OBJECTIVE: To evaluate the efficacy of black cohosh extracts (BCE) in improving the low estrogen status induced by postoperative gonadotropin-releasing hormone agonist (GnRHa) in patients with endometriosis. METHODS: Randomized clinical controlled trial about the improvement of low estrogen status caused by GnRHa with the treatment of BCE in patients with endometriosis after laparoscopic surgery were retrieved from Medline (Ovid), PubMed, Cochrane Library, CNKI, CBMdisc, Wanfang and VIP databases before January 2020, and meta-analysis of included studies was performed by Revman 5.3 software. RESULTS: Seven randomized controlled trials involving 745 patients were included in this study. Meta-analysis results showed that the addition of BCE did not alter hormone levels of patients, including serum estradiol levels [ =1.24, 95% (-4.58, 7.08), >0.05] and luteinizing hormone levels [ =-0.02, 95% (-0.15, 0.11), >0.05]. BCE effectively improved the perimenopausal symptoms induced by low estrogen status:improving hectic fever and sweating [ =0.1, 95% (0.02, 0.47), < 0.01], reducing the occurrence of insomnia symptoms [ =0.23, 95% (0.13, 0.39), < 0.01], improving fatigue [ =0.09, 95% (0.04, 0.20), < 0.01], reducing the occurrence of vaginal dryness [ =0.04, 95% (0.01, 0.30), < 0.01]. BCE affected Kupperman's menopausal index (KMI) score 12 weeks after the surgery [ =-11.50, 95% (-20.09, -2.90), < 0.01] and KMI score 24 weeks after the surgery [ =-23.68, 95% (-39.66, -7.69), < 0.01]. CONCLUSIONS The limited evidence so far indicates that BCE could efficiently improve perimenopausal symptoms cause by low estrogen status of the patients recieved GnRHa treatment after surgery for endometriosis, but does not alter hormone levels of patients.
Cimicifuga ; Endometriosis ; Estrogens ; Female ; Humans ; Plant Extracts

OBJECTIVE: Results of several recent randomized clinical trials and epidemiological studies casted many doubts about the validity and safety of conventional hormone therapy for postmenopausal women. More and more women want to try more natural and safe ways of treating their climacteric symptoms. Black cohosh combined with St. John's wort may be effective in climacteric symptoms alternative to hormone therapy. This multicenter randomized double-blind placebo-controlled prospective clinical trial was carried out to evaluate the effect of the combined preparation of black cohosh and St. John's wort, Feramin-Q(R), on the general climacteric symptoms, hot flushes and climacteric depression. METHODS: Total of 80 postmenopausal women having moderate to severe degree of climacteric symptoms were randomly allocated to receive Feramin-Q(R) (n=40) or placebo (n=40) daily for 12 weeks. Fifty eight subjects completed this clinical study. The primary endpoint, the relief of general climacteric symptom and hot flushes were evaluated by measuring Kupperman index and the secondary endpoint, the relief of climacteric depression by Beck Depression Inventory at 4 and 12 weeks of treatment. RESULTS: After 4 and 12 weeks of treatment, Feramin-Q(R) and placebo groups showed significant decline of Kupperman index and BDI scores compared with baseline scores, but Kupperman index and BDI scores between the groups were not significantly different at 12 weeks. The changes of BDI scores between the groups were different at borderline significant level (p=0.07). Hot flush scores of Feramin-Q(R) groups were significantly decreased after 12 weeks of therapy, which showed significantly different at borderline level (p=0.07) from that of placebo. There was no statistical difference in change of hot flush scores from the baseline between the groups after 12 weeks. Among the 45 postmenopausal women with moderate to severe hot flush, Feramin-Q(R) group showed significant decrease of hot flush scores, which was significantly different compared with placebo group at 12 weeks of therapy. There were more patients (86.4%) in Feramin-Q(R) group, who had much more improvement of hot flushes compared with placebo group (54.6%) (P=0.04). CONCLUSION: There were no significant differences between placebo and Feramin-Q(R) groups concerning the effect on general climacteric symptoms and depression but Feramin-Q(R) was significantly more effective than placebo in relieving of hot flush in postmenopausal women with moderate to severe hot flushes. Therefore Feramin-Q(R) seems to be effective alternative for moderate to severe hot flushes.
Cimicifuga* ; Climacteric* ; Depression ; Epidemiologic Studies ; Female ; Humans ; Hypericum* ; Prospective Studies

