Black Cohosh

Black cohosh is the most popular menopause supplement in North America. D-GRADE for anxiety symptoms (1 study, 28 participants), CRP, blood glucose, cognition, blood flow, and breast density - all showing no effect. Some studies suggest benefits for hot flashes and night sweats, but results are inconsistent and not reflected in graded outcomes. Remifemin is the most studied standardized extract. SAFETY CONCERN: Rare hepatotoxicity cases reported (mechanism unclear). Evidence quality is surprisingly weak given its popularity.

Quick Answer

What it is

Black cohosh is the most popular menopause supplement in North America. D-GRADE for anxiety symptoms (1 study, 28 participants), CRP, blood glucose, cognition, blood flow, and breast density - all showing no effect.

Key findings

  • Grade C: Menopausal Symptoms (Breast Cancer)
  • Grade D: Anxiety Symptoms (Menopause)
  • Grade D: C-Reactive Protein (CRP) (Menopause)

Safety

No specific caution or interaction language was detected in the current summary/outcome notes.

ℹ️ Quick Facts: Black Cohosh

Quick Facts: Black Cohosh

  • Best Evidence:Grade C
  • Conditions Studied:8
  • Research Outcomes:23
  • Key Effect:Breast Cancer
Outcomes by grade:
A0
B0
C1
D8
8 conditions · 23 outcomes

Detailed Outcomes

Grade:
Effect:
Size:
Sort:
|
C
Menopausal Symptoms
Small Improvement
smallImproves
D
Breast Density
No effect
none
D
Anxiety Symptoms
No effect
none
D
C-Reactive Protein (CRP)
No effect
none
?
Menopausal Symptoms
Worsens
?
Estrogen
Worsens
?
Subjective Well-Being
Improves
?
Triglycerides
1 study
Worsens
D
Blood glucose
No effect
none
D
Blood glucose
No effect
none
?
High-density lipoprotein (HDL)
1 study
Improves
?
Insulin
1 study
Worsens
?
Low-density lipoprotein (LDL)
1 study
Worsens
?
Triglycerides
1 study
Worsens
D
Cognition
No effect
none
?
Memory
1 study
Improves
D
Blood Flow
No effect
1 study
none
?
Liver Enzymes
1 study
Worsens
?
Menopausal Symptoms
Worsens
?
Weight
1 study
Worsens
D
C-Reactive Protein (CRP)
No effect
none
?
Bone Mineral Density
Improves
?
Anxiety Symptoms
Worsens

Research Citations (19)

Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidence.
PMID: 33021111
[Efficacy and safety of remifemin compared to tibolone for controlling of perimenopausal symptoms]
PMID: 20003788
First-time proof of endometrial safety of the special black cohosh extract (Actaea or Cimicifuga racemosa extract) CR BNO 1055
PMID: 16837890
Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis
PMID: 20085176
Black cohosh with or without St. John's wort for symptom-specific climacteric treatment--results of a large-scale, controlled, observational study
PMID: 17590291
Menopause: a standardized isopropanolic black cohosh extract (remifemin) is found to be safe and effective for menopausal symptoms
PMID: 22157510
Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial
PMID: 17179056
Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1
PMID: 16782922
Effects of a supplement containing isoflavones and Actaea racemosa L. on asymmetric dimethylarginine, lipids, and C-reactive protein in menopausal women
PMID: 17430734
Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect
PMID: 11975864

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