Black Cohosh Research
39 peer-reviewed studies · Evidence score: 7.5/10
Black cohosh for menopausal symptoms: A Cochrane systematic review
Bai W et al. • Maturitas (2020)
Evidence supports black cohosh for vasomotor symptom relief though heterogeneity in preparations limits definitive conclusions.
- Moderate-quality evidence for reduction in vasomotor symptoms
- Heterogeneity in extract preparations complicated meta-analysis
- Isopropanolic extracts (iCR) showed most consistent effects
Black cohosh for menopause: A Cochrane review
Leach MJ, Moore V • Cochrane Database of Systematic Reviews (2012)
Evidence is inconclusive but suggests possible benefits for vasomotor symptoms.
- Some evidence for hot flash reduction
- Mixed study quality
- Generally safe
Black cohosh extracts in women with menopausal symptoms: an updated pairwise meta-analysis
Sadahiro R et al. • Menopause (New York, N.Y.) (2023)
This study provides updated evidence regarding the potentially beneficial effects of black cohosh extracts for relieving menopausal symptoms in menopausal women.
- However, black cohosh did not significantly improve anxiety (Hedges' g = 0.194, 95% CI = -0.296 to 0.684, P = 0.438) or depressive symptoms (Hedges' g = 0.406, 95% CI = -0.121 to 0.932, P = 0.131).
- The dropout rate for black cohosh products was similar to that for placebo (odds ratio = 0.911, 95% CI = 0.660 to 1.256, P = 0.568).
- This study provides updated evidence regarding the potentially beneficial effects of black cohosh extracts for relieving menopausal symptoms in menopausal women.
Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidence
Castelo-Branco C et al. • Climacteric : the journal of the International Menopause Society (2021)
With its good safety profile in general and at estrogen-sensitive organs, iCR as a non-hormonal herbal therapy can also be used in patients with hormone-dependent diseases who suffer from iatrogenic climacteric symptoms.
- Effect sizes were larger when higher dosages of iCR as monotherapy or in combination with St.
- The clinical data did not reveal any evidence of hepatotoxicity.
- Hormone levels remained unchanged and estrogen-sensitive tissues (e.g. breast, endometrium) were unaffected by iCR treatment.
Weight gain in menopause: systematic review of adverse events in women treated with black cohosh
Naser B et al. • Climacteric : the journal of the International Menopause Society (2022)
In conclusion, this study provides no scientific evidence that the use of Cimicifuga racemosa causes weight gain in menopausal women.
- In total, 1839 women were treated with CR for up to 12 months.
- Two studies reported weight gain as an adverse event; however, no significant differences in weight changes were observed between the groups.
- One case of weight gain (about 2 kg) was reported, but the authors did not specify in which treatment group.
Vasomotor symptoms resulting from natural menopause: a systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause
Sarri G et al. • BJOG : an international journal of obstetrics and gynaecology (2017)
For women who have not undergone hysterectomy, transdermal O+P was the most effective treatment for VMS relief.
- For women who have not undergone hysterectomy, transdermal O+P was the most effective treatment for VMS relief.
- Published in BJOG : an international journal of obstetrics and gynaecology (2017)
- Further research warranted to confirm findings
[Efficacy of black cohosh extracts for improving low estrogen status induced by postoperative GnRHa treatment in patients with endometriosis: a systematic review]
Peng J et al. • Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences (2020)
The limited evidence so far indicates that BCE could efficiently improve perimenopausal symptoms cause by low estrogen status of the patients recieved GnRHa treatment after surgery for endometriosis, but does not alter hormone levels of patients.
- Meta-analysis results showed that the addition of BCE did not alter hormone levels of patients, including serum estradiol levels [ MD=1.24, 95% CI(-4.58, 7.08), P>0.05] and luteinizing hormone levels [ MD=-0.02, 95% CI(-0.15, 0.11), P>0.05].
