Black Cohosh

Updated | 2018-01-19


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Black Cohosh


Overview

Botanical Name: Actaea racemosa / Cimicifuga racemosa


Order: Ranunculales


Family: Ranuculaceae


Do not confuse with Cimicifuga foetida.



Evidence

Strong:

-

Good:

  • Menopausal Complaints and Mood Changes, seems to improve the quality of life (black cohosh blends containing Saint John’s wort may also be effective, but a black cohosh blend containing soy may not be effective) [1-17]
    • Another plant, Cimicifuga foetida, may also be effective [18]

Promising:

-

Conflicting (Unclear):

  • Hot Flashes/Sleep Disturbances from Menopause, there are many conflicting results from clinical trials [19-31]
    • Clinical trials of black cohosh blends containing red clover or soy may not be effective, but blends containing red clover / conjugated equine estrogens / medroxyprogesterone; milk thistle / American ginseng / chaste tree / dong quai / red clover; or tamoxifen may be effective

Limited Evidence:

  • Fertility, black cohosh in combination with clomiphene citrate [32-33]
  • Menopausal Complaints of Breast Cancer Patients [34]
  • Migraines from Menstrual Cycle, a black cohosh blend containing soy / dong quai [35]
  • Osteoporosis (Bone Density Loss) [36-38]
  • Ovarian Cyst [39]

No Evidence:


No Clinical Research:

All other conditions.


Side Effects
Side effects may include:
  • Cramping
  • Dizziness
  • Headache
  • Heaviness in the Legs and Arms
  • Fluid Retention
  • Gastrointestinal Upset
  • Rashes
  • Sweating
  • Vomiting
  • Weakness
  • Weight Gain
Precautions and Adverse Events:
  • Avoid or contact a licensed healthcare practitioner, if you have breast cancer/tumors (and have had breast cancer/tumors), other hormone dependent conditions and cancers, liver problems or a have had liver problems.
  • Monitor your liver while using black cohosh; there is conflicting evidence of liver failure, liver damage, liver necrosis, chronic hepatitis, autoimmune hepatitis.
  • There have been reports of black cohosh causing muscle damage, severe weakness, seizures, pseudolymphoma (an inflammatory response), bradycardia (slow heart rate), abnormal blood clotting, hypotension (low blood pressure), fluid retention, visual disturbances.
[48-71]


Pregnant or Nursing

If you are pregnant or may be pregnant, using black cohosh can cause miscarriage or premature births. In general there is not enough research on the use of supplements containing black cohosh during pregnancy and breast-feeding, so consult a licensed healthcare practitioner before use or avoid use. Black cohosh is used to induce labor, but there is not enough research about how it may affect the newborn infant. [48-71]



Interactions

Major

-

Moderate

  • Drugs changed by Cytochrome P450s (CYPs) in the liver
  • Azathioprine
  • Cyclosporine (Ciclosprin)
[72-74]

Potential

  • Anti-Hypertensive Drugs
  • Hormone-Like Drugs
  • Iron-Containing Products; since black cohosh contains tannins, take iron and black cohosh at least several hours apart to prevent non-absorption of iron
  • Tamoxifen
[72-74]


Dosage

Black cohosh is not a "drug", so the best doses have not been thoroughly established. Make sure to follow the specific product instructions and take as directed on the label, or consult a licensed healthcare practitioner before use.



