Natural Woman Clinical Monograph
Natural Woman Soy-Free Hormone Support
Natural Support for Menopausal Symptoms
Natural Woman offers advanced nutraceutical support for women in their peri- and post menopausal years. Unlike similar products that only provide high concentrations of phytoestrogens to help modulate hormone levels, Natural Woman also addresses problems with increased vascular sensitivity that can exacerbate vasomotor symptoms during menopause.
Natural Woman combines potent concentrates of black cohosh (Cimicifuga racemosa) and sage (Salvia officinalis) along with effective levels of hesperidin (as hesperidin methylchalcone), gamma-oryzanol, and the natural plant lignan, 7-hydroxymatairesinol (HMRlignan™).
These ingredients have been shown in preclinical and clinical studies to stabilize fluctuating hormone levels, improve vascular resistance, sustain lipid and bone metabolism, and significantly modulate hot flashes and other common menopausal complaints.
Natural Woman is an all-natural, vegetarian formulation that is free of soy phytoestrogens and can be used by women from their perimenopausal to their postmenopausal years.
Menopause marks the time in a woman’s life when she transitions from her reproductive to non-reproductive years. This milestone may occur anytime between the ages of 40 and 61 with a median of 51.3 years and is confirmed when menstrual periods are absent for 12 consecutive months.
The time period leading up to menopause when physiological changes and accompanying symptoms may begin to occur is referred to as “perimenopause”, literally “around menopause.”
Perimenopause and menopause involve a natural reduction in ovarian activity ultimately leading to a permanent cessation of menstruation. Menopause can also be artificially induced by surgical removal of the ovaries or other conditions that cause a loss of ovarian function.
The primary biological changes that occur during menopause include declining numbers of ovarian oocytes and associated follicles, reduced production of ovarian steroid hormones such as estrogen, progesterone, and testosterone, and increased (or fluctuating) levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH).
These changes typically produce a variety of symptoms including hot flashes, night sweats, mood alterations, menstrual irregularities, fatigue, atrophy of vaginal tissues, reduced libido, sleep disturbances, and changes in memory and cognitive function.
Declining ovarian hormone levels also increase the risk of a number of serious diseases including osteoporosis and cardiovascular disease.
While menopause is a natural process, the symptoms can be unpleasant, even debilitating. Over 70% of menopausal women report vasomotor symptoms such as flushing and night sweats, and 40-60% experience some form of sleep disturbance.
For many years, the conventional medical approach to managing climacteric symptoms was hormone replacement therapy (HRT). HRT is effective not only for alleviating menopausal discomforts, but for preventing postmenopausal bone loss.
In 2002, however, the large-scale, multicenter Women’s Health Initiative study revealed that significant health risks may be associated with use of synthetic estrogens derived from mares and/or synthetic progestin therapy.
The disturbing findings of the WHI ushered in a new era of interest in safer, non-hormonal approaches to health issues associated with menopause. Since that time, a significant body of evidence has emerged supporting the use of certain natural agents in the treatment of menopausal symptoms.
Scientific studies indicate herbs such as black cohosh and sage and the nutrients hesperidin, gamma-oryzanol, and plant lignans exert a variety of physiological effects in women that promote hormonal, thermoregulatory, vascular, and neurochemical stability. These natural ingredients have been shown to not only effectively moderate hot flashes and other common climacteric complaints, but to beneficially modify risk factors associated with heart disease and osteoporosis.
Black Cohosh (Cimicifuga racemosa)
Black cohosh is an herb indigenous to the Eastern United States and Canada. The herb contains a number of biologically active substances, primarily triterpene glycosides, flavonoids, phenolic acids, and tannins.
Native Americans and early settlers used the roots and rhizomes of black cohosh for a variety of ailments including malaria, rheumatism, kidney dysfunction, pain during childbirth, and menstrual difficulties.
Today, black cohosh is approved by the German Commission E as a treatment for menstrual and menopausal complaints and is perhaps the most widely used natural remedy for menopausal symptoms.
Despite intensive study, black cohosh’s mechanism of action is still unclear. While some investigators believe it acts on specific tissue estrogen receptors, most studies indicate black cohosh has no estrogenic activity.
