Annually, in the US, around 1.3 million women turn menopausal, and experience common symptoms associated with post-menopause. While a significant percentage of women look at hormone replacement therapy to overcome the symptoms, the possible risks associated with HRT have made alternative remedies a strong choice. Black cohosh is one such herbal product that has been used for offering symptomatic relief from menopausal conditions experienced by women. Despite being an herbal option, the possibilities of undesirable effects exist; here is a good look at the side effects of black cohosh and ways and measures to prevent or mitigate the effects.
Overview of black cohosh and mechanism of action
Belonging to the buttercup family, Black Cohosh is a perennial plant that is identified by various names and has been historically used in the treatment of various conditions. Native to North America, the plant has been used for treating fever, cough, and pain (musculoskeletal), apart from symptoms associated with menstruation complications. One of the reasons for the need for understanding the safety of the product is its mechanism of action, which is effectively not hormonal in nature.
While the actual mechanism of action has not been clearly documented, the effects of black cohosh are attributed to a few actions. For instance, the antioxidant properties of the plant, the action on the pathways and the selective estrogen receptive action are known to give the plant its effects. It has been studied for its effects in managing menopausal symptoms; hot flushes and typical disturbances associated with the condition – mood and sleep. The herb comprises active compounds, components such as terpene glycoside, and are complex molecules that cannot be synthesized in laboratories. This is precisely why certain products are only available as herbal or natural remedies.
Various actions and properties of the active compounds are attributed to the desired outcomes of the herb. For instance, components are known to have signaling properties, while come are known to provide protection from pathogens. Certain portions of the herb contain biologically active substances such as tannins, alkaloids and flavonoids. Similarly, the activation of estrogen receptors is also known to deliver the therapeutic effects. Compounds in the herb boost the immune system to fight diseases, while its anti-inflammation properties and the effects on the nerves and the brain help in alleviating the symptoms associated with menopause.
Menopause symptoms experience by women
It is necessary to understand more about the menopausal symptoms experienced by women to be able to correlate the mechanism of action and the outcomes. Women typically experience perimenopause and post menopause symptoms including dryness in the vagina and profuse sweating apart from symptoms mentioned earlier – hot flashes and mood swings. These conditions typically affect women in the period around menopause, wherein a woman ceases to have periods. The symptoms gradually reduce over a period of time, though the condition may continue.
Studies that advocate the use of black cohosh for managing menopause symptoms
Studies conducted in the past to check the efficacy and outcomes of black cohosh are mainly short term in nature. This makes it necessary for individuals to use the herb for short periods and avoid long term use, as its effects over long term use have not been assessed. Studies indicate that the primary effects of black cohosh are related to the symptoms caused by reduced estrogen levels. Documented studies reveal that women in menopause have experienced significant reduction in hot flashes and mood related issues when on black cohosh. Additional effects reported by users in the study include reduction in the amount of sweating experienced. Women are generally known to experience pain during intercourse as a result of dry vagina attributed to menopause. The use of black cohosh is known to help reduce this condition, thereby helping women experience lesser pain during intercourse.
Women also typically experience a distinct ringing sensation in the ears, and the herb helps in reducing this irritating sensation. As a result of pain during intercourse, women end up losing sex drive or interest to indulge in sex. The use of black cohosh is known to help women by indirectly helping in re-igniting interest in sex. One of the conditions of menopause includes a reduction in bone density among women, and the use of black cohosh helps in reducing this effect to an extent. A consequence of sleep and mood disturbances is the effect on mental health, and the use of black cohosh will help in bringing back cheer and reduce irritation. Other conditions that are caused by menopause include a loss of elasticity in the vulva, and possible heart palpitations. The overall effect of black cohosh helps in managing the conditions admirably.
General instructions for users of the herb
There are general instructions that need to be understood and followed diligently by users of the woodland herb. For instance, the herbal formulation is not regulated by the FDA and therefore there is no assurance of standards. To put this differently, the purity and the strength of the remedies may differ from brand to brand and product to product with little or no standardization. Individuals who prefer to take black cohosh as tea are advised to take suitably higher dosages or strengths as the rate of absorption through tea is relatively less.
