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Black cohosh (Actaea racemosa or Cimicifuga racemosa), a member of the buttercup family, is a perennial plant native to North America. Other, mostly historical, names for this herb include snakeroot, black bugbane, rattleweed, macrotys, and rheumatism weed [1,2]. Black cohosh has a long history of use. Native Americans used it, for example, to treat musculoskeletal pain, fever, cough, pneumonia, sluggish labor, and menstrual irregularities [3]. European settlers used black cohosh as a tonic to support women's reproductive health [4].

Preparations of black cohosh are made from its roots and rhizomes (underground stems). They are sold as dietary supplements in such forms as powdered whole herb, liquid extracts, and dried extracts in pill form [7].

Available preparations vary considerably in their chemical composition, in part because the compounds in black cohosh that may be responsible for any relief of menopausal symptoms are not known. Substances in black cohosh that may account for its activity include triterpene glycosides such as actein, 23-epi-26-deoxyactein, and cimicifugoside; resins, such as cimicifugin; and aromatic acid derivatives such as caffeic, isoferulic, and fukinolic acids [8,9].

Products containing black cohosh extract are frequently standardized to provide at least 1 mg triterpene glycosides per daily dose [10]. Remifemin, a commercial black cohosh product used in several studies included in a 2012 Cochrane review described below, is an extract currently standardized to be equivalent to 40 mg black cohosh root/rhizome (extracted with isopropyl alcohol) per daily dose of two tablets, but it is not standardized to triterpene glycoside content [7,11]. The product has been on the market for years and has been reformulated over time [10].

Studies using various designs since the 1950s have attempted to determine whether black cohosh affects menopausal symptoms [12]. Complicating efforts to understand the efficacy of black cohosh for treating menopausal symptoms is the wide variation in the chemical compositions of formulations. Black cohosh's active ingredients and potential mechanism(s) of action are unknown. Studies have found varying results for the plant's effects on human physiology as to whether, for example, it raises the body's levels of estrogen which is present in lower levels in menopausal women than in premenopausal women, or whether it affect levels of luteinizing hormone or follicle-stimulating hormone [13,14]. It is not clear whether black cohosh affects the structure and activity of vaginal and uterine tissues [5,15]. Some researchers believe that black cohosh might exert its effects through a brain-related action, such as moduation of serotonergic pathways, or through its potential ability to act as an antioxidant, anti-inflammatory, or selective estrogen receptor modulator [5,15-17].

After 3, 6, 9, and 12 months of supplementation or placebo, the number of vasomotor symptoms declined significantly in all groups. However, there were no statistically significant differences between the black cohosh and red clover groups compared to placebo, with one exception. The black cohosh group showed worse symptom intensity at 6 and 9 months. This study also investigated secondary endpoints such as somatic symptoms (e.g., insomnia and fatigue), mood changes (e.g., depression and anxiety), and sexual dysfunction (e.g., vaginal dryness). For most of these outcomes, no significant differences were observed between any of the treatment groups at any time.

A 2016 systematic review and meta-analysis of randomized clinical trials examined four studies of herbal and plant-based therapies that included black cohosh (three of which were examined in the Cochrane review described above) to treat menopausal symptoms [20]. The trials randomized a total of 511 women to a daily dose of various formulations of 6.5 to 160 mg/day black cohosh extract or placebo. There were no significant associations between supplementation with black cohosh and reduction in the number of vasomotor symptoms, such as hot flashes. Furthermore, there were no beneficial associations between black cohosh use and relief of menopausal symptoms using self-reported rating scales.

The American College of Obstetricians and Gynecologists, in its 2015 clinical guidelines for managing menopausal symptoms, concluded that "data do not show that" herbal dietary supplements like black cohosh "are efficacious for the treatment of vasomotor symptoms" [21]. The North American Menopause Society advises clinicians against recommending herbal therapies such as black cohosh because "they are unlikely to be beneficial" (italics in original) in alleviating vasomotor symptoms [15].

