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Bco5.0
Black Cohosh Research
Likely helps
105 peer-reviewed studies
What the evidence says
Likely helps
Black Cohosh appears to help in 7 of 10 studies with measurable effects — the evidence leans clearly favourable.
Most evidence is from high-quality meta-analyses and randomised trials published 2002–2026 with a typical study size of 304 participants.
Based on 105 studies · 11 meta-analyses · 52 RCTs · 67,925 total participants
Confidence
High confidence
What the studies found
7helped3unclear· 95 more without graded effect data
By outcome
Menopause & vasomotor symptomsModest, inconsistent reduction in hot flashes and night sweats · 4-8 weeks · Does not change hormone levels; non-estrogenic action · 4-8 weeks
Likely helps91 studies
Safety profile
Mostly mechanism / observational20 studies
Therapeutic & clinical
Probably helps13 studies
Liver health
Mostly mechanism / observational6 studies
Anxiety & stress
Mostly mechanism / observational4 studies
Depression & mood
Probably helps4 studies
Sleep & insomnia
Mostly mechanism / observational3 studies
Bone health
Mostly mechanism / observational3 studies
Fertility & reproductive
Too few graded studies2 studies
Cholesterol & lipids
Too few graded studies1 study
By the numbers
Pulled from 33 studies with measurable effects
Likely real effects
25%
across studies
People studied
68k
typical study: 304 people
Strongest designs
63
11 pooled, 52 randomised
Showed benefit
70%
7/10 studies
How long studies ran
1–3 months
2
3+ months
4
Populations Studied
Menopausal women7
Women with menopausal symptoms2
Women with climacteric complaints2
Patients with menopausal symptoms1
Steady research
28 studies in the last 5 years · Latest meta-analysis: 2024
200220142026
1Systematic Reviewn=2,027 · very large study2012
There is currently insufficient evidence to support the use of black cohosh for menopausal symptoms.
Leach MJ, Moore V · Cochrane Database of Systematic Reviews (2012)
Sixteen RCTs recruiting 2027 perimenopausal or postmenopausal women were identified
No significant difference between black cohosh and placebo in frequency of hot flushes or menopausal symptom scores
Evidence on the safety of black cohosh was inconclusive owing to poor reporting
2Anxiety 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.
3Meta-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.
Shams T, Setia MS, Hemmings R, McCusker J, Sewitch M, Ciampi A · Altern Ther Health Med (2010)
11Serum 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.
12Aspartate 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
19Systematic 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).