Black Cohosh Extract Helps Improve Endothelial Function in Postmenopausal Women

Written by Angeline A. De Leon, Staff Writer. Postmenopausal women who supplemented with black cohosh had significantly improved flow-mediated dilation (FMD) of the brachial artery.

After the onset of menopause, the risk for cardiovascular disease (CVD) becomes about two to six times greater in postmenopausal vs. premenopausal women ¹. A substantial body of research supports the relationship between menopause and CVD, with cohort studies confirming higher incidences of atherosclerosis and acute myocardial infarction in women of postmenopausal age ^2,3. Evidence suggests that estrogen deficiency may increase risk of CVD by influencing cholesterol levels (increasing low-density lipoprotein cholesterol, LDL-C) ⁴ and changing vascular tone ⁵, and although hormone therapy shows relative efficacy in the treatment of vasomotor symptoms ⁶, it appears generally ineffective for preventing CVD ⁷. Among herbal remedies, black cohosh (Cimicifuga racemosa) is one of the most commonly used for managing symptoms of menopause and is noted for its efficacy in controlling vasomotor symptoms in postmenopausal women ^8,9. The therapeutic effects of black cohosh appear to involve a direct interaction with serotonin receptor agonists ¹⁰ and a capacity to regulate cholesterol levels and normalize blood pressure parameters ¹¹. In a 2020 study ¹² published in Climacteric, researchers in Brazil sought to determine whether a short period of supplementation with black cohosh could significantly improve endothelial function (based on flow-mediated dilation, FMD, of the brachial artery) in healthy, postmenopausal women.

A total of 62 postmenopausal women (mean age = 51.6 years) (> 1 year since last menstrual period) were enrolled in a prospective, randomized, double-blind, placebo-controlled trial in which they were randomly assigned to receive 160 mg of dry standardized C. racemosa extract (with 4 mg of triterpene glycosides) or matching placebo daily for 28 days. At baseline and at the end of 28 days, participants underwent an FMD ultrasound assessment of the right brachial artery as a measure of endothelial function.

At the time of enrollment, all participants showed a normal metabolic profile. Women receiving black cohosh extract demonstrated a significant increase in FMD of the brachial artery from baseline to Day 28 (from –0.006 +/- 0.069 to 0.048 +/- 0.073, p = 0.006), unlike the placebo group in whom no significant changes in FMD were detected over the course of the study (from 0.031 +/- 0.085 to 0.028 +/- 0.102, p = 0.842). Furthermore, the number of postmenopausal women showing the presence of brachial artery dilation was significantly higher in the black cohosh group vs. placebo (77.4% vs. 48.4%, p = 0.018).

Evidence from the study supports the capacity of black cohosh extract in improving endothelial function in postmenopausal women. A short-term treatment period of 28 days proved sufficient to achieve increased elasticity of the right brachial artery nerve, confirming the vasodilatory effects long associated with C. racemosa and its clinical relevance to the treatment of menopausal symptoms. Future studies evaluating the effects of short-term intake of black cohosh in postmenopausal women with confirmed CVD would be valuable. The relatively small sample size of the current trial may be considered a study limitation, as well as the absence of other physiological measures of endothelial function, such as endothelial nitric oxide levels. Findings should be replicated in future investigations accounting for these limitations.

Source: Fernandes ES, Celani MFS, Fistarol M, et al. Effectiveness of the short-term use of Cimicifuga racemosa in the endothelial function of postmenopausal women: a double-blind, randomized, controlled trial. Climacteric. 2020; 23(): 245-251. DOI: 10.1080/13697137.2019.1682542.

© 2019 International Menopause Society

Posted September 1, 2020.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

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