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 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:

Health Topics A-Z

Links

Where may I find Links related to Black Cohosh?

Your Country may have Links similar to:

Links

This Links List to third party websites is neither comprehensive nor exhaustive. Inclusion on this Links List does not imply endorsement or recommendation. Non-inclusion on this Links List does not imply non-endorsement or non-recommendation. Third party websites are not under the control of Meno Martha International Menopause Directory. Third party websites may contain explicit medical images and/or sexual references. Please read Meno Martha International Menopause Directory’s Links Policy before proceeding to a Link. Please contact Webmaster if you experience a problem with a Link.

  1. 9 Myths and Misunderstandings About Menopausal Hormone Therapy (MHT): 6. Myth – Complementary Medicines and Therapies Are As Effective As MHT and Safer
  2. Bioidentical Hormones Explained – A British Menopause Society Video
  3. Black Cohosh
  4. Black Cohosh
  5. Black CohoshComplementary & Alternative Therapies
  6. Complementary Medicine Options for Menopausal Symptoms: Black Cohosh
  7. Complementary and Alternative Therapies Explained – A British Menopause Society Video
  8. Compounded Bioidentical Hormone Therapy [Video]
  9. Deciding About Hormone Therapy Use
  10. Dietary Supplements
  11. Dietary Supplements
  12. Dietary Supplements
  13. Dietary Supplements [Topics]
  14. Dietary Supplements: Are Dietary Supplements Safe?
  15. Drug Interactions: What You Should Know
  16. Drugs and Supplements: Herbs, Supplements and Vitamins [Topics]
  17. EMAS Menopause Essentials
  18. Early Menopause: Women’s Experiences – Women’s Profiles
  19. Effectiveness of Natural Therapies: Good Questions To Ask
  20. Experiencing Vaginal Dryness? Here’s What You Need To Know
  21. Frequently Asked Questions (FAQ)
  22. HRT and Alternatives
  23. Herbal Medicine
  24. Herbal Supplements and Heart Medicines May Not Mix
  25. Herbal Supplements: What To Know Before You Buy
  26. Herbs At A Glance: Black Cohosh
  27. Herbs and Phytoestrogens
  28. Herbs and Supplements [Topics]
  29. Hot Flashes
  30. Hot Flashes
  31. Hot Flashes: Diagnosis & Treatment – Alternative Medicine: Dietary Supplements – Black Cohosh
  32. Hot Flashes: What Can I Do? [+ Video: What Are the Signs and Symptoms of Menopause?]
  33. How Long Does Menopause Last? – Ask Dr Jean
  34. How To Find Relief for Hot Flashes At Night
  35. 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
  36. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Signs and Symptoms [+ Video: Talking Menopause With Your GP]
  37. Lifestyle and Behaviour Changes for Menopausal Symptoms
  38. Lifestyle and Behavioural Modifications for Menopausal Symptoms
  39. Managing Menopausal Symptoms—Hormone Replacement Therapy Is Not the Only Option!
  40. Managing Menopause
  41. Mayo Clinic Minute: Help With Hot Flashes Due To Menopause [+ Video Courtesy: Mayo Clinic News Network]
  42. Mayo Clinic Minute: How Lifestyle Changes May Help Manage Menopause Symptoms [+ Video]
  43. Menopausal Hormone Therapy
  44. Menopause
  45. Menopause
  46. Menopause
  47. Menopause & Herbs: Herbal Medicine Glossary (Alphabetical) – Black Cohosh, Actaea Racemosa, (Previously Known As Cimicifuga Racemosa)
  48. Menopause & Hormones Common Questions
  49. Menopause Explained – A British Menopause Society Video
  50. Menopause FAQs: Hot Flashes – Q. Is it safe to take dietary supplements or herbal therapies for my menopause symptoms?
  51. Menopause Management Options: Natural & Complementary Therapies – Herbal Therapies and Remedies for Menopause
  52. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Menopause Medication Tracker
  53. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Questions for Your Health Care Provider
