Phytopreparations based on cimicifuga root extract for relieving menopausal symptoms

Mubarakshina O.A., Somova M.N., Batishcheva G.A., Mubarakshin E.A.

1) N.N. Burdenko Voronezh State Medical University, Voronezh, Russia; 2) ”RZhD-Meditsina” Clinical Hospital, Voronezh, Russia
The severe and moderate course of menopause with pronounced vasomotor manifestations can substantially increase the risk of future vascular catastrophes and negatively affect cognitive functions, accelerating neurodegenerative processes. These are just some of the reasons that do not allow one to ignore the pathological symptoms of the menopausal transition, and particularly the vasomotor symptoms that are among the cardiovascular risk biomarkers. The presented review material contains information on the major therapeutic areas of mitigating the pathological manifestations during menopause and highlights the problem of finding alternative ways to solve this problem. It is proposed to pay attention to the high capacities of herbal remedies containing phytoestrogens. The paper considers their effects versus those of drugs for menopausal hormone therapy (MHT) and arguments in favor of choosing this alternative for MHT. The most studied agents based on cimicifuga root extract are taken as an example.
Conclusion. In the situations, where MHT is impossible for whatever reasons, one of the acceptable alternative treatment options may be the drugs containing phytoestrogens. The latter contained in the cimicifuga root extract have the properties of selective estrogen receptor modulators, fail to affect breast tissue and endometrium, and are well tolerated. At the same time, they demonstrate the efficacy comparable to the effect of estrogens, which allows them to be successfully used to relieve vasomotor and other pathological symptoms during menopause.


menopausal disorders
vasomotor symptoms
hot flashes
selective estrogen receptor modulators


