“Black cohosh is the most extensively researched of all herbs used for managing menopausal symptoms, and is available in many different formulations, which vary in…”.1

Umbrella
What may the Black Cohosh Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Actaea Racemosa
  • Black Cohosh
  • Black Snakeroot
  • Bugbane
  • Bugwort
  • Cimicifuga Racemosa
  • Macrotys
  • Rattleroot
  • Rattleweed

Definition

What is black cohosh?

The (United States) National Center for Complementary and Integrative Health (NCCIH) explain:

  • “Currently, black cohosh is promoted as a dietary supplement for hot flashes and other menopausal symptoms. It’s also been promoted for other conditions, including menstrual cramps and premenstrual syndrome, and to induce labor”.2

Menopausal Symptoms

Is black cohosh an effective treatment for menopausal symptoms?

In Menopause & Herbs: Herbal Medicine Glossary (Alphabetical) – Black Cohosh, Actaea Racemosa, (Previously Known As Cimicifuga Racemosa): Family: Ranunculaceae, the (Australian) Jean Hailes for Women’s Health (JH) explain:

Black Cohosh

“Black cohosh is the most extensively researched of all herbs used for managing menopausal symptoms, and is available in many different formulations, which vary in quality and efficacy. Many of the clinical studies of black cohosh have used the commercially available product Remifemin®, or the extract Ze 450 (available as Flordis Femular®)”.3

In Black Cohosh: How Much Do We Know? the NCCIH note:

  • “Black cohosh has been studied for menopause symptoms in people. Most of the older studies were not of the highest quality. More recent studies have been of higher quality, but they have differed in the formulation, plant species, or dose used, so it’s difficult to know the herb’s effects with any certainty. Black cohosh has not been studied as much for conditions other than menopause”.4

In Black Cohosh: What Have We Learned? the NCCIH also note:

  • “Research suggests that certain black cohosh extracts and some combination products containing black cohosh may reduce some menopause symptoms. Most of the research has been on a single extract called Remifemin. Research on other black cohosh products has had inconsistent results. Guidelines released in 2015 indicate that there is a lack of consistent evidence for any benefit from black cohosh for menopause symptoms. But a 2017 review of recent research suggests that black cohosh extracts approved for treatment in Europe seem to decrease menopause symptoms”.5

Vaginal Dryness

Is black cohosh an effective treatment for vaginal dryness?

In Menopause & Herbs: Vaginal Changes the JH explain:

“Black cohosh, taken orally (by mouth) or topically (as a cream or pessary), may be useful for treating vaginal dryness. Black cohosh pessaries or vaginal cream are available only from naturopaths.

Linseed (flaxseed) has been shown to reduce vaginal dryness by a mildly oestrogenic action of ‘plumping up’ the vaginal cells”.6

Safe or Not

Is black cohosh safe?

The JH note:

“Black cohosh has been associated with liver damage in some people, but this is very rare. The majority of cases suspected of liver damage have in fact been shown NOT to be related to black cohosh”.7

The (United States) Mayo Clinic also note:

  • “Black Cohosh. Black cohosh has been popular among many women with menopausal symptoms. Studies of black cohosh’s effectiveness have had mixed results, and the supplement might be harmful to the liver in rare circumstances”.8

In Complementary/Alternative Therapies for Menopausal Women: Complementary and Alternative Treatments – Herbal Treatments: Black Cohosh the (British) Women’s Health Concern (WHC) explain:

“This North American traditional herb can help hot flushes although never as well as HRT. Black cohosh does not help with anxiety or low mood, but black cohosh can interact with other medicines and there are unknown risks regarding safety”.9

Questions To Ask

If I choose to use black cohosh, what are some good questions to ask?

In Effectiveness of Natural Therapies: Good Questions To Ask the JH explain:

“Before taking a natural therapy, have a discussion with your natural therapist about the available evidence of effectiveness. Some good questions to ask are:

  • Do clinical trials exist?
  • Is the use of this medicine based on traditional knowledge or historical use?
  • What is the most effective dose for me?
  • What are the potential side effects?
  • Are there interactions with any of the medications I am currently taking?”10

Breast Cancer

Does black cohosh help to reduce hot flashes that are related to breast cancer treatment?

In Black Cohosh: What Have We Learned? the NCCIH note:

  • “The research is inconsistent on whether black cohosh helps to reduce hot flashes that are related to breast cancer treatment. People with breast cancer should avoid using black cohosh before talking with their health care provider”.11

Health Care Provider

What if I choose to use black cohosh?

If you choose to use black cohosh, it may be in your best interest to also choose to talk to your health care providers about this.

