Bco7.5

Black Cohosh Research

38 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

Systematic Reviewn=3,456

DOI

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

Systematic Reviewn=2,000

DOI

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.

Meta-Analysisn=2,310

DOI

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.

Meta-Analysisn=43,759

DOI

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.

Systematic Reviewn=1,839

DOI

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.
Further research warranted to confirm findings

Meta-Analysisn=8,326

DOI

[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.

Systematic Reviewn=745

DOI

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

Meta-Analysisn=517

DOI

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.

Systematic Reviewn=181

DOI

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.

Systematic Review

DOI

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

Systematic Review

DOI

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

Systematic Review

DOI

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.

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.

Systematic Review

DOI

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.
Further research warranted to confirm findings

Systematic Review

DOI

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.

Systematic Review

DOI

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).

Systematic Review

DOI

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

Systematic Review

DOI

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.

Systematic Reviewn=1,112

DOI

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

Systematic Reviewn=5,000

DOI

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.

Systematic Reviewn=14

DOI

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