The products are mainly available as ground powder or in liquid formulations, apart from pills. Sourced from the root and the stem of the herb, beneath the ground, the dosage typically follows traditional recommendations. However, recent studies indicate that the ideal dosage range should be anywhere between 40 to 200 milligrams, divided into appropriate doses. Individuals with a need for higher dosages are generally recommended to take the dried powder in three doses per day. Also available as tincture, the dosage in the liquid form is generally between 0.4 to 2 milliliters in a mixture comprising 60 percent of ethanol.
Different studies have shown different strengths to be effective, with different durations. This is generally attributed to the strength of the product. Here is a compilation of different strengths for specific conditions. For instance, women diagnosed at risk of developing post-menopausal breast cancer are advised to take four tablets per day, each with a maximum strength of 2.5 mg for a period of six months. Similarly, women with postmenopausal heart ailments are advised a total of 40 mg of tablet per day for a period of three months. Depending on the condition, women may also be prescribed the tablets for anther three months with a gap in between the two.
Women with mental health issues attributed to postmenopausal conditions are recommended a maximum dosage of 128 mg per day, to be taken for one year. Similarly, women with reduced bone density that occurs as a result of postmenopausal complications, are recommended a dosage of around 40 mg per day for a period of three months.
Commonly reported side effects of black cohosh
One of the reasons for possible unwanted outcomes of the formulations are the very nature of the product. The inadvertent presence of chemical ingredients and botanical ingredients in formulations cannot be ruled out completely. These ingredients might trigger effects and the effects may be clubbed together as the effects of the herb. Most authoritative sources recommend that usage of the herb be restricted to a maximum of one year and not beyond. This will help reduce the possibility of any complications from long term use. As mentioned earlier, the effects of the herb over long term usage have not been studied in-depth. Additionally, women with certain pre-existing conditions are at risk of experiencing stronger undesirable outcomes.
Commonly reported undesirable effects of the herb are as compiled below. There is a possibility of women experiencing liver health issues as a result of undesirable effects of black cohosh. This is regarded as serious in nature and requires medical intervention to prevent adverse complications. Symptoms that indicate possible jaundice or liver complications include a clear yellowish appearance of the eyes, and the skin. Other symptoms include nausea and vomiting hat is not linked to any other health condition. Women may also experience stomach pain and cramps, indicating liver problems. Discoloration of the urine is another symptom, with a distinct dark color indicating complications. The patient may also experience fatigue that is not linked to any strenuous activity.
Possible health complications of black cohosh
Before we look at possible health complications. it is necessary to add that the complications are a possibility and may not necessarily affect all users. In other words, women may or may not end up with side effects, while some may not experience any undesirable effects of the herb. One of the effects of the herbs mechanism of action is the blood thinning effects. Consequently, women with bleeding issues or blood pressure related complications are expected to experience undesirable effects. This is best handled or mitigated with a clinical assessment of the condition and careful monitoring to ensure that the herb does not trigger severe health complications.
Other known side effects include a sudden increase in vaginal discharge, that is unusual, and may or may not be accompanied by increased vaginal bleeding. Women may experience lower levels of blood pressure as a result of the blood thinning effects of the herb. This may also manifest as altered heart beat rates. The formation of blood clots in the lower limbs are also a possibility, attributed to the mechanism of action of the herb. The possibility of a recurrence in breast cancer cannot also be ruled out, while some women in menopause are also known to experience a build-up of fluid in the body. Acute discomfort in the chest is another symptom of undesirable effect of the her, while some women may experience tenderness in the breasts or pain.
Bouts of constipation and possible hepatitis infection are symptoms that require closer evaluation. Weakness in the muscles with out any specific reason is another condition that may be experienced by women. The outbreak of skin lesions or rashes may also be experienced, though this is typically mild in nature. Similarly, women may also experience inflammation of the eye, when on the herb. Vertigo or dizzy feeling may also be experienced by women taking the herb on a long-term basis. As a result of the fluid build-up, there is a possibility of swelling, while some experience profuse sweating without indulging in any physical activity.
Education: Bachelor’s in Biology from the University of California, Berkeley; Certified Health Education Specialist (CHES). Experience: 10 years as a freelance health writer and editor, contributing to blogs and magazines focused on preventive medicine and fitness.
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