Black Cohosh

“Black cohosh is perhaps the most extensively researched
of all herbs used for managing menopausal symptoms.
It is available in many different products…”.1

Umbrella
What may the Black Cohosh Umbrella include?

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

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

Definition

What is black cohosh?

DotS the definition of black cohosh may vary. In Black Cohosh: Introduction the definition used by (United States) Office of Dietary Supplements (ODS) is:

“Black cohosh (Actaea racemose or Cimicifuga racemosa), a member of the buttercup family, is a perennial plant native to North America”.2

Studies

What have studies found about the effectiveness of black cohosh for menopausal symptoms?

In Menopause–Biology, Consequences, Supportive Care, and Therapeutic Options: Current Therapeutic Options – Complementary and Herbal Therapies, published 06 September 2023, the authors elaborate on:

“In numerous trials, black cohosh, not to be confused with blue cohosh, which has known liver toxicity, has been shown to be safe with limited efficacy in some single-site clinical trials. However, the HALT study, which was the most rigorous and comprehensive clinical trial to date, consisting of 351 participants, demonstrated no improvement with black cohosh over placebo among perimenopausal women experiencing VMS”.3

Remifemin® and Flordis Femular®

What commercially available products may have been used in clinical studies?

In Menopause & Herbs: Herbal Medicine Glossary (Alphabetical) – Black Cohosh, Actaea Racemosa, (Previously Known As Cimicifuga Racemosa): Family: Ranunculaceae, last updated 26 August 2023, the (Australian) Jean Hailes for Women’s Health (JH) explain:

“Many of the clinical studies of black cohosh have used the commercially available product Remifemin®, or the extract Ze 450 (available as Flordis Femular®)”.4

Menopausal Symptoms

Is black cohosh an effective treatment for menopausal symptoms?

In Menopause and Natural Therapies: Hot Flushes and Night Sweats the JH note:


Black Cohosh
“Black cohosh is perhaps the most extensively researched of all herbs used for managing menopausal symptoms. It is available in many different products, which vary in quality and effectiveness, and it can be combined with other herbs to tailor a formula specifically for hot flushes. Evidence is conflicting: some studies show it is effective and others do not”.5

In Black Cohosh: How Much Do We Know? the (United States) National Center for Complimentary and Integrative Health (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”.6

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”.7

In What Black Cohosh Can (and Can’t) Do for Menopause Symptoms: Black Cohosh for Other Symptoms of Menopause a (United States) Cleveland Clinic doctor explains:

“Black cohosh is an excellent herb to support people experiencing menopausal symptoms to reduce pain, reduce fatigue and lift your mood — just not consistently for hot flashes,” Dr. Lin says”.8

Placebo or Not

Are the effects of black cohosh any better than a placebo?

In Lots of Women Try Herbs Like Black Cohosh for Menopausal Symptoms Like Hot Flushes – But Does It Work? published 20 September 2023, the authors note:

“Many women like to try herbal therapies for hot flushes and other menopausal symptoms. While black cohosh is generally considered safe and some women may find it helps them, at the moment there is not enough scientific evidence to show its effects are any better than placebo”.9

Vaginal Dryness

Is black cohosh an effective treatment for vaginal dryness?

In Menopause and Natural Therapies: 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”.10

Early Menopause

Is black cohosh used in early menopause?

In Menopause and Natural Therapies: Herbal Medicine Glossary (Alphabetical) – Black Cohosh, Actaea Racemosa, (Previously Known As Cimicifuga Racemosa): Family: Ranunculaceae – Precautions the JH elaborate on:

“Black cohosh is often used in early menopause brought on by cancer treatments, especially breast, ovarian or endometrial cancer. Of all the herbs, black cohosh has the most research about its safety in support of its use. It appears to be safe in breast cancer patients, although further research is needed. Women with breast cancer or other hormone-dependent tumours should always talk to their doctor before taking black cohosh”.11

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”.12

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”.13

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”.14

In What Black Cohosh Can (and Can’t) Do for Menopause Symptoms: How To Take Black Cohosh a Cleveland Clinic doctor explains:

“To ensure that you’re buying a safe, quality product, Dr. Lin recommends purchasing only organic black cohosh from reputable companies that have been independently verified by a third party such as ConsumerLab, U.S. Pharmacopeia or NSF International”.15

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 include:

“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?”16

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 Lots of Women Try Herbs Like Black Cohosh for Menopausal Symptoms Like Hot Flushes – But Does It Work? published 20 September 2023, the authors note:

“Women experiencing troublesome menopausal symptoms, such as hot flushes, should talk to their doctor about the best treatment options for them”.17

In Menopause–Biology, Consequences, Supportive Care, and Therapeutic Options: Current Therapeutic Options – Complementary and Herbal Therapies, the authors note:

“Consideration of over-the-counter remedy use should include a shared decision-making plan to perform intermittent monitoring of liver and renal function because such therapies are not regulated by most national regulating bodies and have been shown to contain doses that differ from that on the label and occasional impurities that could cause harm”.18

Health Topics A-Z

Where may I find Health Topics A-Z related to Black Cohosh?

In Health Topics A-Z you may find:

Health Topics A-Z

Links

Where may I find Links related to Black Cohosh?