Data from animal and human studies indicate black cohosh may help stabilize fluctuating LH levels. Other research has found components of black cohosh bind to serotonin and/or dopamine receptors suggesting a means by which the herb can exert neuromodulatory and thermoregulatory effects.
Clinical trials utilizing black cohosh have yielded inconsistent results, most likely due to non-uniformity in preparations, methodological differences, use of black cohosh in combination with other botanicals, and variations in dosage and treatment times.
Nevertheless, the majority of research studies document clear benefits of black cohosh for alleviating perimenopausal symptoms.
One double-blind, placebo-controlled, multicenter trial reported in the journal Obstetrics & Gynecology examined the effects of 40 mg/day of standardized black cohosh extract in 145 postmenopausal women experiencing climacteric symptoms.
After 12 weeks, scores on a standardized, 10-point Menopause Rating Scale (MRS) were significantly reduced from baseline in women taking black cohosh compared to scores in the placebo group.
Subgroup analyses found women in their early menopausal years and those suffering from hot flashes were the most responsive to black cohosh treatment.
In another prospective trial, 48 menopausal women were administered 80 mg/day of black cohosh extract standardized to 2.5% triterpene glycosides.
After 12 weeks of treatment, mean symptom scores on the Kupperman Menopausal Index decreased significantly from 24.6 (indicative of moderate symptoms) to 12.8 (indicative of very mild symptoms).
During a subsequent 12-week washout period, Kupperman scores reverted back to near-baseline levels.
Importantly, this study evaluated the impact of black cohosh on breast tissue and found no significant changes in nipple aspirate fluid cytology or estrogenic markers over the 24-week intervention and follow-up periods.
A double-blind, placebo-controlled trial designed to compare the effect of standardized black cohosh extract with conjugated estrogens on postmenopausal bone metabolism found both treatments significantly improved serum markers of bone turnover. Researchers noted black cohosh elevated levels of bone-specific alkaline phosphatase, an indicator of increased osteoblastic bone formation, while estrogen therapy tended to reduce markers associated with osteoclastic bone degradation.
Finally, in a prospective, parallel-controlled trial, 64 symptomatic postmenopausal women were administered either 40 mg/day of standardized black cohosh or a combination of transdermal estradiol and an oral progestin.
After three months, both black cohosh and estrogen/progestin treatments were found to significantly reduce vasomotor symptoms, anxiety, and depression to an equivalent degree.
Serum LDL levels also significantly decreased in both treatment groups, but HDL increased only in women taking black cohosh.
At least a dozen other clinical trials conducted in research centers around the world have reported benefits for black cohosh in treating menopausal discomforts.
Hesperidin (as hesperidin methylchalcone)
Hesperidin is a flavanone polyphenol and one of the primary flavonoids found in citrus fruits. Hesperidin is a glycoside consisting of the aglycone hesperetin and the disaccharide sugar rutinose.
Studies dating back to the 1930s report benefits of hesperidin in improving vascular strength and resistance despite the flavonoid’s poor solubility and absorption.
More recently, hesperidin derivatives such as hesperidin methylchalcone (HMC), which have a higher solubility and therefore greater bioavailability, have become available. Preliminary studies indicate HMC’s supportive effects on the microvascular system may limit vasomotor instability caused by hormonal fluctuations during menopause.
In a blinded, controlled, crossover trial, 94 women who had undergone either physiological or surgical menopause received a preparation containing 300 mg of HMC, 900 mg of a hesperidin complex, and 1,200 mg of vitamin C for one month. Comparator treatments were estrogen, salicylamide (as an antipyretic), and placebo.
At the end of the treatment periods, 88% of women receiving the HMC preparation reported complete relief or moderation in hot flashes compared to 66%, 43%, and 19% for estrogen, salicylamide, and placebo, respectively.
Gamma-oryzanol is a mixture of unsaponifiable components from rice bran oil. It consists primarily of triterpene alcohol and phytosterol esters of ferulic acid.
Gamma-oryzanol has been investigated for its antioxidant, neuroendocrine, anabolic, antiulcerogenic, antithrombotic, and antihyperlipidemic properties.
