.
   At this time there is debate in the herbal community regarding the role and effectiveness of black cohosh in treating female conditions, but it appears that this herb could play a positive role. Historically black cohosh has been used to treat some symptoms of menopause.

Black Cohosh dosage and availability
This herb is sold either by itself, or combined with other herbs and nutrients. The dosage of black cohosh extract used in the majority of clinical studies has  been based on the level of a key marker, 27-deoxyactein. The recommended dosage for the relief of menopausal symptoms is one tablet of 20 mg taken twice daily, or one 40 mg capsule daily, with benefits hopefully seen in one to three months.

What is the maximum dose an individual should take? I am taking 545mg now and I am still having hot flashes. I have had a hysterectomy (1993 - left 1 ovary).
   There is still no good evidence of which menopause herbs are most helpful and in what dosages, it may be worthwhile to try different options - as listed on our menopause web page - to see which one(s) are most effective for you, in consultation with your doctor.

Active ingredients
Black cohosh root contains triterpine glycosides such as cimifugaside, 27-deoxyactein and actein, and phenolic acids. Other compounds include alkaloids, amides or esters of hydroxycinnamic acids and betains.

Black Cohosh side effects, is it safe?
Liver damage side effects with black cohosh have been discussed in the medical literature but there is no clear proof yet. Mild side effects of headache, nausea, dizziness, etc have been mentioned.

The January 2010 issue of Canadian Adverse Reaction Newsletter reports that analysis of products labeled as containing black cohosh (Actaea racemosa; syn: Cimicifuga racemosa) and associated with liver-associated adverse reactions have been found to be adulterated with “related herbal species.” Noting that Health Canada “received 6 domestic reports of liver adverse reactions suspected of being associated with black cohosh” between January 2005 and March 2009, all of which “were reported as being serious,” the authors report that analysis of the six products involved have now confirmed that black cohosh was not present in four of them, and that the other two were not authorized for sale in Canada, so that “data on herbal authenticity are not available” for these.

Britain says black cohosh linked to liver damage, but it may not
2006 -- The Medicines and Healthcare products Regulatory Agency (MHRA) n Britain said black cohosh may be linked to liver damage. Therefore, products containing black cohosh will in the future carry a warning. Apparently a review of all available data had concluded that liver injury resulting from black cohosh was rare but could be serious. Symptoms of liver problems include pain on the right side of the stomach just below the ribs, unexplained nausea, flu-like symptoms, dark urine and yellowing of eyes or skin.
     Dr. Sahelian says: I will await more research to determine if Britain is right in their evaluation of this herb.

5alphareductase inhibition
Inhibition of 5alpha-reductase in the rat prostate by Cimicifuga racemosa.
Maturitas. 2006.
The occurrence of prostate cancer and growth of LNCaP cells can be effectively inhibited by finasteride, a synthetic 5alpha-reductase inhibitor and by a black cohosh (Cimicifuga racemosa) extract. In the present contribution we tested whether the aqueous / ethanolic black cohosh extract BNO 1055 contains 5alpha-reductase inhibitors. We foung that the black cohosh extract BNO 1055 contains one or more potent 5alpha-reductase inhibitors which may make this extract suitable for the prevention and treatment of prostate cancer and possibly of benign prostate hyperplasia (BPH).

Allergy benefit
Inhibition of mast cell-dependent allergy reaction by extract of black cohosh.
Immunopharmacol Immunotoxicol. 2004.
Cimicifuga racemosa has been used as therapeutics for pain and inflammation in Korean folk medicine. The potential effects of black cohosh extract on mast cell-dependent allergy reaction, however, have not been well elucidated yet. In the present study, we investigated the effect on the allergy reaction using mast cell-dependent in vivo and in vitro models. Black cohosh showed no potential of skin sensitization in local lymph node assay. The oral administration significantly inhibited the anti-IgE-induced passive cutaneous anaphylaxis reaction. Black cohosh also showed inhibitory potential on the compound 48/80-induced histamine release from rat peritoneal mast cells. In addition, ith inhibited the IL-4, IL-5 and TNF-alpha mRNA induction by PMA and A23187 in human leukemia mast cells, HMC-1. These results demonstrated that black cohosh has an anti-allergic potential and it may be due to the inhibition of histamine release and cytokine gene expression in the mast cells.