Clinical trials using various black cohosh preparations to treat menopausal symptoms have shown that its use is associated with a low incidence of adverse effects. The most commonly reported side effects are gastrointestinal upset and rashes, both of which are mild and transient [1,24]. Other reported adverse effects in clinical trials have included breast pain/enlargement, infection, vaginal bleeding/spotting, and musculoskeletal complaints, although their incidence was similar in women taking black cohosh and those taking placebo [5]. Most studies have examined black cohosh use for short periods, typically 6 months or less, so no published studies have assessed the long-term safety of black cohosh in humans.

In 2007, the Australian Department of Health began requiring that products containing black cohosh carry the following label statement: "Warning: Black cohosh may harm the liver in some individuals. Use under the supervision of a healthcare professional" [29]. In 2008, the U.S. Pharmacopeia (a nonprofit standard-setting organization for foods and drugs) recommended labeling black cohosh products with the following cautionary statement: "Discontinue use and consult a healthcare practitioner if you have a liver disorder or develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice" [30]. However, the U.S. Food and Drug Administration does not require such a warning on black cohosh product labels.

The American Herbal Products Association recommends that pregnant women not take black cohosh except under the supervision of their healthcare provider because studies have not rigorously evaluated its use during pregnancy [1]. The U.S. Pharmacopeia advises that individuals with liver disorders should also avoid black cohosh [30]. It adds that users who develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice, while taking the supplement should discontinue use and contact their doctor.

//Researchers argue in a 2015 study that a racial gap in marriage emerged in the 1960s, when black marriage rates started to decline, first slowly then steeply.// Statistics show that African-Americans have often lagged behind other races when it comes to marriage by the age of 40. Data from 2010, Recent data shows suggests that, at all ages, black Americans have display lower marriage rates than do other racial and ethnic groups. Based on U.S. Census Bureau data from 2008 to 2012, less than two-thirds of black women were married by their early 40s, compared with almost nine out of 10 white and Asian/Pacific Islander women and more than eight in 10 Hispanic women.// (with a far lower proportion of black women having married at least once by the age of 40).

In honor of Black History Month, Grimy Goods is highlighting the most influential black female singers and musicians of all time. Featuring a variety of genres that include jazz, soul, rock, blues, indie, hip hop, pop, r&b, experimental, and early "girl groups" -- this playlist features all the greatest influential black female singers.

An acronym for "you only live once," YOLO is often said just before somebody is about to do something they probably shouldn't. Sure, they're about to make a big mistake, but hey, YOLO. At 40, it's officially time to stop behaving in ways that you know in advance aren't great. Slang or no slang, having one life is no excuse for consciously being foolish, so it's a hard no on the YOLO.

When something is so cool it deserves to be checked out, it's described as "lit." The only thing that needs to be lit in your world is lavender vanilla candles. And for more terms that haven't been in-style in decades, check out The Best Slang Terms from the 1970s That Aren't Cool Today.

When something is accomplished in a particularly slick way, it's done so with finesse. You can finesse something or even be finessed. "I loaned that guy $20 and now he's denying it ever happened I totally got finessed!" Not that similar situations don't happen to people over 40, but a person in your age range just sounds more mature using language like "scammed" or "conned," rather than words that came out of a song featuring Bruno Mars and Cardi B.

This slang term is actually kind of hilarious. It's a weird way of saying that the truth has been exposed, stemming from the shock that people experience when a wig is snatched off one's head without permission. But just because this slang makes us smile doesn't mean it's something that's appropriate for anyone over 40 to use. Announce to a room of your peers that there's been a wig snatched and it's entirely possible they'll think you are referring to an actual stolen hairpiece. As in, "There's been a rash of toupee robberies in the area!"

When you disappear from somebody's life without explanation, you're ghosting them. Or at least that's what it's called if you're a teenager or twenty-something who still uses Tinder. If you're over 40, just call this behavior what it really is: being a jerk.

Short for "in real life," IRL is meant to distinguish between something that happens out in the real world as opposed to the "fictional" world of the internet. If you're over 40, your entire world should be occurring "in real life." There is no other option. If you spend more time chatting with strangers online than IRL, consider this your wake-up call. 59ce067264


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