Studies conducted in Japan have found gamma-oryzanol to be an effective means of ameliorating menopausal symptoms.
According to published reports of an early, untranslated study, 300 mg/day of gamma-oryzanol provided substantial relief to a group of 21 women who had undergone either natural or surgically-induced menopause.
After 38 days, over 65% of the woman reported a 50% or greater improvement in menopausal symptoms, including hot flashes.
A larger, more recent trial examined the effects of 300 mg/day of gamma-oryzanol in 40 women with climacteric complaints.
After eight weeks, symptom scores on the Kupperman index had improved in 85% of the women.
A more detailed analysis revealed that 78.9% of women reporting vasomotor symptoms, 78.1% reporting headaches, 77.8% reporting weakness, 77.4% reporting nervousness, 77.3% reporting melancholia, 75.8% reporting arthralgia/myalgias, and 72.1% reporting sleep disturbances experienced “excellent” or “good” relief from their symptoms.
Studies indicate gamma-oryzanol may also beneficially modify cardiovascular risk profiles.
In animals, addition of gamma-oryzanol to the diet significantly lowers total cholesterol and non-HDL cholesterol fractions.
Human trials have found that supplementation with 300 mg/day of gammaoryzanol for periods ranging from 4-16 weeks significantly reduces blood levels of total cholesterol, LDL, triglycerides, apolipoprotein B, and lipid peroxides, while significantly elevating HDL.
Sage (Salvia officinalis)
Sage is a spice and medicinal herb that has been used throughout recorded history for a variety of health complaints.
According to botanical experts, sage possesses antioxidant, antimicrobial, and antispasmodic properties along with a capacity to relieve excessive perspiration.
Studies also indicate sage has anticholinesterase activity that can beneficially impact mood, memory and cognitive performance.
The active constituents of sage, including monoterpenes, alpha- and beta-thujone, camphor, and 1,8-cineole, are believed to be largely responsible for its medicinal effects.
Reports of sage’s antihidrotic and neuromodulatory benefits have led to two clinical trials evaluating its efficacy as a natural remedy for menopausal symptoms.
A pilot trial conducted in Italy found that an herbal combination of sage and alfalfa markedly reduces hot flashes and night sweats in postmenopausal women.
Of the 30 participating women, 20 reported complete symptom relief, while 10 experienced varying degrees of symptom reduction.
In a more recent multicenter trial, 69 symptomatic postmenopausal women were recruited to test the effects of 280 mg/day of sage extract.
After two months, mean numbers of mild, moderate, severe, and very severe hot flashes were reduced by 46%, 62%, 79%, and 100%, respectively.
Scores on the standardized Menopause Rating Scale (MRS) also diminished by an average of 46%.
Subscale analyses found hot flashes, sleep problems, physical/mental exhaustion, musculoskeletal discomforts, anxiety, depression, and irritability were the symptoms most improved by sage.
Lignans are a type of phytoestrogen, chemically similar to isoflavones and naturally concentrated flaxseeds, whole grains, and certain trees like the Norway spruce.
Upon ingestion, most plant lignans are chemically modified by intestinal bacteria to the human lignans, enterolactone and enterodiol. These enterolignans are absorbed and can modulate estrogen activity by interacting with estrogen receptors (ERs).
Like most phytoestrogens, lignans are believed to exert a biphasic effect, antagonizing ERs in the presence of high estrogen levels and acting as weak ER agonists when estrogen levels are low.
In this way lignans have a normalizing effect on estrogen imbalances in the body.
Lignans also appear to influence estrogen by inhibiting aromatase activity and by shifting estrogen metabolism away from harmful 16-hydroxyestrone metabolites.
A number of studies document improvements in menopausal symptoms following consumption of lignans or high-lignan foods.
One randomized, double-blind trial found postmenopausal women who consumed a high-flaxseed diet for 12 weeks experienced a significant 41% reduction in hot flashes. This clinical benefit correlated with elevated urinary levels of enterolactone and enterodiol.
