Black Cohosh: Was Lydia E. Pinkham on to Something?
For: Hormone Therapy: The Answers Are In,
October 2002
"A positive cure," proclaimed the label, "for all those painful complaints and weaknesses so common to our best female population." In the plainer language of our times, Lydia E. Pinkham's Vegetable Compound—a famous patent medicine and one of the great best-sellers of yore—claimed to cure menstrual cramps and menopausal symptoms, as well as nervous tension and other conditions. Its chief ingredient was black cohosh (Cimicifuga racemosa, a.k.a. black snake root or rattleweed), a native American plant long used to treat "female complaints" when these symptoms could not be mentioned in polite society.
The vegetable compound was a tincture—that is, the herbs were dissolved in alcohol. At 36-proof, it was more alcoholic than wine. Some people thought this was Lydia's true secret. You can still buy Lydia Pinkham's, now reformulated with vitamins E and C and other substances, and not quite as alcoholic. It no longer contains black cohosh. (If you have any antique Lydia Pinkham's bottles, by the way, they have become valuable collector's items.)
Black cohosh, used in various products (such as Remifemin or Black Cohosh Power), is still one of the best-selling herbs for menopausal symptoms. Some women see it as "natural" and prefer it to hormone replacement therapy.
Should they?
That's a hard question to answer, because although the herb has been much studied, evidence is still pretty thin. Some studies have found that it relieves hot flashes, sweating, headaches, and other menopausal symptoms—but few of these studies have been well designed. Some researchers think black cohosh contains plant estrogens and thus has hormonal effects, but the latest reports have found no estrogens or hormonal effects. It's unknown whether black cohosh has any effect, positive or negative, on breast cancer risk. And it is also not clear whether women taking birth control pills or hormone replacement therapy can safely take black cohosh.
The possible side effects of black cohosh include stomach upset, headache, dizziness, and weight gain. Women who are pregnant or breast feeding should steer clear of it. It seems to increase the risk of miscarriage. Even its advocates (one of them is the herb expert Varro Tyler) say that women who decide to try it for menopausal symptoms should not take it for more than six months, though others say three months. Since so little is known about it, and there's no guarantee how much of it is in any given product, it's difficult to say how these experts arrived at such a conclusion.
Other claims: Black cohosh was used at one time to treat joint pain, and it does contain salicylates, which are similar to the compounds in aspirin—but in amounts too small to have a therapeutic effect. It may be a mild sedative, so avoid taking it if you are taking tranquilizers. And it may interfere with hypertension medication.
Final thoughts: If you try black cohosh, be sure your physician knows. Ask whether it might interact with other medications you are taking. Black cohosh is an interesting herb. Perhaps good studies will one day be done, so that you could be more certain of its benefits and side effects. Thus far its traditional uses and benefits have no solid support from scientific research.
UC Berkeley Wellness Letter, February 2001