  1. Schoenaker D.A., Jackson C.A., Rowlands J.V., Mishra G.D. Socioeconomic position, life-style factors and age at natural menopause: a systematic review and meta-analyses of studies across six continents. Int. J. Epidemiol. 2014; 43(5): 1542-62. https://dx.
  2. Сметник В.П., Сухих Г.Т., Андреева Е.Н., Балан В.Е., Гависова А.А., Григорян О.Р., Ермакова Е.И., Зайдиева Я.З., Ильина Л.М., Касян В.М., Марченко Л.А., Подзолкова Н.М., Роговская С.И., Сметник А.А., Чернуха Г.Е., Юренева С.В. Менопаузальная гормонотерапия и сохранение здоровья женщин зрелого возраста. Климактерий. 2014; 4: 36с. [Smetnik V.P. et al. Menopausal hormone therapy and health preservation in mature age women. Klimakteriy/Menopause. 2014; 4: 36p. (in Russian)]
  3. Faubion S.S., Kuhle C.L., Shuster L.T., Rocca W.A. Long-term health consequences of premature or early menopause and considerations for management. Climacteric. 2015; 18(4): 483-91. https://dx.
  4. Biglia N., Cagnacci A., Gambacciani M., Lello S., Maffei S., Nappi R.E. et al. Vasomotor symptoms in menopause: a biomarker of cardiovascular disease risk and other chronic diseases? Climacteric. 2017; 20(4): 306-12. https://dx. 10.1080/13697137.2017.1315089.
  5. De Villiers T.J., Gass M.L., Haines C.J., Hall J.E., Lobo R.A., Pierroz D.D. et al. Global consensus statement on menopausal hormone therapy. Climacteric. 2013; 16(2): 203-4. https://dx.
  6. Hill D.A., Crider M., Hill S.R. Hormonal therapy and other treatments for symptoms in menopause. Am. Fam. Physician. 2016; 94(11): 884-9.
  7. The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of the North American Menopause Society. Menopause. 2017; 24(7): 728-53. https://dx.
  8. Rossouw J.E., Anderson G.L., Prentice R.L., LaCroix A.Z., Kooperberg C., Stefanick M.L. et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002; 288(3): 321-33. https://dx. 10.1001/jama.288.3.321.
  9. Юренева С.В., Ермакова Е.И. Оценка эффективности альтернативных методов лечения менопаузальных симптомов у женщин в постменопаузе. Гинекология. 2017; 19(1): 21-6. [Yureneva S.V., Ermakova E.I. Evaluation of the effectiveness of alternative treatments for menopausal symptoms in postmenopausal women. Ginekologiya (Gynecology). 2017; 19 (1): 21-6.(in Russian)]
  10. Балан В.Е., Зайдиева Я.З. Возможности коррекции климактерических расстройств негормональными средствами. Лечащий врач. 2000; 5-6: 24-6. [Balan V.E., Zaidieva Ya.Z. Possibilities of correction of menopausal disorders with nonhormonal agents. Lechashchiy Vrach. (Attending Physician). 2000; 5-6: 24-6. (in Russian)]
  11. Кузнецова И.В. Фитоэстрогены в лечении климактерических расстройств. Гинекология. 2012; 14(6): 20-3. [I.V. Kuznetsova. Phytoestrogens in the treatment of menopausal disorders. Ginekologiya/Gynecology. 2012; 14(6): 20-3. (in Russian)]
  12. Радзинский В.Е., ред. Лекарственные растения в акушерстве и гинекологии. М.: Эксмо; 2016. 320с. [Radzinsky V.E., ed. Medicinal plants in obstetrics and gynecology. M.: Eksmo; 2016. 320p. (in Russian)]
  13. Franco O.H., Chowdhury R. et al. Use of plant-based therapies and menopausal symptoms: a systematic review and meta-analysis. JAMA. 2016; 315(23): 2554-63. https://dx.
  14. Gorman G.S, Coward L., Darby A. et al. Effects of herbal supplements on the bioactivation of chemotherapeutic agents. J. Pharm. Pharmacol. 2013; 65(7): 1014-25. https://dx.
  15. Прилепская В.Н. Климактерический синдром: инновации в менопаузальной терапии. РМЖ. 2017; 2: 105-8. [Prilepskaya V.N. Menopausal syndrome: innovations in menopausal therapy. Russian Medical Journal. 2017; 2: 105-8. (in Russian)]
  16. Прилепская В.Н., Богатова И.К., Радзинский В.Е. Новое в профилактике и терапии климактерического синдрома. Гинекология. 2016; 18(1): 7-12. [Prilepskaya V.N., Bogatova I.K., Radzinsky V.E. Novelty in the prevention and treatment of menopausal syndrome. Ginekologiya/Gynecology. 2016; 18(1): 7-12. (in Russian)]
  17. Maki P.M., Dumas J. Mechanisms of action of estrogen in the brain: insights from human neuroimaging and psychopharmacologic studies. Semin. Reprod. Med. 2009; 27(3): 250-9. https://dx.
  18. Drogos L., Rubin L.H., Geller S.E., Banuvar S., Shulman L.P., Maki P.M. Objective cognitive performance is related to subjective memory complaints in midlife women with moderate to severe vasomotor symptoms. Menopause. 2013; 20(12): 1236-42. https://dx.
  19. Van Driel C.M.G., Stuursma A.S., Schroevers M.J., Mourits M.J., de Bock G.H. Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: a systematic review and meta-analysis. BJOG. 2019; 126(3): 330-9.
  20. Lauritsen C.G., Chua A.L., Nahas S.J. Current treatment options: Headache related to menopause – diagnosis and management. Curr. Treat. Options Neurol. 2018; 20(4): 7. https://dx.
  21. Avis N.E., Crawford S.L., Greendale G. et al. Duration of menopausal vasomotor symptoms over the menopause transition (Study of Women's Health Across the Nation). JAMA Intern. Med. 2015; 175(4): 531-9. https://dx. 10.1001/jamainternmed.2014.8063.
  22. Sarri G., Pedder H., Dias S. et al. Vasomotor symptoms resulting from natural menopause: a systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause. BJOG. 2017; 124(10): 1514-23. https://dx.
