Comparing the effect of black Cohosh versus Vitagnus on the impovement of menopause symptoms

Document Type : Original Article


1 Assistant Professor, Department of Pediatric's Nursing, Non-Communicable Diseases Research Center, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

2 M.Sc. in Geriatric Nursing, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

3 Assistant Professor, Department of Midwifery, Geriatric Care Research Center, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.


Introduction: Menopause is one of the crises in women’s life and most women experience physical and psychological symptoms along with mood changes during this period. Among non-hormonal alternative treatments, medicinal herbs with phytoestrogen have been more considered. Therefore, the present study was conducted with aim to compare the effect of black Cohosh versus Vitagnus on the improvement of menopause symptoms.
Methods: This double-blind clinical trial was performed on 135 menopausal women who were under the coverage of the health centers of Rafsanjan in 2015. The subjects were randomly assigned into three groups of black Cohosh, Vitagnus and control. Data about menopause symptoms were collected using MRS questionnaire before, four weeks and eight weeks after the intervention. Data were analyzed using SPSS software (version 18), and variance analysis, Chi-square, and Mann-Whitney tests. PResults: There was no significant statistical difference in the mean of total score of menopausal symptoms in the three groups of black Cohosh, Vitagnus and control before the intervention (p = 0.85). Four and eight weeks after the intervention, there was a significant statistical difference between the three groups (p < 0.001); so that the mean of total score of menopausal symptoms in two groups of black Cohosh and Vitagnus was less than the control group, and the mean of total score of menopausal symptoms in two groups of black Cohosh and Vitagnus had no significant difference (p>0.05).
Conclusion: Considering the effectiveness of both plants of black Cohosh and Vitagnus on the improvement of menopause symptoms, it is recommended to use this treatment, but the use of Vitagnus seems more affordable because it is a local plant in Iran.