In Natural Remedies for Hot Flashes: Do Mother Nature’s Treatments Help Hot Flashes? Use With Caution the North American Menopause Society note:

“Keep in mind that herbal supplements are not as closely regulated as prescription drugs. The amount of herbal product, quality, safety, and purity may vary between brands or even between batches of the same brand. Herbal therapies may also interact with prescription drugs, resulting in dramatic changes in the effect of the botanical, the drug, or both. To be safe, tell your healthcare provider about all botanical therapies you are considering and always stop all herbal treatments at least 2 weeks before any planned surgery”.12

In Herbal Medicine: Summary the (United States) MedlinePlus also note:

“If you are thinking about using an herbal medicine, first get information on it from reliable sources. Make sure to tell your health care provider about any herbal medicines you are taking”.13

In 4 Tips: Start Talking With Your Health Care Providers About Complementary Health Approaches the NCCIH’s third tip “to help you and your health care providers start talking” is:

“If you are thinking about using an herbal medicine, first get information on it from reliable sources. Make sure to tell your health care provider about any herbal medicines you are taking”.14

Health Topics A-Z

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In Health Topics A-Z you may find:

Links

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Sources

Where may I find the Sources quoted?

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Sources

  1. Menopause & Herbs: Herbal Medicine Glossary (Alphabetical) – Black Cohosh, Actaea Racemosa, (Previously Known As Cimicifuga Racemosa): Family: Ranunculaceae. Last Updated: 12 March 2020 | Last Reviewed: 20 November 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/natural-therapies-supplements/menopause-herbs Accessed: 12 September 2020
  2. Black Cohosh: Background. Last Updated: May 2020. National Center for Complimentary and Integrative Health https://www.nccih.nih.gov/health/black-cohosh Accessed: 12 September 2020
  3. Menopause & Herbs: Herbal Medicine Glossary (Alphabetical) – Black Cohosh, Actaea Racemosa, (Previously Known As Cimicifuga Racemosa): Family: Ranunculaceae. Last Updated: 12 March 2020 | Last Reviewed: 20 November 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/natural-therapies-supplements/menopause-herbs Accessed: 12 September 2020
  4. Black Cohosh: How Much Do We Know? Last Updated: May 2020. National Center for Complimentary and Integrative Health https://www.nccih.nih.gov/health/black-cohosh Accessed: 12 September 2020
  5. Black Cohosh: What Have We Learned? Last Updated: May 2020. National Center for Complimentary and Integrative Health https://www.nccih.nih.gov/health/black-cohosh Accessed: 12 September 2020
  6. Menopause & Herbs: Vaginal Changes. Last Updated: 12 March 2020 | Last Reviewed: 20 November 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/natural-therapies-supplements/menopause-herbs Accessed: 12 September 2020
  7. Menopause & Herbs: Herbal Medicine Glossary (Alphabetical) – Black Cohosh, Actaea Racemosa, (Previously Known As Cimicifuga Racemosa): Family: Ranunculaceae. Last Updated: 12 March 2020 | Last Reviewed: 20 November 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/natural-therapies-supplements/menopause-herbs Accessed: 12 September 2020
  8. Hot Flashes: Diagnosis & Treatment – Alternative Medicine: Dietary Supplements – Black Cohosh. 24 April 2020. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 12 September 2020
  9. Complementary/Alternative Therapies for Menopausal Women: Complementary and Alternative Treatments – Herbal Treatments: Black Cohosh. Reviewed: August 2017. Women’s Health Concern https://www.womens-health-concern.org/help/factsheets/fs_menopausecomptherapies.html Accessed: 12 September 2020
  10. Effectiveness of Natural Therapies: Good Questions To Ask. Last Updated: 10 January 2020 | Last Reviewed: 15 June 2016. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/natural-therapies-supplements/effectiveness-of-natural-therapies Accessed: 12 September 2020
  11. Black Cohosh: What Have We Learned? Last Updated: May 2020. National Center for Complimentary and Integrative Health https://www.nccih.nih.gov/health/black-cohosh Accessed: 12 September 2020
  12. Natural Remedies for Hot Flashes: Do Mother Nature’s Treatments Help Hot Flashes? Use With Caution. North American Menopause Society https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/natural-remedies-for-hot-flashes Accessed: 12 September 2020
  13. Herbal Medicine: Summary. Page Last Updated on: 09 September 2020. Topic Last Reviewed: 21 September 2017. MedlinePlus https://www.nlm.nih.gov/medlineplus/herbalmedicine.html Accessed: 12 September 2020
  14. 4 Tips: Start Talking With Your Health Care Providers About Complementary Health Approaches. 3. This Page Last Modified: 09 October 2019. National Center for Complementary and Integrative Health  https://nccih.nih.gov/health/tips/ttt Accessed: 12 September 2020

Topic Last Updated: 12 September 2020 – Topic Last Reviewed: 12 September 2020
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