Breast cancer prevention
Black cohosh has a non-estrogenic, or estrogen-antagonistic effect on human breast cancer cells. This leads to the conclusion that such herbal treatment may be a safe, natural remedy for menopausal symptoms in breast cancer.

Dr. Timothy R. Rebbeck of the University of Pennsylvania School of Medicine in Philadelphia compared 949 women with breast cancer to 1,524 healthy controls. Women who reported taking black cohosh (5 percent of blacks and 2 percent of whites) were at 61 percent lower risk of breast cancer. Also, those who took an herbal preparation derived from black cohosh called Remifemin had a 53 percent lower risk of the disease. Previous studies have shown that black cohosh can block cell growth. The herb is also an antioxidant, and has been shown to have anti-estrogen effects as well. International Journal of Cancer, 2007.

Gene expression analysis of the mechanisms whereby black cohosh inhibits human breast cancer cell growth.
Anticancer Res. 2007.
Previous studies indicate that specific extracts and the pure triterpene glycoside actein obtained from black cohosh inhibit growth of human breast cancer cells. Our aim is to identify alterations in gene expression induced by treatment with a methanolic extract of black cohosh. We treated MDA-MB-453 human breast cancer cells with the extract. At 6 h after treatment there was significant increase in expression of ER stress (GRP78), apoptotic (GDF15), lipid biosynthetic (INSIG1 and HSD17B7) and Phase 1 (CYP1A1) genes and, at 24 h, decrease in expression of cell cycle (HELLS and PLK4) genes. Since the black cohosh extract activated genes that enhance apoptosis and repressed cell cycle genes, it may be useful in the prevention and therapy of breast cancer.

Cimicifuga racemosa extract inhibits proliferation of estrogen receptor-positive and negative human breast carcinoma cell lines by induction of apoptosis.
Breast Cancer Res Treat. 2004.
Our results indicate that black cohosh extract exerts no proliferative activity, but kills the estrogen receptor positive MCF-7 as well as estrogen receptor negative MDA-MB231 cells by activation of caspases and induction of apoptosis. black cohosh root.

Growth inhibitory activity of extracts and purified components of black cohosh on human breast cancer cells.
Breast Cancer Res Treat. 2004.
The purpose of this study was to determine whether black cohosh contains constituents that inhibit the growth of human breast cancer cells, and therefore might eventually be useful in the prevention or treatment of breast cancer. Black cohosh rhizomes were extracted with methanol/water and fractionated by solvent-solvent partitioning to yield three fractions: hexane, ethyl acetate and water. The ethyl acetate fraction displayed the highest potency in two cell-based assays, growth inhibition and cell cycle analysis. Further studies are in progress to identify the mechanisms by which actein and related compounds present in black cohosh inhibit growth of human breast cancer cells.

Menopause and hot flashes
The field of hormone or herbal therapy during or after menopause is very complicated and there is no consensus within the medical community regarding the best option for long term therapy. The medical community seems to be shifting its viewpoint on hormone replacement. It appears that most traditional doctors now prefer using low doses of hormones for a brief period of time to treat menopausal symptoms, but prefer not to continue hormone replacement therapy indefinitely as in the past.
The results of studies evaluating black cohosh in the therapy of menopausal symptoms have not been consistent, butsome of studies lean towards this herbal extract providing some sort of benefit, but certainly not in any way as powerful as estrogen itself. But estrogen has its risks, and, if needed, should be used at the lowest effective dose and hopefully not for very extended periods.

Climacteric. 2015. Cimicifuga racemosa extract for relieving menopausal symptoms: a randomized controlled trial. To evaluate the effectiveness of black cohosh extract 40 mg/day for relieving moderate to severe menopausal symptoms and improving quality of life in Thai women. Participants were peri- or postmenopausal Thai women aged at least 40 years, who have moderate to severe menopausal symptoms evaluated using the Kupperman index (KI). Outcome measures included KI, frequency of hot flushes, Menopause-Specific Quality of Life (MENQOL) score, participants' global satisfaction and safety outcomes. A black cohosh extract of 40 mg/day is not superior to a placebo for relieving moderate to severe menopausal symptoms or improving quality-of-life scores in Thai women.