OBJECTIVE: The fears and side effects of a prolonged hormone replacement therapy on the postmenopausal symptoms reinforce a growing interest about alternatives. The present study was performed to investigate whether black cohosh root extract (BCRE) can be used or not as an alternative to hormone replacement therapy (HRT) in order to relieve postmenopausal symptoms. MATERIAL & METHODS: Randomized, double-blind prospective clinical trial examined the effects of BCRE and HRT on Kupperman index, biochemical bone markers, lipid profiles, and side effects in 74 women with postmenopausal symptoms. Treatments included placebo (Festal(R)) (n=12), BCRE (Feramin(R)) (n=32) and HRT (Premarin(R)) (n=30) for 3 months. Kupperman index, biochemical bone markers (osteocalcin and deoxypyridinoline), and lipid profiles (total cholesterol, triglyceride and HDL-cholesterol) were measured at 0, 1 and 3 months. Side effects were checked at 3 months. RESULTS: BCRE was significantly effective in lowering of Kupperman index as much as HRT at two control times (1 month: p<0.05, 3 months: p<0.001). It also showed slightly favorable effects on biochemical bone markers and lipid profiles but not statistically significant. Fewer side effects were seen in BCRE than HRT. CONCLUSION: BCRE appears to be a safe and effective alternative to HRT for early postmenopausal symptoms and may be especially useful in women with intolerances or contraindications to traditional HRT.
Cholesterol ; Cimicifuga* ; Female ; Hormone Replacement Therapy* ; Humans ; Prospective Studies ; Triglycerides

OBJECTIVE: The fears and side effects of a prolonged hormone replacement therapy on the postmenopausal symptoms reinforce a growing interest about alternatives. The present study was performed to investigate whether black cohosh root extract (BCRE) can be used or not as an alternative to hormone replacement therapy (HRT) in order to relieve postmenopausal symptoms. MATERIAL & METHODS: Randomized, double-blind prospective clinical trial examined the effects of BCRE and HRT on Kupperman index, biochemical bone markers, lipid profiles, and side effects in 74 women with postmenopausal symptoms. Treatments included placebo (Festal(R)) (n=12), BCRE (Feramin(R)) (n=32) and HRT (Premarin(R)) (n=30) for 3 months. Kupperman index, biochemical bone markers (osteocalcin and deoxypyridinoline), and lipid profiles (total cholesterol, triglyceride and HDL-cholesterol) were measured at 0, 1 and 3 months. Side effects were checked at 3 months. RESULTS: BCRE was significantly effective in lowering of Kupperman index as much as HRT at two control times (1 month: p<0.05, 3 months: p<0.001). It also showed slightly favorable effects on biochemical bone markers and lipid profiles but not statistically significant. Fewer side effects were seen in BCRE than HRT. CONCLUSION: BCRE appears to be a safe and effective alternative to HRT for early postmenopausal symptoms and may be especially useful in women with intolerances or contraindications to traditional HRT.
Cholesterol ; Cimicifuga* ; Female ; Hormone Replacement Therapy* ; Humans ; Prospective Studies ; Triglycerides

PURPOSE: The purpose of this study was to evaluate bone response to anodized titanium implants coated with the extract of black cohosh, Asarum Sieboldii, and pharbitis semen. MATERIALS AND METHODS: Forty anodized titanium implants were prepared as follows: group 1 was for control; group 2 were implants soaked in a solution containing triterpenoids extracted from black cohosh for 24 hours; group 3 were implants soaked in a solution containing extracts of black cohosh and Asarum Sieboldii for 24 hours; group 4 were implants soaked in a solution containing extracts of pharbitis semen for 24 hours. The implants from these groups were randomly and surgically implanted into the tibiae of ten rabbits. After 1, 2, and 4 weeks of healing, the nondecalcified ground sections were subjected to histological observation, and the percentage of bone-to-implant contact (BIC%) was calculated. RESULTS: All groups exhibited good bone healing with the bone tissue in direct contact with the surface of the implant. Group 2 (52.44 +/- 10.98, 25.54 +/- 5.56) showed a significantly greater BIC% compared to that of group 3 (45.34 +/- 5.00, 22.24 +/- 2.20) with respect to the four consecutive threads and total length, respectively. The BIC% of group 1 (25.22 +/- 6.00) was significantly greater than that of group 3 (22.24 +/- 2.20) only for total length. CONCLUSION: This study did not show any remarkable effects of the extract of black coshosh and the other natural products on osseointegration of anodized titanium implants as coating agents. Further studies about the application method of the natural products on to the surface of implants are required.
Animals* ; Asarum ; Biological Products ; Bone and Bones ; Cimicifuga* ; Methods ; Osseointegration ; Rabbits ; Semen ; Tibia ; Titanium*

OBJECTIVE: The aim of the study is to assess the effects of treatment with an extract from Cimicifuga racemosa for 1 year in postmenopausal women with symptoms. METHODS: In a randomised, open-label, group-comparative study, the change on the Kupperman menopausal index, serum FSH and E2 level, bone densitometry (BMD), and mammographic density by an extract from Cimicifuga racemosa (GYNO-Qx ) (N=40) were compared with an conjugated equine estrogen combined with medroxyprogesterone acetate (CEE/MPA) (N=36) during 12 months in menopausal women. RESULTS: There were no statistical differences in the change of Kupperman index, serum FSH and E2 level, and mammographic density between two groups after 12 months, except the effect of BMD that the CEE/MPA group (+6.6%) was significantly increased as compared to the extract from Cimicifuga racemosa (+1.1%) baseline. CONCLUSION: This study suggests that an extract of Cimicifuga racemosa is a safe, effective alternative to estrogen replacement therapy for patients in whom hormone replacement therapy is either refused or contraindicated.
Cimicifuga* ; Densitometry ; Estrogen Replacement Therapy ; Estrogens ; Female ; Hormone Replacement Therapy ; Humans ; Medroxyprogesterone Acetate ; Menopause

