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Bco7.5
Black Cohosh Research
Probably helpsModerate safety
43 peer-reviewed studies
What the evidence says
Probably helps
Black Cohosh helped in about half (6/9) of the studies that measured an effect — promising, but not unanimous.
Most evidence is from high-quality meta-analyses and randomised trials published 2003–2026 with a typical study size of 304 participants.
Based on 43 studies · 7 meta-analyses · 14 RCTs · 75,821 total participants
Confidence
High
What the studies found
6helped3unclear· 34 more without graded effect data
By outcome
Menopause & vasomotor symptomsMay help manage menopausal symptoms like hot flashes and mood changes · 4-8 weeks · Supports healthy estrogen metabolism and hormonal equilibrium · 4-8 weeks
Probably helps39 studies
Safety profile
Mostly mechanism / observational14 studies
Therapeutic & clinical
Probably helps8 studies
Liver health
Mostly mechanism / observational6 studies
Depression & moodReduced hot flashes and night sweats · 4-8 weeks
Probably helps4 studies
Anxiety & stress
Mostly mechanism / observational3 studies
Sleep & insomnia
Too few graded studies1 study
Fertility & reproductiveMay support reproductive health and fertility markers · 4-12 weeks
Too few graded studies1 study
Cholesterol & lipids
Too few graded studies1 study
By the numbers
Pulled from 26 studies with measurable effects
Likely real effects
25%
across studies
People studied
76k
typical study: 304 people
Strongest designs
21
7 pooled, 14 randomised
Showed benefit
67%
6/9 studies
How long studies ran
1–3 months
1
3+ months
4
Populations Studied
Menopausal women5
Women with menopausal symptoms2
General population2
Patients with menopausal symptoms1
Active research area
14 studies in the last 5 years · Latest meta-analysis: 2024
200320142026
1Systematic Reviewn=3,456 · very large study2020
Evidence supports black cohosh for vasomotor symptom relief though heterogeneity in preparations limits definitive conclusions.
Bai W et al. · Maturitas (2020)
Moderate-quality evidence for reduction in vasomotor symptoms
Heterogeneity in extract preparations complicated meta-analysis
Isopropanolic extracts (iCR) showed most consistent effects
3Anxiety symptomsMeta-AnalysisCited 5×n=2,310 · very large study2023
This study provides updated evidence regarding the potentially beneficial effects of black cohosh extracts for relieving menopausal symptoms in menopausal women.
Sadahiro R et al. · Menopause (New York, N.Y.) (2023)
No clear effect
← WorseNo effectBetter →
Could be chance
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.
4Meta-AnalysisCited 21×n=43,759 · very large study2021
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.
Castelo-Branco C et al. · Climacteric : the journal of the International Menopause Society (2021)
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.
7Serum estradiol levelsSystematic ReviewCited 2×n=745 · large study2020
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.
Peng J et al. · Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences (2020)
No clear effect
← WorseNo effectBetter →
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.
8Aspartate aminotransferase levelsMeta-AnalysisCited 54×n=517 · large study2011
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.
Naser B et al. · Menopause (New York, N.Y.) (2011)
No clear effect
← WorseNo effectBetter →
Could be chance
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.
This article discusses the medicinal and traditional histories of various Cimicifuga species.
Fatima S et al. · Fitoterapia (2024)
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.
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.
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.
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.
However, well-designed larger clinical trials are needed before these herbs can be recommended and to further assess their psycho-oncologic relevance.
Yeung KS et al. · Phytotherapy research : PTR (2018)
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.
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.
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.
Further research warranted to confirm findings
15Systematic ReviewCited 11×2019
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.
Ruan X et al. · Climacteric : the journal of the International Menopause Society (2019)
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.
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.
Hill DA et al. · American family physician (2016)
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).
17Systematic ReviewCited 26×2012
CR monotherapy as well as HP and Agnus castus showed no better effect than placebo.
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.
The combination of CR with HP demonstrated a positive effect on climacteric complaints.
18Efficacy for menopausal symptomsSystematic ReviewCited 73×n=1,112 · large study2008
The efficacy of black cohosh as a treatment for menopausal symptoms is uncertain and further rigorous trials seem warranted.
Borrelli F et al. · Pharmacological research (2008)
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.