- BCE affected Kupperman's menopausal index (KMI) score 12 weeks after the surgery [ MD=-11.50, 95% CI(-20.09, -2.90), P < 0.01] and KMI score 24 weeks after the surgery [ MD=-23.68, 95% CI(-39.66, -7.69), P < 0.01].
- The limited evidence so far indicates that BCE could efficiently improve perimenopausal symptoms cause by low estrogen status of the patients recieved GnRHa treatment after surgery for endometriosis, but does not alter hormone levels of patients.
Suspected black cohosh hepatotoxicity: no evidence by meta-analysis of randomized controlled clinical trials for isopropanolic black cohosh extract
Naser B et al. • Menopause (New York, N.Y.) (2011)
The results of this meta-analysis of five randomized, double-blind, and controlled clinical trials showed no evidence that iCR has any adverse effect on liver function.
- The overall fixed effect ± SEM was 0.055 ± 0.062 (P=0.37) for aspartate aminotransferase and 0.063 ± 0.062 (P=0.31) for alanine aminotransferase.
- The results of this meta-analysis of five randomized, double-blind, and controlled clinical trials showed no evidence that iCR has any adverse effect on liver function.
- Further research warranted to confirm findings
Systematic Review of Black Cohosh (Cimicifuga racemosa) for Management of Polycystic Ovary Syndrome-Related Infertility
Fan CW et al. • Journal of pharmacy practice (2022)
Short-term use of black cohosh appears to be safe.
- There were no differences in adverse events.
- Studies demonstrated several risk-of-bias concerns.
- There is a lack of high-quality evidence supporting the effectiveness of black cohosh for improving pregnancy rates in PCOS-related infertility.
Phytochemistry and ethnopharmacological studies of genus Cimicifuga: A systematic and comprehensive review
Fatima S et al. • Fitoterapia (2024)
This article discusses the medicinal and traditional histories of various Cimicifuga species.
- This article discusses the medicinal and traditional histories of various Cimicifuga species.
- Because quality control and safety assessments of Cimicifuga species are currently lacking, only a limited portion of the plant may be used as medication.
- The majority of current research focuses on triterpene glycosides.
Modulation of the hypothalamic-pituitary-adrenal (HPA) axis by plants and phytonutrients: a systematic review of human trials
Lopresti AL et al. • Nutritional neuroscience (2022)
For most phytonutrients, the effects of supplementation on HPA-axis activity in humans is unclear.
- For most phytonutrients, the effects of supplementation on HPA-axis activity in humans is unclear.
- Before more definitive conclusions about the effects of phytonutrients on the HPA-axis can be made, further research is required.
- Further research warranted to confirm findings
Impact of phytoestrogens on treatment of urogenital menopause symptoms: A systematic review of randomized clinical trials
Abdi F et al. • European journal of obstetrics, gynecology, and reproductive biology (2021)
After using a variety of phytoestrogens in different forms indicators of urogenital atrophy and urinary disorders improved and women's sexual function improved after treatment.
- After using a variety of phytoestrogens in different forms indicators of urogenital atrophy and urinary disorders improved and women's sexual function improved after treatment.
- The use of phytoestrogens as a safe, low-risk compared to hormone therapy and almost accessible method for women can relieve urogenital symptoms and promote the sexual satisfaction and quality of life.
- Further research warranted to confirm findings
Herbal medicine for depression and anxiety: A systematic review with assessment of potential psycho-oncologic relevance
Yeung KS et al. • Phytotherapy research : PTR (2018)
However, well-designed larger clinical trials are needed before these herbs can be recommended and to further assess their psycho-oncologic relevance.Copyright © 2018 John Wiley & Sons, Ltd.
- Overall, 45% of studies reported positive findings with fewer adverse effects compared with conventional medications.
- Based on available data, black cohosh, chamomile, chasteberry, lavender, passionflower, and saffron appear useful in mitigating anxiety or depression with favorable risk-benefit profiles compared to standard treatments.
- These may benefit cancer patients by minimizing medication load and accompanying side effects.