Compounds
Black Cohosh compounds


References

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Black cohosh with or without St. John's wort for symptom-specific climacteric treatment--results of a large-scale, controlled, observational study. Maturitas. 2007 Aug 20;57(4):405-14. 5. Chung DJ, Kim HY, Park KH, Jeong KA, Lee SK, Lee YI, Hur SE, Cho MS, Lee BS, Bai SW, Kim CM, Cho SH, Hwang JY, Park JH. Black cohosh and St. John's wort (GYNO-Plus) for climacteric symptoms. Yonsei Med J. 2007 Apr 30;48(2):289-94. 6. Drewe J, Zimmermann C, Zahner C. The effect of a Cimicifuga racemosa extracts Ze 450 in the treatment of climacteric complaints--an observational study. Phytomedicine. 2013 Jun 15;20(8-9):659-66. 7. Frei-Kleiner S, Schaffner W, Rahlfs VW, Bodmer Ch, Birkhäuser M. Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial. Maturitas. 2005 Aug 16;51(4):397-404. 8. Juliá Mollá MD, García-Sánchez Y, Romeu Sarri A, Pérez-lópez FR. Cimicifuga racemosa treatment and health related quality of life in post-menopausal Spanish women. Gynecol Endocrinol. 2009 Jan;25(1):21-6. 9. Nappi RE, Malavasi B, Brundu B, Facchinetti F. Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol. Gynecol Endocrinol. 2005 Jan;20(1):30-5. 10. Osmers R, Friede M, Liske E, Schnitker J, Freudenstein J, Henneicke-von Zepelin HH. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol. 2005 May;105(5 Pt 1):1074-83. Erratum in: Obstet Gynecol. 2005 Sep;106(3):644. 11. Raus K, Brucker C, Gorkow C, Wuttke W. First-time proof of endometrial safety of the special black cohosh extract (Actaea or Cimicifuga racemosa extract) CR BNO 1055. Menopause. 2006 Jul-Aug;13(4):678-91. 12. Reed SD, Newton KM, LaCroix AZ, Grothaus LC, Grieco VS, Ehrlich K. Vaginal, endometrial, and reproductive hormone findings: randomized, placebo-controlled trial of black cohosh, multibotanical herbs, and dietary soy for vasomotor symptoms: the Herbal Alternatives for Menopause (HALT) Study. Menopause. 2008 Jan-Feb;15(1):51-8. 13. Sammartino A, Tommaselli GA, Gargano V, di Carlo C, Attianese W, Nappi C. Short-term effects of a combination of isoflavones, lignans and Cimicifuga racemosa on climacteric-related symptoms in postmenopausal women: a double-blind, randomized, placebo-controlled trial. Gynecol Endocrinol. 2006 Nov;22(11):646-50. 14. Uebelhack R, Blohmer JU, Graubaum HJ, Busch R, Gruenwald J, Wernecke KD. Black cohosh and St. John's wort for climacteric complaints: a randomized trial. Obstet Gynecol. 2006 Feb;107(2 Pt 1):247-55. 15. Verhoeven MO, van der Mooren MJ, van de Weijer PH, Verdegem PJ, van der Burgt LM, Kenemans P; CuraTrial Research Group. Effect of a combination of isoflavones and Actaea racemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind study. Menopause. 2005 Jul-Aug;12(4):412-20. 16. Vermes G, Bánhidy F, Acs N. The effects of remifemin on subjective symptoms of menopause. Adv Ther. 2005 Mar-Apr;22(2):148-54. 17. Wuttke W, Seidlová-Wuttke D, Gorkow C. The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers. Maturitas. 2003 Mar 14;44 Suppl 1:S67-77. 18. Zheng TP, Sun AJ, Xue W, Wang YP, Jiang Y, Zhang Y, Lang JH. Efficacy and safety of Cimicifuga foetida extract on menopausal syndrome in Chinese women. Chin Med J (Engl). 2013;126(11):2034-8. 19. Colau JC, Vincent S, Marijnen P, Allaert FA. Efficacy of a non-hormonal treatment, BRN-01, on menopausal hot flashes: a multicenter, randomized, double-blind, placebo-controlled trial. Drugs R D. 2012 Sep 1;12(3):107-19. 