  1. Bryant C, Judd FK, Hickey M. Anxiety during the menopausal transition: a systematic review. J Affect Disord 2012; 139(2):141-8.
  2. Geller SE, Studee L. Contemporary alternatives to plant estrogens for menopause. Maturitas 2006; 55(Suppl 1):S3-13.
  3. Abdi N, Solhi M. Quality of life in postmenopausal women in Tehran. Iran J Health Educ Health Promot 2014; 2(2):87-96. (Persian).
  4. Menopausal complaints. Pharmaceuticals, Bayer: Science for a Better Life. Available at: URL:; 2016.
  5. Halloran L. Is it hot in here? Menopause symptom management. J Nurse Practit 2014; 10(9):759-60.
  6. Abdi N, Solhi M. Quality of life in postmenopausal women in Tehran. Iran J Health Educ Health Promot 2014; 2(2):87-96. (Persian).
  7. Oddens B, Boulet M, Lehert P, Visser A. Has the climacteric been medicalized? A study on the use of medication for climacteric complaints in four countries. Maturitas 1992; 15(3):171-81.
  8. Pan HA, Wu MH, Hsu CC, Yao BL, Huang KE. The perception of menopause among women in Taiwan. Maturitas 2002; 41(4):269-74.
  9. Farag N, Mills P. A randomized-controlled trial of the effects of a traditional herbal supplement on sleep onset insomnia. Complement Ther Med 2003; 11(4):223-5.
  10. Gartoulla P, Bell RJ, Worsley R, Davis SR. Moderate-severely bothersome vasomotor symptoms are associated with lowered psychological general wellbeing in women at midlife. Maturitas 2015; 81(4):487-92.
  11. Duffy O, Iversen L, Hannaford PC. The impact and management of symptoms experienced at midlife: a community‐based study of women in northeast Scotland. BJOG 2012; 119(5):554-64.
  12. Ayers B, Hunter M. Health-related quality of life of women with menopausal hot flushes and night sweats. Climacteric 2013; 16(2):235-9.
  13. Abedzadeh-Kalahroudi M, Taebi M, Sadat Z, Saberi F, Karimian Z. Prevalence and severity of menopausal symptoms and related factors among women 40-60 years in Kashan, Iran. Nurs Midwifery Stud 2012; 1(2):88-93. (Persian).
  14. Avis NE, Brockwell S, Randolph Jr JF, Shen S, Cain VS, Ory M, et al. Longitudinal changes in sexual functioning as women transition through menopause: results from the study of women’s health across the nation. Menopause 2009; 16(3):442-52.
  15. Xu Q, Lang CP, Rooney N. A systematic review of the longitudinal relationships between subjective sleep disturbance and menopausal stage. Maturitas 2014; 79(4):401-12.
  16. Davis SR, Panjari M, Robinson PJ, Fradkin P, Bell RJ. Menopausal symptoms in breast cancer survivors nearly 6 years after diagnosis. Menopause 2014; 21(10):1075-81.
  17. Ajoodani Z, Babayanzad Ahari S, Nasrollahi S. Assessment of Pap smear specimens’ adequacy based on Bethesda System-2001 and its association with clinical factors. Iran J Obstet Gynecol Infertil 2015; 18(174):1-5. (Persian).
  18. Lindh-Åstrand L, Hoffmann M, Hammar M, Spetz Holm AC. Hot flushes, hormone therapy and alternative treatments: 30 years of experience from Sweden. Climacteric 2015; 18(1):53-62.
  19. Hosseini SH, Rajabzadeh R, Nosrati H, Naseri F, Toroski M, Mohaddes Hakkak H, et al. Prevalence of medicinal herbs consumption in pregnant women referring to Bojnurd health care centers. Iran J Obstet Gynecol Infertil 2017; 20(9):33-40. (Persian).
  20. Gentry-Maharaj A, Karpinskyj C, Glazer C, Burnell M, Bailey K, Apostolidou S, et al. Prevalence and predictors of complementary and alternative medicine/non-pharmacological interventions use for menopausal symptoms within the UK Collaborative Trial of Ovarian Cancer Screening. Climacteric 2017; 20(3):240-7.
  21. Heydari L, Suhrabi Z, Sayehmiri F, Sayehmiri K. Effect of herbaceous medicines effective in hot flashes of menopause women: a systematic review and meta-analysis in Iran. Iran J Obstet Gynecol Infertil 2014; 17(109):16-25. (Persian).
  22. Borrelli F, Ernst E. Alternative and complementary therapies for the menopause. Maturitas 2010; 66(4):333-43.
  23. Nadaoka I, Yasue M, Sami M, Kitagawa Y. Oral administration of Cimicifuga racemosa extract affects immobilization stress-induced changes in murine cerebral monoamine metabolism. Biomed Res 2012; 33(2):133-7.
  24. Vimal A, Vikram L, Singhal S, Anil B. Vitex negundo: a chinese chaste tree. Int J Pharm Innovation 2011; 1(5):9-20.
  25. van Die MD, Burger HG, Teede HJ, Bone KM. Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials. Planta Med 2013; 79(7):562-75.
  26. Boroomandfar K, Kazemiyan A, Safdari F, Delaram M, Nooriyan K, Bromandfard K, et al. Effect of Vitex on hot flash of menopausal women referred to health center of Isfahan. J Birjand Univ Med Sci 2007; 14(332):13-9. (Persian).
  27. Zheng T, Sun A, Xue W, Wang Y, Jiang Y, Zhang Y, et al. Efficacy and safety of Cimicifuga foetida extract on menopausal syndrome in Chinese women. Chin Med J 2012; 126(11):2034-8.
  28. Ross SM. Menopause: a standardized isopropanolic black cohosh extract (remifemin) is found to be safe and effective for menopausal symptoms. Holist Nurs Pract 2012; 26(1):58-61.
  29. Arbabisarjou AP, Mahnaz G. The effect of vitagnus on treatment of hot flash in menopause. Life Sci J 2013; 10(1):628-32.
  30. Golian Tehrani S, Bazzazian S, Bakhtiarian A, Ghobadzadeh M. Effects of calci soya balance and vitagnus on menopausal symptoms. Iran Red Crescent Med J 2014; 16(10):e13651.
  31. Heinemann K, Ruebig A, Potthoff P, Schneider HP, Strelow F, Heinemann LA. The Menopause Rating Scale (MRS) scale: a methodological review. Health Qual Life Outcomes 2004; 2(1):45.
  32. Newton KM, Reed SD, LaCroix AZ, Grothaus LC, Ehrlich K, Guiltinan J. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placeboa randomized trialherbal alternatives for menopause trial. Ann Intern Med 2006; 145(12):869-79.
  33. Laakmann E, Grajecki D, Doege K, zu Eulenburg C, Buhling KJ. Efficacy of Cimicifuga racemosa, Hypericum perforatum and Agnus castus in the treatment of climacteric complaints: a systematic review. Gynecol Endocrinol 2012; 28(9):703-9.
  34. Williams S. Authentication and investigation of potential hepatotoxicity of Black Cohosh. Leicester, England: De Montfort University; 2017.
  35. Daniele C, Thompson Coon J, Pittler M, Ernst E. Vitexagnuscastus: a systematic review of adverse events. Drug Saf 2005; 28(4):319-32.
  36. Kazamian A, Bromanfar K, Alireza GH, Norian K. Effect of Vitex and pasibi on hot flash of menopause women. J Shahrekord Univ Med Sci 2006; 7(1):39-44. (Persian).
  37. Kh B, Kazamian A, Safdari F, Delaram M, Norian K. Effect of the Vitex on hot flash of menopause in Isfahan. J Birjand Univ Med Sci 2006; 14(3):13-9. (Persian).
  38. Taghizadeh Z, Rezaipour A, Kazemnejad A, Mirsaeedi Z. The study of the effect of vitex agnus-castus on the early menopausal complications in menopaused women. J Hayat 2006; 12(1):67-76. (Persian).
  39. Abaspor Z, Hagikhani NA, Afshari P. Effect of vitex agnus castuson menopausal symptoms in postmenopausal women. J Sabzevar Univ Med Sci 2006; 12(2):26-30. (Persian).
  40. Saghafi N, Mahmoodinya M, Ayati S, Behdani F, Shakeri MT, Rakhshandeh A. Comparison of effects of black cohosh and fluoxetine in treatment of menopausal symptoms. Iran J Obstet Gynecol Infertil 2012; 15(32):1-7. (Persian).
  41. Peng W, Adams J, Sibbritt DW, Frawley JE. Critical review of complementary and alternative medicine use in menopause: focus on prevalence, motivation, decision-making, and communication. Menopause 2014; 21(5):536-48.
  42. Cora MC, Gwinn W, Wilson R, King D, Waidyanatha S, Kissling GE, et al. A black cohosh extract causes hematologic and biochemical changes consistent with a functional cobalamin deficiency in female B6C3F1/N mice. Toxicol Pathol 2017; 5(5):614-23.
  43. Franco DL, Kale S, Lam-Himlin DM, Harrison ME. Black cohosh hepatotoxicity with autoimmune hepatitis presentation. Case Rep Gastroenterol 2017; 11(1):23-8.
  44. Medicines and Healthcare products Regulatory Agency (MHRA). Liver failure case highlights need to use Black Cohosh remedies carefully. London: Medicines and Healthcare products Regulatory Agency (MHRA). Press; 2012.
  45. Shams T, Setia MS, Hemmings R, McCusker J, Sewitch M, Ciampi A. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Alternat Ther Health Med 2010; 16(1):36-44.