J Steroid Biochem Mol Biol. 2014. The non-estrogenic alternative for the treatment of climacteric complaints: Black cohosh (Cimicifuga or Actaea racemosa). Extracts of the rhizome of black cohosh did not bind to estrogen receptors and were shown to be devoid of estrogenic effects on mammary cancer cells in vitro and on mammary gland and uterine histology in ovariectomized rats. In addition in this rat model the special extract black cohosh BNO 1055 inhibited the occurrence of hot flushes and development of osteoporosis. In postmenopausal women BNO 1055 reduced major climacteric complaints as effectively as conjugated estrogens and significantly more than placebo. Similar data were published for other European preparations whereas 2 US American preparations were ineffective. This was most likely due to the too high doses or due to the adulteration with Asian Cimicifuga preparations. In all European studies neither effects in the uterus nor in mammary glands were observed. The effective compounds in black cohosh are most likely neurotransmitter-mimetic in nature: dopaminergic, noradrenergic, serotoninergic and GABAergic effects were demonstrated and some have been structurally identified. We conclude that black cohsoh extracts at low doses are effective to ameliorate climacteric complaints but are devoid of adverse estrogenic effects.

There is currently insufficient evidence to support the use of black cohosh for menopausal symptoms. However, there is adequate justification for conducting further studies in this area. Cochrane Database Syst Rev. 2012.

Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial.
Maturitas. 2005.
To compare the efficacy and safety of the black cohosh root extract Cr 99 with placebo in women with climacteric complaints. A multicenter, randomized, placebo-controlled, double-blind, parallel group study was conducted in 122 menopausal women (intention-to-treat population) with > or =3 hot flashes a day, treated over 12 weeks. The results indicate a superiority of the tested black cohosh extract compared to placebo in patients with menopausal disorders of at least moderate intensity according to a Kupperman Index > or =20, but not in the intention-to-treat population as a whole.

An extract of the herb, black cohosh, marketed as Remifemin, is effective in relieving menopausal symptoms. The herbal compound works best on hot flashes, night sweats and subsequent sleep disturbances but other complaints such as nervousness and depressive moods are also improved. The research was sponsored by Schaper and Bruemmer GmbH and Company KG, Salzgitter, Germany, the maker of Remifemin. Most studies of this herbal remedy were conducted in the 1980s and 1990s. To gain more up-to-date information, researchers randomly assigned 304 women with various climacteric complaints to black cohosh 40 milligrams per day or placebo. At 12 weeks, depending on symptom onset, black cohosh was significantly more effective than placebo in relieving symptoms, the team reports in the May issue of the journal Obstetrics and Gynecology. The "effect size", say the investigators, was comparable to that seen in a recent hormone replacement study. In particular, they note, the agent was more helpful in women in the early menopausal years and seemed to be most effective in reducing hot flushes. Obstetrics and Gynecology 2005.

Pilot evaluation of black cohosh for the treatment of hot flashes in women.
Cancer Invest. 2004.
We undertook a pilot study to estimate the effectiveness of black cohosh to reduce hot flashes. Black cohosh was given in the form of the commercial product Remifemin. Therapy was given for 4 weeks. Six patients were taking tamoxifen or raloxifene. Overall, patients reported less trouble with sleeping, less fatigue, and less abnormal sweating. No patients stopped the herbal therapy because of adverse effects. Black cohosh appeared to reduce hot flashes and had a low toxicity.

The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers.
Wuttke W.
In the present study, therapeutic effects of the Cimicifuga racemosa preparation CR BNO 1055 (Klimadynon / Menofem) on climacteric complaints, bone metabolism and endometrium will be compared with those of conjugated estrogens (CE) and placebo. The question whether black cohosh contains substances with selective estrogen receptor modulator (SERM) activity will be investigated. Sixty-two evaluable postmenopausal women were included in study, and treated either with (black cohsoh (daily dose corresponding to 40 mg herbal drug), 0.6 mg CE, or matching placebo, for 3 months. Black cohosh proved to be equipotent to CE and superior to placebo in reducing climacteric complaints. There was had no effect on endometrial thickness, which was significantly increased by CE. Vaginal superficial cells were increased under CE and black cohosh treatment. The results concerning climacteric complaints and on bone metabolism indicate an equipotent effect of black cohosh in comparison to 0.6 mg CE per day. It is proposed that black cohosh contains substances with SERM activity, i.e. with desired effects in the brain/hypothalamus, in the bone and in the vagina, but without exerting uterotrophic effects.