Another randomized, crossover trial compared the effects of 40 g/day of flaxseeds (equivalent to 21 mg/day of lignans) with HRT in a group of 25 menopausal women.
After 2 months, significant reductions in menopausal symptom scores (as measured by the Kupperman index) were noted in both treatment groups.
A third, blinded, controlled trial involving 28 postmenopausal women reported a significant reduction in hot flash severity along with a non-significant trend toward reduced hot flash frequency following 16 weeks of supplementation with 25 g/day of flaxseed.
Preliminary data indicate the novel lignan, 7-hydroxymatairesinol (HMRlignan™), holds particular promise for managing menopausal symptoms. Derived from Norway spruce trees, HMRlignan™ is a direct enterolignan precursor.
Unlike dietary lignans, which exist as glycosides and must be cleaved within the intestinal tract, HMRlignan™ is delivered in its pure aglycone form for more rapid and efficient transformation into bioactive enterolactone.
A randomized, single-blind, pilot study tested the effects of 25 or 50 mg/day of HMRlignan™ in a group of 20 symptomatic postmenopausal women.
After eight weeks, mean numbers of daily hot flashes were reduced by 14% in the 25 mg group and by 53.5% in the 50 mg group. The results were significant for both groups, but demonstrate a superior effect for the higher dosage.
Similar to gamma-oryzanol, lignans also exert a favorable influence on lipid metabolism and cardiovascular risk markers.
A recent meta-analysis of 28 studies found supplementation with either whole flaxseed or flax lignans leads to significant reductions in both total and LDL cholesterol.
One study utilizing a postmenopausal cohort of the Framingham Offspring Study reported that women in the highest vs the lowest quartile of lignan consumption have higher HDL levels, reduced triglycerides, and significantly lower waist-to-hip ratios.
Data from animal and human studies also show intake of specific lignans can significantly lower markers of vascular inflammation and endothelial dysfunction.
Natural Woman provides natural relief for symptoms commonly associated with menopause.
This formula is especially recommended for women with vasomotor symptoms such as hot flashes and night sweats.
Women at higher risk of developing heart disease and/or osteoporosis may also benefit from regular use of Natural Woman.
|Serving Size: 1 Capsule
Servings per Container: 60
|Amount Per Serving||% Daily Value|
|Hesperidin Methylchalcone||150 mg||*|
(from rice bran oil)
root and rhizome,
dried extract, min. 2.5% triterpene glycosides,
calculated as 27-deoxyactein
|Sage (Salvia officinalis) leaf||60 mg||*|
|Norway Spruce (Picea abies)
dried lignan extract containing hydroxymatairesinol‡
|* Daily value not established|
‡HMRlignan™ brand, a trademark of Linnea SA.
As a dietary supplement, take one (1) capsule twice daily, or as recommended by a healthcare professional.
While not clinically confirmed, black cohosh has a long history of use for induction of labor and may induce premature uterine contractions if taken during the first trimester of pregnancy.
Several case reports have linked black cohosh with possible hepatotoxicity; however, multiple, independent literature reviews conclude there is no credible evidence to indicate black cohosh has an adverse effect on liver function.
In vitro, black cohosh constituents have been shown to augment the cytotoxicity of doxorubicin, docetaxel, paclitaxel, and 5-fluorouracil, but to decrease the cytotoxicity of cisplatin. These effects have not been demonstrated in animals or humans.
Persons taking chemotherapeutic agents and pregnant women should consult with a healthcare professional before using Natural Woman. Do not use Natural Woman if you have known allergies or sensitivities to any of its ingredients.
60 vegetarian capsules per bottle with full-bottle shrinkwrap. Packaged 12 bottles per case.
Store in a cool, dry place (59°F-85°F) away from direct light. For long term storage up to two years, the product should be stored at a temperature between 36°F-46°F. Keep out of reach of children.
Adlercreutz H. Lignans and human health. Crit Rev Clin Lab Sci 2007;44:483-525.
Blumenthal, M (ed). The ABC Clinical Guide to Herbs. Austin, TX: American Botanical Council; 2003.
Bommer S, Klein P, Suter A. First time proof of sage's tolerability and efficacy in menopausal women with hot flushes. Adv Ther 2011;28:490-500.
