Naturopath Recommended PCOS Supplements: Black Cohosh
Natural Treatments for PCOS Series: Spotlight on Black Cohosh
In this blog, I will be talking about the herb Cimicifuga racemosa, commonly known as Black Cohosh and its evidence-based role in the treatment of Poly Cystic Ovarian Syndrome (PCOS). Black Cohosh is also known as Actaea racemosa.
You may have heard of Black Cohosh being mentioned in association with menopausal hot flushes. Few however, know about its role in the management of PCOS and ovulation support.
PCOS is a hormonal condition that may be characterised by a delay in ovulation, long, irregular menstrual cycles, high levels of male androgens, a higher than normal number of cysts on the ovaries as well as higher levels of blood glucose and insulin.
Many women who have PCOS are prescribed Metformin which is a drug used for Type 2 Diabetes. Metformin can help manage a hyper insulin state, which women with PCOS are often found to have. High insulin levels can then impact the hormonal system, namely Leutenising Hormone (which will be discussed below) as well as androgens such as testosterone.
Women with PCOS wishing to conceive may be put on drugs such as Clomid or Letrozole which promote ovulation by reducing or blocking the level of Oestrogen. A reduction in Oestrogen leads to an increase in the hormone FSH, which dials up the message between the brain and the ovaries to ovulate. PCOS women undergoing ovulation induction treatment may also be prescribed Ovedril which is a drug that is used to help with the final release of the dominant egg.
There are a number of natural interventions available for women with PCOS which will be discussed in the blog series “Natural Treatments for Poly Cystic Ovarian Syndrome”. In this current blog, the focus will be on the herb Black Cohosh which has been appearing in numerous studies for its role in the treatment and management of PCOS.
Black Cohosh is native to North America and is a member of the butter cup (Ranunculacea) family. (1) In the late 1800’s a prominent, eclectic physician discovered Black Cohosh as a key herb to treat a number of female reproductive health conditions. (2) More recently, it is one of the main herbs used to treat Menopausal symptoms. The studies shared below, however, demonstrate the use of Black Cohosh in the treatment and management of PCOS.
Black cohosh in several animal studies has been found to improve the FSH to LH ratio. (3)
What is the FSH to LH ratio you may ask?
FSH (Follicle Stimulating Hormone) which has been mentioned above is a hormone secreted by the pituitary gland that is responsible for the growth and development of the follicles each cycle. LH (Leutenising Hormone) also secreted by the pituitary gland, is responsible for the release of the egg belonging to the most dominant follicle. This is the process that occurs during ovulation. The ratio between FSH and LH is usually either 1:1 or slightly higher FSH to LH. In PCOS however, this ratio can be out of balance where LH is notably higher than FSH. When this happens, it is known as LH dominance which can prolong the timing of ovulation and as a consequence, cause a delay in menstruation.
Cimicifuga racemosa was involved in a trial where it was compared to the drug Clomid to stimulate ovulation in women with PCOS. In this trial Black Cohosh was found to improve the FSH to LH ratio, improve LH and progesterone levels, improve ovulation, endometrial thickness and pregnancy rates. The author of the study concluded that Black Cohosh may be used as an alternative to Clomid (Clomiphene) for ovulation induction and that it was an important herb to consider for irregular menstrual patterns where LH was found to be dominant.
Another PCOS study found that combining Black Cohosh with Clomid for ovulation induction demonstrated better cycle outcomes and pregnancy rates. A systematic review noted that three randomised controlled trials also showed improvements in pregnancy rates when black cohosh was combined with Clomid.
This same review interestingly found an improvement in hormone regulation and endometrial thickness for black cohosh groups compared to Clomid. For women who have LH dominance and long menstrual cycles, Black Cohosh can be a key herbal intervention. It is best however to consult with a naturopath that has a special interest in reproductive health before taking this herb.
As a trained and experienced naturopath I will always carry out proper hormonal assessments before prescribing any remedies. Please note that not all women with PCOS have high LH and there are a variety of hormonal presentations with PCOS that need to be identified before being treated.
Taking remedies that are naturopathically prescribed ensures correct and safe dosing as well as ensuring that you are taking the highest quality, TGA approved remedy.
If you have been diagnosed with PCOS or have irregular or long menstrual cycles, I would definitely recommend getting in touch to start the process of having your hormones tested at a specific day in the cycle. Once these have been tested then herbal and nutritional medicine will be prescribed to you that is specifically tailored to your hormonal profile.
For more information, you can get in touch with me via my contact page.
(1) http://herbalgram.org/resources/herbalgram/issues/45/table-of-contents/article2659/
(2) http://herbalgram.org/resources/herbalgram/issues/45/table-of-contents/article2659/
