Black Cohosh - NutraPedia

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Black Cohosh: An Overview

1) Studied Conditions

Black cohosh has been studied for a variety of conditions, most notably:

  • Menopause symptoms such as hot flashes, night sweats, and mood swings.
  • Menstrual cramps and premenstrual syndrome (PMS).
  • Arthritis and muscle pain.
  • Sleep disturbances.
  • Osteoporosis.

2) Efficacy in Treating Conditions

The effectiveness of black cohosh in treating these conditions is mixed:

  • Some studies suggest that black cohosh may help reduce menopausal symptoms, but results are inconclusive.
  • There is limited evidence for its effectiveness in treating menstrual cramps, PMS, or muscle pain.
  • Its role in improving sleep disturbances is not well supported by evidence.
  • There is little evidence to support its use in preventing or treating osteoporosis.

3) Health Benefits

Potential health benefits of black cohosh include:

  • Alleviation of menopausal symptoms, potentially as an alternative to hormone replacement therapy.
  • Reduction of inflammation, which could benefit arthritis and muscle pain.
  • Mild sedative effects that may help with sleep disturbances in some individuals.

4) Downsides

Black cohosh does have potential downsides, including:

  • Gastrointestinal disturbances such as stomach pain, cramps, and nausea.
  • Headaches and dizziness.
  • Potential liver toxicity, with some reports of liver damage in people using black cohosh.
  • Interactions with other medications, particularly those metabolized by the liver.
  • Not recommended for use during pregnancy or lactation due to a lack of safety data.

5) Genetic Variations and Effects

Research on black cohosh and genetic variations is limited. However, some points to consider include:

  • Individuals with genetic variations affecting liver function may be at increased risk of liver toxicity from black cohosh.
  • There is currently no clear evidence linking black cohosh benefits or harms to specific genetic variations.
  • More research is needed to determine if there are genetic populations that would benefit more or experience more harm from black cohosh use.

Black Cohosh (Cimicifuga racemosa) as a Treatment for Menopausal Symptoms

Black Cohosh, known scientifically as Cimicifuga racemosa, has been reviewed across multiple clinical studies, totaling 43,759 women, to evaluate its efficacy in treating menopausal symptoms. Of these, 13,096 women were treated with an isopropanolic extract of Black Cohosh (iCR). The review suggests that iCR is more effective than a placebo for alleviating menopausal symptoms, with increased effectiveness at higher doses and when combined with St. John's wort (HP), especially for psychological symptoms. iCR's efficacy is comparable to low-dose transdermal estradiol or tibolone, but with a better safety profile.

Effectiveness and Safety

iCR was well-tolerated, caused minor adverse events similar to placebo, and presented no evidence of liver toxicity. Hormone levels remained stable, and estrogen-sensitive tissues were unaffected. The studies recommend iCR as a non-hormonal herbal therapy option for menopausal symptoms, particularly for those with hormone-dependent diseases.

Sleep Improvement in Postmenopausal Women

A study showed that Black Cohosh significantly improved sleep efficiency and reduced wakefulness after sleep onset in postmenopausal women with sleep disturbances. Quality of life also improved, and no safety concerns were reported.

Black Cohosh for Breast Cancer Survivors

A trial involving breast cancer survivors found that Black Cohosh did not significantly outperform a placebo in reducing hot flashes or other menopausal symptoms.

Comparative Efficacy with Hormonal Treatments

In comparison with tibolone, Black Cohosh demonstrated similar effectiveness in reducing menopause symptoms with fewer adverse effects. Another comparison with low-dose transdermal estradiol showed that Black Cohosh could be a viable alternative for managing climacteric symptoms.

Potential Toxicity and Mechanisms of Action

Despite the positive outcomes for menopausal symptoms, concerns about the potential genetic toxicity of Black Cohosh have been raised due to findings of chromosomal damage in human cells. The exact mechanisms of action remain unclear, with various theories proposed, such as selective estrogen receptor modulation, serotonergic pathway effects, antioxidant properties, or influence on inflammatory pathways.


Black Cohosh shows promise as an effective treatment for menopausal symptoms with a good safety profile. It may improve sleep, alleviate vasomotor symptoms, and serve as an alternative to hormone therapy. However, further research is necessary to understand its mechanisms and address potential toxicity concerns.


  1. Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidence
  2. Black Cohosh
  3. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance
  4. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer
  5. Subjective and objective measures of hot flashes
  6. [Efficacy and safety of remifemin compared to tibolone for controlling of perimenopausal symptoms]
  7. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis
  8. Black cohosh extracts and powders induce micronuclei, a biomarker of genetic damage, in human cells
  9. Black cohosh has central opioid activity in postmenopausal women: evidence from naloxone blockade and positron emission tomography neuroimaging
  10. Black Cohosh: Insights into its Mechanism(s) of Action
  11. Influence of Cimicifuga racemosa on the proliferation of estrogen receptor-positive human breast cancer cells
  12. Evidence for selective estrogen receptor modulator activity in a black cohosh (Cimicifuga racemosa) extract: comparison with estradiol-17beta
  13. Effect of exercise and Cimicifuga racemosa (CR BNO 1055) on bone mineral density, 10-year coronary heart disease risk, and menopausal complaints: the randomized controlled Training and Cimicifuga racemosa Erlangen (TRACE) study
  14. Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol

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