Borrelli F, Ernst E. Alternative and complementary therapies for the menopause. Maturitas 2010;66:333-43.
Brooks JD, Ward WE, Lewis JE, et al. Supplementation with flaxseed alters estrogen metabolism in postmenopausal women to a greater extent than does supplementation with an equal amount of soy. Am J Clin Nutr 2004;79:318-25.
Bulliyya G. Risk of coronary heart disease in women after menopause. J Indian Med Assoc 2001;99:478-80, 482.
Burdette JE, Liu J, Chen SN, et al. Black cohosh acts as a mixed competitive ligand and partial agonist of the serotonin receptor. J Agric Food Chem 2003;51:5661-70.
Chanal JL, Cousse H, Sicart MT, Bonnaud B, Marignan R. Absorption and elimination of (14C) hesperidin methylchalcone in the rat. Eur J Drug Metab Pharmacokinet 1981;6:171-7.
Cicero AF, Gaddi A. Rice bran oil and gamma-oryzanol in the treatment of hyperlipoproteinaemias and other conditions. Phytother Res 2001;15:277-89.
Dalais FS, Rice GE, Wahlqvist ML, et al. Effects of dietary phytoestrogens in postmenopausal women. Climacteric 1998;1:124-9.
de Kleijn MJ, van der Schouw YT, Wilson PW, Grobbee DE, Jacques PF. Dietary intake of phytoestrogens is associated with a favorable metabolic cardiovascular risk profile in postmenopausal U.S. women: the Framingham study. J Nutr 2002;132:276-82.
De Leo V, Lanzetta D, Cazzavacca R, Morgante G. [Treatment of neurovegetative menopausal symptoms with a phytotherapeutic agent]. Minerva Ginecol 1998;50:207-11. [Article in Italian; abstract in English]
Dugoua JJ, Seely D, Perri D, Koren G, Mills E. Safety and efficacy of black cohosh (Cimicifuga racemosa) during pregnancy and lactation. Can J Clin Pharmacol 2006;13:e257-61.
Duker EM, Kopanski L, Jarry H, Wuttke W. Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats. Planta Med 1991;57:420-4.
Einbond LS, Shimizu M, Nuntanakorn P, et al. Actein and a fraction of black cohosh potentiate antiproliferative effects of chemotherapy agents on human breast cancer cells. Planta Med 2006;72:1200-6.
Felmlee MA, Woo G, Simko E, Krol ES, Muir AD, Alcorn J. Effects of the flaxseed lignans secoisolariciresinol diglucoside and its aglycone on serum and hepatic lipids in hyperlipidaemic rats. Br J Nutr 2009;102:361-9.
Firenzuoli F, Gori L, di Sarsina PR. Black cohosh hepatic safety: follow-up of 107 patients consuming a special Cimicifuga racemosa rhizome herbal extract and review of literature. Evid Based Complement Alternat Med 2011;2011:821392.
Franco OH, Burger H, Lebrun CE, et al. Higher dietary intake of lignans is associated with better cognitive performance in postmenopausal women. J Nutr 2005;135:1190-5.
Garg A, Garg S, Zaneveld LJ, Singla AK. Chemistry and pharmacology of the citrus bioflavonoid hesperidin. Phytother Res 2001;15:655-69.
Hudson T. Women’s Encycolpedia of Natural Medicine. Los Angeles, CA: Keats Publishing; 1999.
Ishihara M. Effect of gamma-oryzanol on serum lipid peroxide level and clinical symptoms of patients with climacteric disturbances. Asia Oceania J Obstet Gynaecol 1984;10:317-23.
Ishihara M, Ito Y, Nakakita T, et al. [Clinical effect of gamma-oryzanol on climacteric disturbance - on serum lipid peroxides (author's transl)]. Nihon Sanka Fujinka Gakkai Zasshi 1982;34:243-51. [Article in Japanese; abstract in English]
Jarry H, Harnischfeger G, Duker E. Studies on the endocrine effects of the contents of Cimicifuga racemosa 2. In vitro binding of compounds to estrogen receptors. Planta Med 1985;51:316-319.