Cimicifuga racemosa for the treatment of hot flushes in women surviving breast cancer.
Maturitas. 2003. Parque Humboldt, Prados del Este, Caracas, Venezuela.
We accrued 136 breast cancer survivors aged 35-52 years. After treatment with segmental or total mastectomy, radiation therapy and adjuvant chemotherapy, participants were in open-label randomly assigned (1-2) to receive tamoxifen 20 mg per day orally or tamoxifen (same dose and posology) plus black cohosh (Menofem/Klimadynon, corresponding to 20 mg of herbal drug; intervention group). Duration of treatment was 5 years for tamoxifen, according to international standards for adjuvant therapies, and 12 months for black cohosh. Follow-up included clinical assessment every 2 months; the primary endpoint was to record the number and intensity of hot flushes. Comparing patients assigned to usual-care group with those assigned to intervention group, the number and severity of hot flushes were reduced after intervention. Almost half of the patients of the intervention group were free of hot flushes, while severe hot flushes were reported by 24% of patients of intervention group and 73.9% of the usual-care group. Hot flushes were the most frequent adverse reaction to tamoxifen adjuvant therapy in breast cancer survivors. The combined administration of tamoxifen plus black cohosh for a period of 12 months allowed satisfactory reduction in the number and severity of hot flushes.

My name is Amy Sutton, I'm a writer with HealthDay news service, and I'm doing a story on recent study about black cohosh, published in May, 2006 issue of the Journal of Agricultural and Food Chemistry.
Sutton: In my conversation with Kennelly, he stressed that clinical research has shown black cohosh to be effective at relieving hot flashes. But the results of this study may seem daunting to consumers. What advice do you have for women who want to take black cohosh for menopausal symptoms, but aren't sure how to choose an effective product?
     Sahelian: First, there is no evidence yet that black cohosh is better for decreasing menopause symptoms than Asian actaea. Therefore, if some products have the Asian version or a mix, that does not mean they are not going to be effective. We have no idea which compounds in these plants, triterpene glycosides, phenolic constituents, and formononetin , or combinations of such compounds are effective.
     The most practical advice that I can provide is this: Since menopausal symptoms are not life threatening and do not cause serious illness, a woman has time to experiment with different herbs or combinations to see what works for her best. Therefore, a woman could buy one particular brand of black cohosh, try it for a month, and if not effective try a completely different brand, If still not effective after another month, then other choices are available. Trying other herbs or phytoestrogens for a few weeks, or a woman has the option to take estrogen. No major harm would have occurred within this time period having tried the black cohosh or other natural options. After all, there is a risk to estrogen, so at least less estrogen replacement would have been used which could be helpful in reducing potential long term estrogen side effects.

I'm a reporter and am working on a consumer article based on a new study, funded by NIA and NCCAM, showing that black cohosh works no better than placebo at reducing menopausal symptoms. Annals of Internal Medicine tip sheet for Dec. 19, 2006. Black Cohosh No More Effective for Symptoms of Menopause than Dummy Pill. Data from the HALT study, Herbal Alternatives for Menopause, found that black cohosh, in three formulations, was no better than placebo in reducing symptoms of hot flashes and night sweats during menopause. The randomized, controlled trial assigned women to one of five groups taking: a black cohosh pill, a multibotanical pill with black cohosh and nine other ingredients, the multibotanical pill plus counseling to encourage intake of soy products, hormone therapy (estrogen with or without progestin), or a placebo pill. Hormone therapy worked as expected in substantially reducing the number and severity of symptoms. None of the herbal formulations worked any better than placebo. Black cohosh products are widely used as treatments for menopausal symptoms. An accompanying editorial says that the study is a "well-designed, adequately powered RCT that makes an important contribution, albeit one that will disappoint women who have been hoping for an effective, safe alternative to estrogen" (Editorial, p. 924). The good news, says the writer, is that women in the placebo group experienced about a 30 percent reduction in severity and frequency of symptoms during the 12-month follow-up period. This means that many women will probably have fewer symptoms within six to 12 months without any treatment at all.
    A. Commenting on a latest study is like watching a tennis game. One second the ball is on the right, another second later it is on the left. I prefer to comment on the totality of studies over a period of time as opposed to the latest findings. It does appear, though, that real hormones are much better at treating hot flashes and other menopausal symptoms that black cohosh or other herbs, but hormone replacement can have serious side effects including raising the risk for cancer. It is possible that some women may find black cohosh, other herbs, or a combination helpful. In that case, there is no harm in trying an herbal approach since there is a placebo effect an no apparent harm is being done.