20. Geller SE, Shulman LP, van Breemen RB, Banuvar S, Zhou Y, Epstein G, Hedayat S, Nikolic D, Krause EC, Piersen CE, Bolton JL, Pauli GF, Farnsworth NR. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause. 2009 Nov-Dec;16(6):1156-66. 21. Hernández Muñoz G, Pluchino S. Cimicifuga racemosa for the treatment of hot flushes in women surviving breast cancer. Maturitas. 2003 Mar 14;44 Suppl 1:S59-65. 22. Jacobson JS, Troxel AB, Evans J, Klaus L, Vahdat L, Kinne D, Lo KM, Moore A, Rosenman PJ, Kaufman EL, Neugut AI, Grann VR. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol. 2001 May 15;19(10):2739-45. 23. Maki PM, Rubin LH, Fornelli D, Drogos L, Banuvar S, Shulman LP, Geller SE. Effects of botanicals and combined hormone therapy on cognition in postmenopausal women. Menopause. 2009 Nov-Dec;16(6):1167-77. 24. Newton KM, Reed SD, LaCroix AZ, Grothaus LC, Ehrlich K, Guiltinan J. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial. Ann Intern Med. 2006 Dec 19;145(12):869-79. 25. Oktem M, Eroglu D, Karahan HB, Taskintuna N, Kuscu E, Zeyneloglu HB. Black cohosh and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized trial. Adv Ther. 2007 Mar-Apr;24(2):448-61. 26. Pockaj BA, Gallagher JG, Loprinzi CL, Stella PJ, Barton DL, Sloan JA, Lavasseur BI, Rao RM, Fitch TR, Rowland KM, Novotny PJ, Flynn PJ, Richelson E, Fauq AH. Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1. J Clin Oncol. 2006 Jun 20;24(18):2836-41. 27. Pockaj BA, Loprinzi CL, Sloan JA, Novotny PJ, Barton DL, Hagenmaier A, Zhang H, Lambert GH, Reeser KA, Wisbey JA. Pilot evaluation of black cohosh for the treatment of hot flashes in women. Cancer Invest. 2004;22(4):515-21. 28. Ross SM. Menopause: a standardized isopropanolic black cohosh extract (remifemin) is found to be safe and effective for menopausal symptoms. Holist Nurs Pract. 2012 Jan-Feb;26(1):58-61. 29. Rotem C, Kaplan B. Phyto-Female Complex for the relief of hot flushes, night sweats and quality of sleep: randomized, controlled, double-blind pilot study. Gynecol Endocrinol. 2007 Feb;23(2):117-22. 30. Van der Sluijs CP, Bensoussan A, Chang S, Baber R. A randomized placebo-controlled trial on the effectiveness of an herbal formula to alleviate menopausal vasomotor symptoms. Menopause. 2009 Mar-Apr;16(2):336-44. 31. Verhoeven MO, van der Mooren MJ, van de Weijer PH, Verdegem PJ, van der Burgt LM, Kenemans P; CuraTrial Research Group. Effect of a combination of isoflavones and Actaea racemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind study. Menopause. 2005 Jul-Aug;12(4):412-20. 32. Shahin AY, Ismail AM, Shaaban OM. Supplementation of clomiphene citrate cycles with Cimicifuga racemosa or ethinyl oestradiol--a randomized trial. Reprod Biomed Online. 2009 Oct;19(4):501-7. 33. Shahin AY, Ismail AM, Zahran KM, Makhlouf AM. Adding phytoestrogens to clomiphene induction in unexplained infertility patients--a randomized trial. Reprod Biomed Online. 2008 Apr;16(4):580-8. 34. Rostock M, Fischer J, Mumm A, Stammwitz U, Saller R, Bartsch HH. Black cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints - a prospective observational study. Gynecol Endocrinol. 2011 Oct;27(10):844-8. 35. Burke BE, Olson RD, Cusack BJ. Randomized, controlled trial of phytoestrogen in the prophylactic treatment of menstrual migraine. Biomed Pharmacother. 