Jarry H, Metten M, Spengler B, Christoffel V, Wuttke W. In vitro effects of the Cimicifuga racemosa extract BNO 1055. Maturitas 2003;44 Suppl 1:S31-8.
Kennedy DO, Pace S, Haskell C, Okello EJ, Milne A, Scholey AB. Effects of cholinesterase inhibiting sage (Salvia officinalis) on mood, anxiety and performance on a psychological stressor battery. Neuropsychopharmacology 2006;31:845-52.
Kong X, Yang JR, Guo LQ, et al. Sesamin improves endothelial dysfunction in renovascular hypertensive rats fed with a high-fat, high-sucrose diet. Eur J Pharmacol 2009;620:84-9.
Lemay A, Dodin S, Kadri N, Jacques H, Forest JC. Flaxseed dietary supplement versus hormone replacement therapy in hypercholesterolemic menopausal women. Obstet Gynecol 2002;100:495-504.
Lewis JE, Nickell LA, Thompson LU, Szalai JP, Kiss A, Hilditch JR. A randomized controlled trial of the effect of dietary soy and flaxseed muffins on quality of life and hot flashes during menopause. Menopause 2006;13:631-42.
Linnea website. HMRlignan™ Bioavailability and pharmacokinetics. http://www.hmrlignan.com/html/bioavailability.htm. Accessed 10/27/11. Linnea website. HMRlignan™ Questions & Answers. http://www.hmrlignan.com/ html/qanda.htm. Accessed 10/27/11.
Mahady GB. Is black cohosh estrogenic? Nutr Rev 2003;61:183-6.
Murase Y, Iishima H. Clinical studies of oral administration of gamma-oryzanol on climacteric complaints and its syndrome. Obstet Gynecol Prac 1963;12:147-9. As reported in Patel M, Naik SN. Gamma-oryzanol from rice bran oil – a review. Journal of Scientific & Industrial Research 2004;63:569-78; and in Hudson T. Women’s Encyclopedia of Natural Medicine. Los Angeles, CA: Keats Publishing; 1999.
Nappi RE, Malavasi B, Brundu B, Facchinetti F. Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol. Gynecol Endocrinol 2005;20:30-5.
Naser B, Schnitker J, Minkin MJ, de Arriba SG, Nolte KU, Osmers R. Suspected black cohosh hepatotoxicity: no evidence by meta-analysis of randomized controlled clinical trials for isopropanolic black cohosh extract. Menopause 2011;18:366-75.
Nelson HD. Menopause. Lancet 2008;371:760-70.
Newairy AS, Abdou HM. Protective role of flax lignans against lead acetate induced oxidative damage and hyperlipidemia in rats. Food Chem Toxicol 2009;47:813-8.
Ogawa H, Sasagawa S, Murakami T, Yoshizumi H. Sesame lignans modulate cholesterol metabolism in the stroke-prone spontaneously hypertensive rat. Clin Exp Pharmacol Physiol Suppl 1995;22:S310-2.
Osmers R, Friede M, Liske E, Schnitker J, Freudenstein J, Henneicke-von Zepelin HH. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol 2005;105:1074-83.
Pan A, Yu D, Demark-Wahnefried W, Franco OH, Lin X. Meta-analysis of the effects of flaxseed interventions on blood lipids. Am J Clin Nutr 2009;90:288-97.
Pellegrini N, Valtuena S, Ardigo D, et al. Intake of the plant lignans matairesinol, secoisolariciresinol, pinoresinol, and lariciresinol in relation to vascular inflammation and endothelial dysfunction in middle age-elderly men and postmenopausal women living in Northern Italy. Nutr Metab Cardiovasc Dis 2010;20:64-71.
Powell SL, Godecke T, Nikolic D, et al. In vitro serotonergic activity of black cohosh and identification of N(omega)- methylserotonin as a potential active constituent. J Agric Food Chem 2008;56:11718-26.
Rapkin AJ. Vasomotor symptoms in menopause: physiologic condition and central nervous system approaches to treatment. Am J Obstet Gynecol 2007;196:97-106.
