Black cohosh is popular as an alternative to hormonal therapy in the treatment of menopausal symptoms such as hot flashes, mood disturbances, excessive sweating, palpitations, and vaginal dryness. Several studies have reported black cohosh may improve menopausal symptoms for up to one year, although the evidence is mixed.
The mechanism of action of black cohosh remains unclear. Research suggests that there may be no direct effects on estrogen receptors, although this is an area of active controversy.
Safety and efficacy beyond one year have not been proven. Reports suggest the safety of short-term use, including in women with menopausal symptoms for whom estrogen replacement therapy is not suggested. Nonetheless, caution is advised until better-quality safety data are available. There have been reports of liver damage and higher lead levels in the blood from black cohosh. Use of black cohosh in high-risk populations (such as in women with a history of breast cancer) should be under the supervision of a licensed healthcare professional.
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Combination product examples
: GYNO-Plus (black cohosh and St. John's wort), PNC (pennyroyal, red raspberry, lobelia, blue cohosh, black cohosh, blessed thistle), Phyto-Female Complex (standardized extracts of black cohosh, dong quai, milk thistle, red clover, American ginseng, chaste-tree berry), Reumalex® (contains 35mg of black cohosh, 100mg of white willow bark, 25mg of sarsaparilla (4:1), 17mg of poplar bark (7:1), and 40mg of guaiacum resin).
Note: Black cohosh (Cimicifuga racemosa) is not to be confused with blue cohosh (Caulophyllum thalictroides) , which contains potentially cardiotoxic or vasoconstrictive chemicals. Black cohosh (Cimicifuga racemosa) is also not to be confused with Cimicifuga foetida, bugbane, fairy candles, or sheng ma; these are species from the same family (Ranunculaceae) with different therapeutic effects.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
A study using black cohosh and other herbs reduced pain. Due to limited research, the effect of black cohosh on arthritis is unclear. Additional studies are needed in this area.
Bone density (postmenopausal women)
Studies show that black cohosh has mixed effects on bone density. More research is needed in this area.
Research suggests that black cohosh has mixed results on breast cancer, possibly due to product variability and dosage. Additional studies are needed in this area.
Heart disease (postmenopausal women)
Limited research shows mixed results regarding black cohosh on cholesterol and heart disease risk. More well-designed studies involving humans are needed in this area.
Available research suggests that the effect of black cohosh on infertility is unclear. Additional research is needed in this area.
Black cohosh is a popular alternative to prescription hormonal therapy for the treatment of menopausal symptoms. Initial human research suggests that black cohosh may improve some of these symptoms for up to one year. However, the current evidence is mixed, and additional research needed.
Mental performance (postmenopausal women)
Black cohosh has not been well studied for mental performance in postmenopausal women. More research is needed in this area.
Black cohosh may be a potential treatment for migraines associated with menstruation. Additional research on black cohosh alone is warranted.