2002 Aug;56(6):283-8. 36. Bebenek M, Kemmler W, von Stengel S, Engelke K, Kalender WA. 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. Menopause. 2010 Jul;17(4):791-800. 37. Wuttke W, Gorkow C, Seidlová-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study. Menopause. 2006 Mar-Apr;13(2):185-96. 38. Wuttke W, Seidlová-Wuttke D, Gorkow C. The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers. Maturitas. 2003 Mar 14;44 Suppl 1:S67-77. 39. Kamel HH. Role of phyto-oestrogens in ovulation induction in women with polycystic ovarian syndrome. Eur J Obstet Gynecol Reprod Biol. 2013 May;168(1):60-3. 40. Hirschberg AL, Edlund M, Svane G, Azavedo E, Skoog L, von Schoultz B. An isopropanolic extract of black cohosh does not increase mammographic breast density or breast cell proliferation in postmenopausal women. Menopause. 2007 Jan-Feb;14(1):89-96. 41. Lundström E, Hirschberg AL, Söderqvist G. Digitized assessment of mammographic breast density--effects of continuous combined hormone therapy, tibolone and black cohosh compared to placebo. Maturitas. 2011 Dec;70(4):361-4. 42. Maki PM, Rubin LH, Fornelli D, Drogos L, Banuvar S, Shulman LP, Geller SE. Effects of botanicals and combined hormone therapy on cognition in postmenopausal women. Menopause. 2009 Nov-Dec;16(6):1167-77. 43. Bebenek M, Kemmler W, von Stengel S, Engelke K, Kalender WA. 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. Menopause. 2010 Jul;17(4):791-800. 44. Verhoeven MO, Teerlink T, Kenemans P, Zuijdgeest-van Leeuwen SD, van der Mooren MJ. Effects of a supplement containing isoflavones and Actaea racemosa L. on asymmetric dimethylarginine, lipids, and C-reactive protein in menopausal women. Fertil Steril. 2007 Apr;87(4):849-57. 45. Spangler L, Newton KM, Grothaus LC, Reed SD, Ehrlich K, LaCroix AZ. The effects of black cohosh therapies on lipids, fibrinogen, glucose and insulin. Maturitas. 2007 Jun 20;57(2):195-204. 46. Spangler L, Newton KM, Grothaus LC, Reed SD, Ehrlich K, LaCroix AZ. The effects of black cohosh therapies on lipids, fibrinogen, glucose and insulin. Maturitas. 2007 Jun 20;57(2):195-204. 47. Ehrlich M, Rao J, Pabby A, Goldman MP. Improvement in the appearance of wrinkles with topical transforming growth factor beta(1) and l-ascorbic acid. Dermatol Surg. 2006 May;32(5):618-25. 48. Cohen SM, O'Connor AM, Hart J, Merel NH, Te HS. Autoimmune hepatitis associated with the use of black cohosh: a case study. Menopause. 2004 Sep-Oct;11(5):575-7. 49. DerMarderosian A, Beutler JA. The review of natural products: the most complete source of natural product information. 7th ed. St. Louis, MO, USA: Wolters Kluwer Health; 2012. 50. Dugoua JJ, Seely D, Perri D, Koren G, Mills E. Safety and efficacy of black cohosh (Cimicifuga racemosa) during pregnancy and lactation. Can J Clin Pharmacol. 2006 Fall;13(3):e257-61. 51. Fetrow CW, Avila JR. The complete guide to herbal medicines. Spring House, PA, USA: Springhouse Corporation; 2000. 52. Gruenwald J, Brendler T, Jaenicke C, editors. PDR for herbal medicines. 4th ed. Montvale, NJ, USA: Thomson Healthcare; 2007. 53. Huntley A, Ernst E. A systematic review of the safety of black cohosh. Menopause. 2003 Jan-Feb;10(1):58-64. 54. Joy D, Joy J, Duane P. Black cohosh: a cause of abnormal postmenopausal liver function tests. Climacteric. 2008 Feb;11(1):84-8. 