Menopausal symptoms
Burbos N et al. • BMJ clinical evidence (2011)
In this systematic review we present information relating to the effectiveness and safety of the following interventions: agnus castus, antidepressants, black cohosh, clonidine, oestrogens, phyto-oestrogens, progestogens, testosterone, and tibolone.
- In this systematic review we present information relating to the effectiveness and safety of the following interventions: agnus castus, antidepressants, black cohosh, clonidine, oestrogens, phyto-oestrogens, progestogens, testosterone, and tibolone.
- Published in BMJ clinical evidence (2011)
- Further research warranted to confirm findings
Benefit-risk profile of black cohosh (isopropanolic Cimicifuga racemosa extract) with and without St John's wort in breast cancer patients
Ruan X et al. • Climacteric : the journal of the International Menopause Society (2019)
In conclusion, with its positive benefit-risk profile, iCR/iCR + HP may offer a safe non-hormonal therapeutic option for breast cancer survivors receiving endocrine therapy.
- After breast cancer, even if receiving tamoxifen, patients using iCR/iCR + HP had significantly increased recurrence-free survival rates compared to non-users.
- These results are substantiated by experimental data demonstrating antiproliferative and anti-invasive effects of iCR in breast cancer cells and enhancement of the antineoplastic effects of tamoxifen.
- There are no known clinical interactions for iCR and HP with endocrine therapies.
Hormone Therapy and Other Treatments for Symptoms of Menopause
Hill DA et al. • American family physician (2016)
The decision to use hormone therapy depends on clinical presentation, a thorough evaluation of the risks and benefits, and an informed discussion with the patient.
- One systematic review suggests modest improvement in hot flashes and vaginal dryness with soy products, and small studies suggest that clinical hypnosis significantly reduces hot flashes.
- Patients with genitourinary syndrome of menopause may benefit from vaginal estrogen, nonhormonal vaginal moisturizers, or ospemifene (the only nonhormonal treatment approved by the U.S.
- Food and Drug Administration for dyspareunia due to menopausal atrophy).
Efficacy of Cimicifuga racemosa, Hypericum perforatum and Agnus castus in the treatment of climacteric complaints: a systematic review
Laakmann E et al. • Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology (2012)
CR monotherapy as well as HP and Agnus castus showed no better effect than placebo.
- CR monotherapy as well as HP and Agnus castus showed no better effect than placebo.
- The combination of CR with HP demonstrated a positive effect on climacteric complaints.
- Further research warranted to confirm findings
Black cohosh (Cimicifuga racemosa) for menopausal symptoms: a systematic review of its efficacy
Borrelli F et al. • Pharmacological research (2008)
The efficacy of black cohosh as a treatment for menopausal symptoms is uncertain and further rigorous trials seem warranted.
- Trials were excluded if they did not focus on menopausal problems, they included women suffering medically induced menopause, they did not use black cohosh monopreparations, or they did not use placebo or a standard drug treatment for the control group.
- Six studies with a total of 1112 peri- and post-menopausal women met our inclusion criteria.
- The evidence from these RCTs does not consistently demonstrate an effect of black cohosh on menopausal symptoms; a beneficial effect of black cohosh on peri-menopausal women cannot be excluded.
Safety of black cohosh: A systematic review
Borrelli F, Ernst E • Drug Safety (2008)
Black cohosh is generally well-tolerated; liver toxicity appears rare.
- Rare hepatotoxicity cases
- Generally safe profile
- Monitoring recommended
Black cohosh and breast cancer: a systematic review
Fritz H et al. • Integrative cancer therapies (2014)
Current evidence does not support an association between black cohosh and increased risk of breast cancer.
- Current evidence does not support an association between black cohosh and increased risk of breast cancer.
- There is a lack of evidence supporting the efficacy of black cohosh for reduction of hot flashes in breast cancer patients.
- Given conflicting but promising results, and apparent safety, further research is warranted.