To establish a fingerprint for Cimicifugae Rhizoma from different producing areas. Column kromasil (4.6 mm x 250 mm, 5 microm) was employed with acetonitrile-0.1% formic acid solution as the mobile phase for gradient elution. The flow rate was 1.0 mL x min(-1), the detection wavelength was 254 nm. Twenty chromatographic peaks were extracted as the common peaks of fingerprint, and 21 batches of samples were compared and classified with such methods as similarity evaluation, cluster analysis and principle component analysis. The results showed 12 common peaks and three categories of samples. The method was so highly reproducible, simple and reliable that it could provide basis for quality control and evaluation of Cimicifugae Rhizoma from different producing areas.
Chromatography, High Pressure Liquid ; methods ; Cimicifuga ; chemistry ; Drug Stability ; Quality Control

AIMTo look for new active constituents from the aerial part of Cimicifuga foetida L.

METHODSVarious column chromatographic techniques were used for the isolation and purification of the ingredients. The structure were elucidated on the basis of spectral evidences and chemical reaction.

RESULTSFive compounds were obtained and identified as 23-O-acetylshengmanol-3-O-alpha-L-arabinopyranoside (1), 23-O-acetylshengmanol-3-O-beta-D-xylopyranoside (2), 25-anhydrocimigenol-3-O-beta-D-xylopyranoside (3), cimigenol-3-O-alpha-L-arabinopyranoside (4), cimigenol-3-O-beta-D-xylopyranoside (5).

CONCLUSIONCompound 1 is a new compound, and compounds 2 and 4 were isolated from this plant for the first time.

Cimicifuga ; chemistry ; Molecular Structure ; Plant Stems ; chemistry ; Plants, Medicinal ; chemistry ; Saponins ; chemistry ; isolation & purification

OBJECTIVETo establish the fingerprint chromatograms of the extract of Cimicifugae Rhizoma firstly.

METHODPhenolic acids and triterpenoid saponins were analyzed by HPLC. Hypersil BDS C18 (4.6 mm x 250 mm, 5 microm) column was used, the mobile phase was composed of acetonitrile -0.1% H3PO4 with gradient elution, flow rate was 1.0 mL x min(-1), column temprature was 30 degrees C, and the detection wavelength was set at 316 nm and 210 nm.

RESULTIn the fingerprint of phenolic acids, thirteen feature peaks were found and the RSD of relative retention time and relative peak area were all less than 3% in the precision and repeation experiments. The similarity of ten batches of samples were all more than 0.90. In the fingerprint of triterpenoid saponins, fourteen feature peaks were found and the RSD of relative retention time and relative peak area were all less than 4% in the precision and repeation experiments. The similarity of ten batches of samples were all more than 0.90.

CONCLUSIONThis method is comprehensive, stable, reliable and can be used to evaluate the quality of the extract of Cimicifugae Rhizoma. It has provided a reference to the analysis on pharmacodynamic deferences of Cimicifuga extracts and also laid the foundation for its further development.

Chromatography, High Pressure Liquid ; methods ; Cimicifuga ; chemistry ; Hydroxybenzoates ; analysis ; Plant Extracts ; analysis ; Saponins ; analysis ; Triterpenes ; analysis

OBJECTIVE: The aim of this study was to assess the efficacy and safety of the combined preparation of black cohosh and St. John's wort (GYNO-Plus(R)) in post menopausal women with symptoms. METHODS: A total number of 60 postmenopausal women with climacteric symptoms was allocated to take GYNO-Plus(R) for 3 months. And the change of the Kupperman menopausal index (KI), serum FSH and E2 level, bone densitometry (BMD), mammographic density, liver function test (LFT) and adverse effects were assessed. RESULTS: There was statistical difference in the decline of KI after 3 months treatment. But, there were no statistical differences in the change of serum FSH and E2 level, BMD, mammographic density, and LFT. There were nine adverse events in study, but two cases were directly related to the drug and they were resolved without any sequela. CONCLUSION: This study suggests that the combined preparation of black cohosh and St. John's wort is a safe, effective alternative treatment option for patients in whom hormone replacement therapy is either refused or contraindicated.
Cimicifuga* ; Climacteric ; Densitometry ; Female ; Hormone Replacement Therapy ; Humans ; Hypericum* ; Liver Function Tests ; Menopause