  23. Шапошник О.Д. Климакс и сердечно-сосудистые заболевания: Учебное пособие для врачей. Челябинск: УГМАДО; 2005. 75 с. [Shaposhnik O.D. Menopause and cardiovascular diseases: A textbook for doctors. Chelyabinsk: UGMADO; 2005. 75 p. (in Russian)].
  24. Thurston R.C., Sutton-Tyrrell K., Everson-Rose S.A., Hess R., Powell L.H., Matthews K.A. Hot flashes and carotid intima media thickness among midlife women. Menopause. 2011; 18(4): 352-8. https://dx.
  25. Chester R.C., Kling J.M., Manson J.E. What the Woman’s Health Initiative hastaughtus about menopausal hormone therapy. Clin. Cardiol. 2018; 41(2): 247-52. https://dx.
  26. Biglia N., Cagnacci A., Gambacciani M. et al. Vasomotor symptoms in menopause: a biomarker of cardiovascular disease risk and other chronic diseases? Climacteric. 2017; 20(4): 306-12. https://dx.
  27. Юренева С.В., Эбзиева З.Х. Роль гипоталамических (триггеров) нейропептидов в генезе приливов жара. Перспективы новых терапевтических подходов к лечению вазомоторных климактерических симптомов. Акушерство и гинекология. 2017; 8: 105-10. [Yureneva S.V., Ebzieva Z.Kh. The role of hypothalamic (triggers of) neuropeptides in the genesis of hot flashes. Prospects for new therapeutic approaches to treating vasomotor menopausal symptoms. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; 8: 105-10. (in Russian)]
  28. ACOG Practice Bulletin No. 141: Management of menopausal symptoms. Obstet. Gynecol. 2014; 123(1): 202-16. https://dx. 10.1097/01.AOG.0000441353.20693.78.
  29. Schulte-Michels J., Wolf A., Aatz S. et al. α-Hederin inhibits G protein-coupled receptor kinase 2-mediated phosphorylation of β 2-adrenergic receptors. Phytomedicine. 2016; 23(1): 52-7. https://dx.
  30. Wahab F., Shahab M., Behr R. The involvement of gonadotropin inhibitory hormone and kisspeptin in the metabolic regulation of reproduction. J. Endocrinol. 2015; 225(2): R49-66. https://dx.
  31. Tsutsui K., Bentley G.E., Ubuka T., Saigoh E., Yin H., Osugi T. The general and comparative biology of gonadotropin-inhibitory hormone (GnIH). Gen. Comp. Endocrinol. 2007; 153(1-3): 365-70. 10.1016/j.ygcen.2006.10.005.
  32. Сметник В.П., Ильина Л.М., ред. Ведение женщин в пери- и постменопаузе: практические рекомендации. Ярославль: Литера; 2010. 221с. [Smetnik V.P., Ilyina L.M., ed. Management of peri- and postmenopausal women: practical recommendations. Yaroslavl: IPK “Litera”; 2010. 221 p. (in Russian)]
  33. Ohmichi M., Tasaka K., Kurachi H., Murata Y. Molecular mechanism of action of selective estrogen receptor modulator in target tissues. Endocr. J. 2005; 52(2): 161-7. https://dx.
  34. Ильина Т.А. Большая иллюстрированная энциклопедия лекарственных растений. М.: Эксмо; 2008. 304c. [Ilyina T.A. The great illustrated encyclopedia of medicinal plants. M.: Eksmo; 2008. 304 p. (in Russian)]
  35. Wuttke W., Jarry H., Heiden I., Seidlova-Wuttke D. Effects of Cimicifuga racemosa on estrogen-dependent tissues. Maturitas. 2000; 35(Suppl.1):S34.
  36. Вуттке В., Горков К., Сайдлова, Вуттке Д. Влияние цимицифуги (Cimicifuga racemosa) на метаболизм в костной ткани, состояние слизистой оболочки влагалища и различные параметры анализа крови у женщин в постменопаузе: двойное слепое плацебо-контролируемое и контролируемое конъюгированными эстрогенами исследование. Русский медицинский журнал. 2008; 16(20): 3-11. [Wuttke V., Gorkov K., Saidlova, Wuttke D. The effect of cimicifuga (Cimicifuga racemosa) on bone metabolism, the vaginal mucosa, and various parameters of blood analysis in postmenopausal women: a double-blind, placebo-controlled and conjugated estrogen-controlled study. Rus. Med. Journal. 2008; 16 (20): 3–11.(in Russian)]
  37. Beer A.-M., Neff A. Differentiated evaluation of extract-specific evidence on Cimicifuga racemosa's efficacy and safety for climacteric complaints. Evid. Based Complement. Alternat. Med. 2013; 2013: 860602. https://dx. 10.1155/2013/860602.2013.
  38. Рауш К., Брюкер К., Горков К., Вуттке В. Первые доказательства безопасности для эндометрия экстракта клопогона кистевидного (Actaea и Cimicifuga racemosa). Русский медицинский журнал. 2008; 16(9): 1-8. [Rausch K., Brucker K., Gorkov K., Wuttke V. First evidence for the endometrial safety of black cohosh (Cimicifuga racemosa). Rus. Med. Journal. 2008; 16 (9): 1-8. (in Russian)]
  39. Коломойцева Т.Н., Орлов О.А., Козлова Г.А. Опыт использования препарата из экстракта цимицифуги (Климадинон) в комплексной реабилитации больных раком шейки матки. Опухоли женской репродуктивной системы. 2008; 3: 57-61. [Kolomoitseva T.N., Orlov O.A., Kozlova G.A. Experience with a cimicifuga extract-based drug (Klimadynon) in the complex rehabilitation of patients with cervical cancer. OZhRS (Female Reproductive System Tumors). 2008; 3: 57-61.(in Russian)]
  40. Hill C.A., Harris R.C., Kim H.J., Harris B.D., Sale C., Boobis L.H. et al. Influence of beta-alanine supplementation on skeletal muscle carnosine concentrations and high intensity cycling capacity. Amino Acids. 2007; 32(2): 225-33. https://dx. 10.1007/s00726-006-0364-4.