Reed SD, Newton KM, LaCroix AZ, Grothaus LC, Grieco VS, Ehrlich K. Vaginal, endometrial, and reproductive hormone findings: randomized, placebo-controlled trial of black cohosh, multibotanical herbs, and dietary soy for vasomotor symptoms: the Herbal Alternatives for Menopause (HALT) Study. Menopause 2008;15:51-8.
Rockwell S, Liu Y, Higgins SA. Alteration of the effects of cancer therapy agents on breast cancer cells by the herbal medicine black cohosh. Breast Cancer Res Treat 2005;90:233-9.
Rong N, Ausman LM, Nicolosi RJ. Oryzanol decreases cholesterol absorption and aortic fatty streaks in hamsters. Lipids 1997;32:303-9.
Rossouw JE, Anderson GL, Prentice RL, 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;288:321-33.
Ruhlen RL, Haubner J, Tracy JK, et al. Black cohosh does not exert an estrogenic effect on the breast. Nutr Cancer 2007;59:269-77.
Sasaki J, Takada Y, Handa K, et al. Effects of gamma-oryzanol on serum lipids and apolipoproteins in dyslipidemic schizophrenics receiving major tranquilizers. Clin Ther 1990;12:263-8.
Schmiderer C, Grausgruber-Groger S, Grassi P, Steinborn R, Novak J. Influence of gibberellin and daminozide on the expression of terpene synthases and on monoterpenes in common sage (Salvia officinalis). J Plant Physiol 2010;167:779-86.
Scholey AB, Tildesley NT, Ballard CG, et al. An extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers. Psychopharmacology (Berl) 2008;198:127-39.
Seetharamaiah GS, Krishnakantha TP, Chandrasekhara N. Influence of oryzanol on platelet aggregation in rats. J Nutr Sci Vitaminol (Tokyo) 1990;36:291-7.
Seidlova-Wuttke D, Hesse O, Jarry H, et al. Evidence for selective estrogen receptor modulator activity in a black cohosh (Cimicifuga racemosa) extract: comparison with estradiol-17beta. Eur J Endocrinol 2003;149:351-62.
Smith CJ. Non-hormonal control of vaso-motor flushing in menopausal patients. Chic Med 1964;67:193-5.
Teschke R. Black cohosh and suspected hepatotoxicity: inconsistencies, confounding variables, and prospective use of a diagnostic causality algorithm. A critical review. Menopause 2010;17:426-40.
Udani J, Hardy M. 7-Hydroxymatairesinol (7-HMR). New pharmacokinetic data and effect on enterolactone metabolites and hot flashes in menopausal women. Linnea website. http://www.hmrlignan.com/images/Research.pdf. Accessed 10/27/11.
Verhoeven MO, van der Mooren MJ, Teerlink T, Verheijen RH, Scheffer PG, Kenemans P. The influence of physiological and surgical menopause on coronary heart disease risk markers. Menopause 2009;16:37-49.
Wilson TA, Nicolosi RJ, Woolfrey B, Kritchevsky D. Rice bran oil and oryzanol reduce plasma lipid and lipoprotein cholesterol concentrations and aortic cholesterol ester accumulation to a greater extent than ferulic acid in hypercholesterolemic hamsters. J Nutr Biochem 2007;18:105-12.
Wuttke W, Gorkow C, Seidlova-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study. Menopause 2006;13:185-96.
Yamada M, Tanabe F, Arai N, Mitsuzumi H, Miwa Y, et al. Bioavailability of glucosyl hesperidin in rats. Biosci Biotechnol Biochem 2006;70:1386-94.
Yoshie A, Kanda A, Nakamura T, Igusa H, Hara S. Comparison of gamma-oryzanol contents in crude rice bran oils from different sources by various determination methods. J Oleo Sci 2009;58:511-8.
Yoshino G, Kazumi T, Amano M, et al. Effects of gamma-oryzanol and probucol on hyperlipidemia. Curr Ther Res 1989;45:975-82.
Yoshino G, Kazumi T, Amano M, et al. Effects of gamma-oryzanol on hyperlipidemic subjects. Curr Ther Res 1989;45:543-52.