“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 the Black Cohosh: Black Cohosh and Menopausal Symptoms the ODS elaborate on:

“Studies using various designs since the 1950s have attempted to determine whether black cohosh affects menopausal symptoms. 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. It is not clear whether black cohosh affects the structure and activity of vaginal and uterine tissues…”.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 – Precautions 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 & Herbs: 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 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

Hot Flashes

Is black cohosh an effective treatment for hot flashes?

In What Black Cohosh Can (and Can’t) Do for Menopause Symptoms: Black Cohosh for Other Symptoms of Menopause a 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

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”.9

Early Menopause

Is black cohosh used in early menopause?

In Menopause & Herbs: Herbal Medicine Glossary (Alphabetical) – Black Cohosh, Actaea Racemosa, (Previously Known As Cimicifuga Racemosa): Family: Ranunculaceae – Precautions the JH explain:

“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”.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

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”.12

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”.13

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?”14

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 dugs, 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”.15

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”.16

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

“Don’t wait for your providers to ask about any complementary health practice you are using. Be proactive. Start the conversation”.17

Health Topics A-Z

Where may I find Health Topics related to Black Cohosh?

In Health Topics A-Z you may find:

Links

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Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Menopause & Herbs: Hot Flushes and Night Sweats. Last Updated: 18 March 2022 | Last Reviewed: 20 November 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/natural-therapies-supplements/menopause-herbs Accessed: 08 December 2022
  2. Black Cohosh: Introduction. Updated: 03 June 2020. Office of Dietary Supplements https://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/ Accessed: 08 December 2022
  3. Black Cohosh: Black Cohosh and Menopausal Symptoms. Updated: 30 June 2020. Office of Dietary Supplements https://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/ Accessed: 08 December 2022
  4. Menopause & Herbs: Herbal Medicine Glossary (Alphabetical) – Black Cohosh, Actaea Racemosa, (Previously Known As Cimicifuga Racemosa): Family: Ranunculaceae. Last Updated: 18 March 2022 | Last Reviewed: 20 November 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/natural-therapies-supplements/menopause-herbs Accessed: 08 December 2022
  5. Menopause & Herbs: Hot Flushes and Night Sweats. Last Updated: 18 March 2022 | Last Reviewed: 20 November 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/natural-therapies-supplements/menopause-herbs Accessed: 08 December 2022
  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: 08 December 2022
  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: 08 December 2022
  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: 08 December 2022
  9. Menopause & Herbs: Vaginal Changes. Last Updated: 18 March 2022 | Last Reviewed: 20 November 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/natural-therapies-supplements/menopause-herbs Accessed: 08 December 2022
  10. Menopause & Herbs: Herbal Medicine Glossary (Alphabetical) – Black Cohosh, Actaea Racemosa, (Previously Known As Cimicifuga Racemosa): Family: Ranunculaceae – Precautions. Last Updated: 18 March 2022 | Last Reviewed: 20 November 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/natural-therapies-supplements/menopause-herbs Accessed: 08 December 2022
  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: 08 December 2022
  12. Menopause & Herbs: Herbal Medicine Glossary (Alphabetical) – Black Cohosh, Actaea Racemosa, (Previously Known As Cimicifuga Racemosa): Family: Ranunculaceae – Precautions. Last Updated: 18 March 2022 | Last Reviewed: 20 November 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/natural-therapies-supplements/menopause-herbs Accessed: 08 December 2022
  13. Hot Flashes: Diagnosis & Treatment – Alternative Medicine: Dietary Supplements – Black Cohosh. 20 May 2022. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 08 December 2022
  14. 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: 08 December 2022
  15. 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: 08 December 2022
  16. Herbal Medicine: Summary. Page Last Updated: 21 September 2017. MedlinePlus https://www.nlm.nih.gov/medlineplus/herbalmedicine.html Accessed: 08 December 2022
  17. 4 Tips: Start Talking With Your Health Care Providers About Complementary Health Approaches. 4. National Center for Complementary and Integrative Health  https://nccih.nih.gov/health/tips/ttt Accessed: 08 December 2022
Topic Last Updated: 08 December 2022 – Topic Last Reviewed: 08 December 2022

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