Received 27.08.2020

Accepted 02.09.2020

About the Authors

Galina A. Batishcheva, MD, Professor, Head of the Department of Clinical Pharmacology, N.N. Burdenko Voronezh State Medical University.
Tel.: +7(4732)65-68-47. E-mail: ORCID: 0000-0003-4771-7466. 394036, Russia, Voronezh, Studentcheskaya str., 10.
Olga A. Mubarakshina, MD, PhD, Department of Clinical Pharmacology, N.N. Burdenko Voronezh State Medical University.
Tel.: +7(903)025-32-47. E-mail: ORCID: 0000-0001-6799-6322. 394036, Russia, Voronezh, Studentcheskaya str., 10.
Marina N. Somova, PhD, assistant professor of clinical pharmacology, N.N. Burdenko Voronezh State Medical University.
Tel.: +7(4732)65-68-47. E-mail: ORCID: 0000-0002-6511-4098. 394036, Russia, Voronezh, Studentcheskaya str., 10.
Eduard A. Mubarakshin, physician of gynecological department, Road Clinical Hospital. Tel.: +7(4732)65-29-17. E-mail:
394024, Russia, Voronezh, per. Zdorovya, 2.

For citation: Mubarakshina O.A., Somova M.N., Batishcheva G.A., Mubarakshin E.A. Phytopreparations based on cimicifuga root extract for relieving menopausal symptoms.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2020; 9: 199-206 (in Russian).

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.