55. Kistin SJ, Newman AD. Induction of labor with homeopathy: a case report. J Midwifery Womens Health. 2007 May-Jun;52(3):303-7. 56. Lynch CR, Folkers ME, Hutson WR. Fulminant hepatic failure associated with the use of black cohosh: a case report. Liver Transpl. 2006 Jun;12(6):989-92. 57. McKenzie SC, Rahman A. Bradycardia in a patient taking black cohosh. Med J Aust. 2010 Oct 18;193(8):479-81. 58. Meyer S, Vogt T, Obermann EC, Landthaler M, Karrer S. Cutaneous pseudolymphoma induced by Cimicifuga racemosa. Dermatology. 2007;214(1):94-6. 59. Minciullo PL, Saija A, Patafi M, Marotta G, Ferlazzo B, Gangemi S. Muscle damage induced by black cohosh (Cimicifuga racemosa). Phytomedicine. 2006 Jan;13(1-2):115-8. 60. Naser B, Schnitker J, Minkin MJ, de Arriba SG, Nolte KU, Osmers R. Suspected black cohosh hepatotoxicity: no evidence by meta-analysis of randomized controlled clinical trials for isopropanolic black cohosh extract. Menopause. 2011 Apr;18(4):366-75. 61. Nisbet BC, O'Connor RE. Black cohosh-induced hepatitis. Del Med J. 2007 Nov;79(11):441-4. 62. Pierard S, Coche JC, Lanthier P, Dekoninck X, Lanthier N, Rahier J, Geubel AP. Severe hepatitis associated with the use of black cohosh: a report of two cases and an advice for caution. Eur J Gastroenterol Hepatol. 2009 Aug;21(8):941-5. 63. Roemheld-Hamm B, Dahl NV. Herbs, menopause, and dialysis. Semin Dial. 2002 Jan-Feb;15(1):53-9. 64. Teschke R, Bahre R, Fuchs J, Wolff A. Black cohosh hepatotoxicity: quantitative causality evaluation in nine suspected cases. Menopause. 2009 Sep-Oct;16(5):956-65. 65. Teschke R, Bahre R, Genthner A, Fuchs J, Schmidt-Taenzer W, Wolff A. Suspected black cohosh hepatotoxicity--challenges and pitfalls of causality assessment. Maturitas. 2009 Aug 20;63(4):302-14. 66. Teschke R, Schwarzenboeck A. Suspected hepatotoxicity by Cimicifugae racemosae rhizoma (black cohosh, root): critical analysis and structured causality assessment. Phytomedicine. 2009 Jan;16(1):72-84. 67. Teschke R. Black cohosh and suspected hepatotoxicity: inconsistencies, confounding variables, and prospective use of a diagnostic causality algorithm. A critical review. Menopause. 2010 Mar;17(2):426-40. 68. Tsai HH, Lin HW, Simon Pickard A, Tsai HY, Mahady GB. Evaluation of documented drug interactions and contraindications associated with herbs and dietary supplements: a systematic literature review. Int J Clin Pract. 2012 Nov;66(11):1056-78. 69. Walji R, Boon H, Guns E, Oneschuk D, Younus J. Black cohosh (Cimicifuga racemosa [L.] Nutt.): safety and efficacy for cancer patients. Support Care Cancer. 2007 Aug;15(8):913-21. 70. Whiting PW, Clouston A, Kerlin P. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust. 2002 Oct 21;177(8):440-3. 71. Zimmermann R, Witte A, Voll RE, Strobel J, Frieser M. Coagulation activation and fluid retention associated with the use of black cohosh: a case study. Climacteric. 2010 Apr;13(2):187-91. 72. DerMarderosian A, Beutler JA. The review of natural products: the most complete source of natural product information. 7th ed. St. Louis, MO, USA: Wolters Kluwer Health; 2012. 73. Fetrow CW, Avila JR. The complete guide to herbal medicines. Spring House, PA, USA: Springhouse Corporation; 2000. 74. Gruenwald J, Brendler T, Jaenicke C, editors. PDR for herbal medicines. 4th ed. Montvale, NJ, USA: Thomson Healthcare; 2007.

The "-" means that there is no information.