Q. I had read on your site, and many others, about black cohosh for treatment of night sweats and other menopausal symptoms. I started roughly six months ago and it was working well but now seems to be losing its effectiveness as night sweats are starting up again. I now recall something about six months treatment recommended and came back to do further research. What I cannot find is information about what one is supposed to do AFTER six months. Take a break? For how long? And then resume? And/or switch to something else in the meantime? If so, what?
   A. These are all good questions that do not have clear answers at this time and it is a matter of trial and error. It's probably good to switch to something else.

Black Cohosh and St. Johns' wort for menopause
To see if a fixed combination of the herbal medicines could offer an alternative to hormone replacement therapy, the researchers studied 301 women who had been experiencing menopausal symptoms for at least three months, along with depressed mood. Half took the St. John's wort and black cohosh combo, while the other half took placebo pills. In each tablet, the black cohosh contained 1 milligram of the substances that are believed to be responsible for the herb's activity, triterpene glycosides, while the St. John's wort component contained 0.25 milligrams of the active ingredient hypericine. Study participants took the two tablets twice a day for the first eight weeks of the study, and once daily thereafter. After 16 weeks, women who took the two-herb combination showed a 50 percent reduction in symptoms such as hot flashes and sweating, compared to 19 percent for those on placebo. Scores measuring depression fell by 41 percent among women on the herbal medicines, compared to 12 percent for those on placebo. There was no significant difference between the groups in the number of adverse events or side effects seen from the medicine. The improvement in menopausal symptoms was similar to that seen among women taking hormone therapy for three months. Source: Obstetrics & Gynecology, February 2006.

Black cohosh and St. John's wort (GYNO-Plus) for climacteric symptoms.
Yonsei Med J. 2007. Department of Obstetrics and Gynecology, Yonsei University College of Medicine, 134 Sinchon-Dong, Seodaemun-Gu, Seoul, Korea.
The combination of black cohosh (Cimicifuga racemosa) and St. John's wort (Hypericum perforatum) was tested in women with climacteric symptoms. In this double-blind randomized, placebo-controlled, multicenter study, 89 peri- or postmenopausal women experiencing climacteric symptoms were treated with St. John's wort and black cohosh extract (Gynoplus), Jin-Yang Pharm., Seoul, Korea) or a matched placebo for 12 weeks. The combination was found to be effective in alleviating climacteric symptoms.

Quality of Black Cohosh sold over the counter
Evaluation of the Botanical Authenticity and Phytochemical Profile of Black Cohosh Products by High-Performance Liquid Chromatography with Selected Ion Monitoring Liquid Chromatography-Mass Spectrometry.
J Agric Food Chem. 2006. Jiang B, Kronenberg F, Nuntanakorn P, Qiu MH, Kennelly EJ. The Richard and Hinda Rosenthal Center for Complementary & Alternative Medicine, Department of Rehabilitation Medicine, College of Physicians & Surgeons, Columbia University, New York, New York, Department of Biological Science, Lehman College and The Graduate Center, City University of New York, Bronx, New York 10468, and State Key Laboratory of Phytochemistry and Plant Resource in West China, Kunming Institute of Botany, The Chinese Academy of Sciences, Kunming, Yunnan, People's Republic of China.
 In this study, 11 black cohosh products were analyzed for triterpene glycosides, phenolic constituents, and formononetin. Three of the 11 products were found to contain the marker compound cimifugin and not cimiracemoside C, thereby indicating that these plants contain Asian Actaea instead of black cohosh. One product contained both black cohosh and an Asian Actaea species. For the products containing only black cohosh, there was significant product-to-product variability in the amounts of the selected triterpene glycosides and phenolic constituents, and as expected, no formononetin was detected.