  54. Menopause Patient Information [Videos] 5. Lifestyle Advice In Menopause & Perimenopause
  55. Menopause Preparedness Toolkit Video Series: Lifestyle Tips for Menopause
  56. Menopause Preparedness Toolkit Video Series: Treating Vasomotor Symptoms of Menopause
  57. Menopause Preparedness Toolkit: A Woman’s Empowerment Guide
  58. Menopause Symptoms and Relief
  59. Menopause Treatments: What Works, What Doesn’t
  60. Menopause: Diagnosis & Treatment
  61. Menopause: Menopause – Hormone Treatments
  62. National Center for Complementary and Integrative Health
  63. National Center for Complementary and Integrative Health: 4 Things To Know About Menopausal Symptoms and Complementary Health Practices
  64. National Center for Complementary and Integrative Health: 4 Tips: Start Talking With Your Health Care Providers About Complementary Health Approaches
  65. National Center for Complementary and Integrative Health: 5 Tips: What You Should Know About Popular Herbs
  66. National Center for Complementary and Integrative Health: 6 Tips: How Herbs Can Interact With Medicines
  67. National Center for Complementary and Integrative Health: Black Cohosh
  68. National Center for Complementary and Integrative Health: Dietary and Herbal Supplements
  69. National Center for Complementary and Integrative Health: Herbs At A Glance
  70. National Center for Complementary and Integrative Health: How Safe Is This Product or Practice?
  71. National Center for Complementary and Integrative Health: Menopausal Symptoms: In Depth: What the Science Says About Complementary Health Approaches for Menopausal Symptoms
  72. National Center for Complementary and Integrative Health: Natural Doesn’t Necessarily Mean Safer, or Better
  73. National Center for Complementary and Integrative Health: Rhodiola
  74. National Center for Complementary and Integrative Health: Traditional Chinese Medicine: In Depth
  75. Natural Medicines
  76. Natural Remedies To Help Manage Perimenopause Symptoms
  77. Natural Remedies for Hot Flashes: Do Mother Nature’s Natural Remedies Work?
  78. Natural Therapies
  79. Natural Therapies & Supplements
  80. Non-Estrogen Treatments for Menopausal Symptoms
  81. Non-Hormonal Treatment Options for Menopausal Symptoms
  82. NonHormonal Treatments for Menopausal Symptoms
  83. Office of Dietary Supplements [United States]: Background Information: Dietary Supplements
  84. Office of Dietary Supplements [United States]: Dietary Supplement Fact Sheets
  85. Office of Dietary Supplements [United States]: Dietary Supplements: What You Need To Know
  86. Questions and Answers on Dietary Supplements
  87. Review & Meta-Analysis: Isopropanolic Black Cohosh Extract iCR for Menopausal Symptoms – An Update on the Evidence
  88. Safety of Natural Therapies
  89. Supplements for Menopausal Symptoms — Solutions or Snake Oil?
  90. Symptoms of Menopause
  91. Urogenital Atrophy Explained – A British Menopause Society Video
  92. Using Natural Therapies In the Menopause Transition – Webinar
  93. Vaginal Dryness After Menopause: How To Treat It? I’m postmenopausal and often have vaginal dryness, which makes intercourse painful. Is there anything I can do about it?
  94. Video Series-2021: Treatment Options for Vaginal Dryness and Urinary Issues
  95. Video Series-2021: What Women Need To Know About Hormone Therapies
  96. Video Series-2022: Perimenopause: Signs, Symptoms, and Solutions
  97. Weight Gain In Menopause: Systematic Review of Adverse Events In Women Treated With Black Cohosh
  98. What Black Cohosh Can (and Can’t) Do for Menopause Symptoms
  99. What Everyone Should Know About Menopause Symptoms
  100. Women’s Wellness: How To Treat Vaginal Dryness After Menopause

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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