Your Country may have Links similar to:

Links

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  15. Effectiveness of Natural Therapies: Good Questions To Ask
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  24. Hot Flashes: Diagnosis & Treatment – Alternative Medicine: Dietary Supplements – Black Cohosh
  25. Hot Flashes: What Can I Do? [+ Video: What Are the Signs and Symptoms of Menopause?]
  26. How Long Does Menopause Last? – Ask Dr Jean
  27. How To Find Relief for Hot Flashes At Night
  28. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause
  29. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Signs and Symptoms of Menopause [+ Video: Talking Menopause With Your GP]
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  31. Lots of Women Try Herbs Like Black Cohosh for Menopausal Symptoms Like Hot Flushes – But Does It Work?
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  34. Mayo Clinic Minute: Help With Hot Flashes Due To Menopause [+ Video Courtesy: Mayo Clinic News Network]
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  56. Menopause: Understanding the Changes and Finding Relief | Dr Susan Davis | The Proof Podcast EP 256
  57. Mymenoplan.org [My Menoplan, United States]
  58. National Center for Complementary and Integrative Health
  59. National Center for Complementary and Integrative Health: 4 Tips: Start Talking With Your Health Care Providers About Complementary Health Approaches
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  74. Office of Dietary Supplements [United States]: Background Information: Dietary Supplements
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  76. Office of Dietary Supplements [United States]: Dietary Supplements: What You Need To Know
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Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Menopause and Natural Therapies: Hot Flushes and Night Sweats. Last Updated: 19 January 2024 | Last Reviewed: 20 November 2018. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/menopause-herbs Accessed: 26 February 2024
  2. Black Cohosh: Introduction. Updated: 30 June 2020. Office of Dietary Supplements https://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/ Accessed: 26 February 2024
  3. Davis, S. R, Pinkerton, JA., Santoro, N., Simoncini, T. Menopause–Biology, Consequences, Supportive Care, and Therapeutic Options: Current Therapeutic Options – Complementary and Herbal Therapies. Published 06 September 2023 https://www.cell.com/cell/fulltext/S0092-8674(23)00905-4 Accessed: 26 February 2024
  4. Menopause & Herbs: Herbal Medicine Glossary (Alphabetical) – Black Cohosh, Actaea Racemosa, (Previously Known As Cimicifuga Racemosa): Family: Ranunculaceae. Last Updated: 26 August 2023 | Last Reviewed: 20 November 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/natural-therapies-supplements/menopause-herbs Accessed: 22 November 2023
  5. Menopause and Natural Therapies: Hot Flushes and Night Sweats. Last Updated: 19 January 2024 | Last Reviewed: 20 November 2018. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/menopause-herbs Accessed: 26 February 2024
  6. 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: 26 February 2024
  7. 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: 26 February 2024
  8. What Black Cohosh Can (and Can’t) Do for Menopause Symptoms: Black Cohosh for Other Symptoms of Menopause. 03 August 2022. Cleveland Clinic https://health.clevelandclinic.org/what-is-black-cohosh/ Accessed: 26 February 2024
  9. Taylor, S. and Davis, S. Lots of Women Try Herbs Like Black Cohosh for Menopausal Symptoms Like Hot Flushes – But Does It Work? 20 September 2023 https://theconversation.com/lots-of-women-try-herbs-like-black-cohosh-for-menopausal-symptoms-like-hot-flushes-but-does-it-work-211272 Accessed: 26 February 2024
  10. Menopause and Natural Therapies: Vaginal Changes. Last Updated: 19 January 2024 | Last Reviewed: 20 November 2018. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/menopause-herbs Accessed: 26 February 2024
  11. Menopause & Herbs: Herbal Medicine Glossary (Alphabetical) – Black Cohosh, Actaea Racemosa, (Previously Known As Cimicifuga Racemosa): Family: Ranunculaceae – Precautions. Last Updated: 26 August 2023 | Last Reviewed: 20 November 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/natural-therapies-supplements/menopause-herbs Accessed: 22 November 2023
  12. 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: 26 February 2024
  13. Menopause & Herbs: Herbal Medicine Glossary (Alphabetical) – Black Cohosh, Actaea Racemosa, (Previously Known As Cimicifuga Racemosa): Family: Ranunculaceae – Precautions. Last Updated: 26 August 2023 | Last Reviewed: 20 November 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/natural-therapies-supplements/menopause-herbs Accessed: 22 November 2023
  14. Hot Flashes: Diagnosis & Treatment – Alternative Medicine: Dietary Supplements – Black Cohosh. 12 December 2023. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 26 February 2024
  15. What Black Cohosh Can (and Can’t) Do for Menopause Symptoms: How To Take Black Cohosh. 03 August 2022. Cleveland Clinic https://health.clevelandclinic.org/what-is-black-cohosh/ Accessed: 26 February 2024
  16. Effectiveness of Natural Therapies: Good Questions To Ask. Last Updated: 26 August 2023 | 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: 22 November 2023
  17. Taylor, S. Davis, S. Lots of Women Try Herbs Like Black Cohosh for Menopausal Symptoms Like Hot Flushes – But Does It Work? 20 September 2023 https://theconversation.com/lots-of-women-try-herbs-like-black-cohosh-for-menopausal-symptoms-like-hot-flushes-but-does-it-work-211272 Accessed: 26 February 2024
  18. Davis, S. R, Pinkerton, JA., Santoro, N., Simoncini, T. Menopause–Biology, Consequences, Supportive Care, and Therapeutic Options: Current Therapeutic Options – Complementary and Herbal Therapies. Published 06 September 2023 https://www.cell.com/cell/fulltext/S0092-8674(23)00905-4 Accessed: 26 February 2024
Topic Last Updated: 26 February 2024 – Topic Last Reviewed: 26 February 2024

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