2006 - U.S. District Court Dismisses Experts and Lawsuit in Black Cohosh Complaint; Errors Noted in 'Probable' Case Report
2006-09-18 - American Herbal Products Association (AHPA)
     Silver Spring, MD — The U.S. District Court for Nebraska on September 8, 2006, dismissed a lawsuit that had been filed against two manufacturers of black cohosh (Actaea racemosa, syn. Cimicifuga racemosa) products. The suit had been filed by a woman who had required a liver transplant five months after starting to use these products, and by her husband. The Court also ruled to exclude the testimony of both of the plaintiffs’ experts, and stated that the plaintiffs “have no evidence to establish either general or specific causation.” In coming to this decision, the Court considered testimony obtained from both the patient and her physician, who had been retained as one of her two experts, which contradicted a published case report of this event.(1) As originally published, the authors, who included the expert physician, reported that the patient “did not drink alcohol or use illicit drugs, and was not taking any medications, including other herbal medications, acetaminophen, or nonsteroidal anti-inflammatory drugs” (emphasis added). In fact, the testimony revealed that the woman regularly consumed wine, used Advil® (ibuprofen, a non-steroidal anti-inflammatory drug) on a regular basis, and had been prescribed Valtrex®, a drug that lists “liver enzyme abnormalities; hepatitis” as a reported adverse reaction.
Importantly, this case was one of only two that some health authorities have identified as presenting a “probable” causal relationship between black cohosh and liver damage. But their analysis was based only on the published case report, which had inexplicably misreported an absence of drug and alcohol use by the patient. This U.S. District Court ruling is therefore significant in the ongoing international attention to black cohosh, which has resulted in label requirements and/or consumer advisories in Australia, the European Union, the United Kingdom, and Canada for products that contain the herb.(2,3) The American Herbal Products Association (AHPA) has initiated communications with each of these international health agencies to suggest reconsideration of the relevance of this case. The case discussed above is Grant and Beck v. Pharmavite, LLC and Nutraceutical Corp.

Effect on serotonin receptors
This herb contains small amounts of n methyl serotonin and may possibly have some of its effects through the activity of n methyl serotonin.

Interactions, testimonial
My wife is of Chinese race, 52 years old. She often has hot flushes and cannot sleep well with night sweats. After advise from our local health care provider and many hours of internet research, my wife is taking now four single ingredient products. She is taking since 6 weeks on a daily basis a total of:80mg Black Cohosh (Actaea racemosa syn. Cimicifuga racemosa) in two capsules each 40mg (one on the morning and one in the evening), 150mg French Pine Bark (Pinus pinaster ssp. Atlantica) in three capsules each 50mg150mg Asian Ginseng (Panax ginseng) in three capsules each 50mg10mg Lycopene (as part of a multivitamin product also containing Vitamin A, B-complex, C, D3, E and Zinc. She feels better and can sleep and the occasion of hot flushes have reduced but she often complains now about head aches, mild constipation and a mild itchy skin rash. Our HCP says these are normal mild side effects but i am worried that it is the combination of these four ingredients that contribute to the side effects.

Is there a difference in quality between black cohosh and Remifemin? Is Remifemin more effective?
   It is a marketing tool for every company, including Remifemin, who sells their product to claim that their ingredient - in this case black cohosh - is the best. However, most reputable companies will buy their raw ingredients from the same suppliers. There are sometimes unscrupulous companies that sell inferior material, but this is not common. Remifemin has 20 mg of black cohosh extract root and rhizome. You can easily find the same black cohosh extract for much cheaper. We do applaud the Remifemin company for sponsoring many black cohosh studies, and they should get a good market share to support their ongoing research.

Natrol, Black Cohosh Extract, 80 mg, 60 Capsules
uy Black Cohosh Extract

Supplement Facts Natrol, Black Cohosh Extract, 80 mg
Serving Size: 2 Capsules
Servings Per Container: 30
  Amount Per Serving % Daily Value
Black Cohosh Extract (Cimicifuga racemosa) (root) 160 mg *
Triterpene glycosides 4 mg *
*Daily Value (DV) not established.

For Menopause Symptoms
Standardized Potency • Women's Formula

Black Cohosh Extract capsules contain extract standardized to 2.5% triterpene glycosides. Containing valuable phytoestrogens, it has been used for a number of feminine conditions and recently been recognized for its ability to support menopause symptoms naturally.

Suggested Usage:  1 black cohosh capsule, 1- 2 times per day preferably before meals or as directed by a health care professional.
Other supplements to consider include chaste berry extract and the herb red clover for menopause support.
Buy Black Cohosh supplement, Hot Flash supplement

Supplement Facts
Black Cohosh root 40 mg pill
(cimifuga racemosa), extract - Triterpene glycosides (2.5%) - 1 mg

Caution: In rare cases this herb has been reported to affect the liver. Discontinue use and consult a healthcare practitioner if you have a liver disorder or develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice. If you plan to take black cohosh for prolonged periods, take a week off each month.