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Black cohosh for menopausal symptoms

Happy Sunday! Today I would like to discuss black cohosh as a potential alternative to treat menopausal or perimenopausal symptoms.

During perimenopause, ovarian function starts to decrease, lowering inhibin B and anti-mullerian hormone, while increasing the secretion of follicle-stimulating hormone (FSH), resulting in irregular ovulatory cycles and oestrogen levels. These hormonal changes can result in hot-flashes, vaginal dryness and sleep disturbances. While many women will then consider hormone replacement therapy to address these symptoms, others interested in natural alternatives often turn to cimicifuga racemosa or Black Cohosh (BC).

Some studies describe the herb to have weak oestrogen-like effects on the body, mimicking oestradiol while suppressing luteinising hormone secretion. Other studies describe BC’s effect as a selective oestrogen receptor modulation (SERM). Other researchers are of the opinion that BC’s effects relate to the central nervous system, perhaps in relation to serotonergic pathways or due to its anti-inflammatory effects. More recent articles suggest that BC’s hormonal effect might have been misunderstood, and that the herb may actually contain antinociceptive agents, blocking the sensory results of painful stimulus.

So at the moment, there is not a clear view of how BC really works. However, the Committee on Herbal Medicinal Products (HMPC) considers black cohosh as an acceptable herbal treatment for menopausal symptoms, based on its well-established use, meaning that the active ingredient of BC has been used for +10 years with documented results in approximately 20 clinical studies involving over 6,000 patients.

BC does not seem to present any known food interactions, although there are reports of BC interacting with certain drugs: atorvastatin, cisplatin, drugs metabolised by P450 2D6 (CYP2D6) and hepatotoxic drugs – so if you are on any of these, consult with your doctor before you start taking BC.

Potential adverse effects of BC to take into account could include headaches, dizziness, breast tenderness, vaginal bleeding and/or irritability, amongst others. Furthermore, research indicates that BC could result in liver toxicity in some women. So if you are taking statins or drink alcohol regularly, you would need to be extra careful with your liver health. Also, BC should be taken only up to a year, as current research haven’t examined its effect for longer periods of time.

Hope this was useful! Let us know if you have any questions or would like further nutritional support. Stay healthy!

Reference List

Borelli, F. and Ernst, E. (2008). Black cohosh (Cimicifuga racemosa) for menopausal symptoms: A systematic review of its efficacy. Pharmacological Research, 58(1), pp.8-14.

Borrelli, F., Izzo, A. and Ernst, E. (2003). Pharmacological effects of Cimicifuga racemosa. Life Sciences, 73(10), pp.1215-1229.

Burger, H., Hale, G., Dennerstein, L. and Robertson, D. (2008). Cycle and hormone changes during perimenopause. Menopause, 15(4), pp.603-612.

European Commission. (2019). Herbal medicinal products.

European Medicines Agency. (2018). Cimicifugae rhizoma - European Medicines Agency.

European Union Law. (2019). Directive 2004/24/EC.

GOV.UK. (2019). Herbal medicines granted a traditional herbal registration (THR).

Huntley, A. and Ernst, E. (2003). A systematic review of the safety of black cohosh. Menopause, 10(1)(Jan-Feb), pp.58-64.

Johnson, T. and Fahey, J. (2012). Black cohosh: Coming full circle?. Journal of Ethnopharmacology, 141(3), pp.775-779.

Leach, M. and Moore, V. (2012). Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database of Systematic Reviews.

Muqeet-Adnan, M., Khan, M., Hashmi, S., Hamza, M., AbdulMujeeb, S. and Amer, S. (2014). Black Cohosh and Liver Toxicity: Is There a Relationship?. Case Reports in Gastrointestinal Medicine, 2014, pp.1-3.

Natural Medicines. (2019). Natural Medicines.

Newton, K., Reed, S., LaCroix, A., Grothaus, L., Ehrlich, K. and Guiltinan, J. (2006). Treatment of Vasomotor Symptoms of Menopause with Black Cohosh, Multibotanicals, Soy, Hormone Therapy, or Placebo. Annals of Internal Medicine, 145(12), p.869.

Seidlova-Wuttke, D., Hesse, O., Jarry, H., Christoffel, V., Spengler, B., Becker, T. and Wuttke, W. (2003). Evidence for selective estrogen receptor modulator activity in a black cohosh (Cimicifuga racemosa) extract: comparison with estradiol-17beta. European Journal of Endocrinology, pp.351-362.

Shams, T., Setia, M., Hemmings, R., McCusker, J., Sewitch, M. and Ciampi, A. (2010). Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Alternative Therapies in Health and Medicine., Jan-Feb(16(1), pp.36-44.

Szmyd, M., Lloyd, V., Hallman, K., Aleck, K., Mladenovik, V., McKee, C., Morse, M., Bedgood, T. and Dinda, S. (2018). The effects of black cohosh on the regulation of estrogen receptor and progesterone receptor in breast cancer cells. Breast Cancer: Targets and Therapy, Volume 10, pp.1-11.

Tandra, S. and Vuppalanchi, R. (2009). Use of statins in patients with liver disease. Current Treatment Options in Cardiovascular Medicine, 11(4), pp.272-278.

Trickey, R. (2003). Women, hormones & the menstrual cycle. 2nd ed. Fairfield, Vic.: Ruth Trickey/Trickey Enterprises (Victoria), pp.469-472.

Viereck, V., Emons, G. and Wuttke, W. (2005). Black cohosh: just another phytoestrogen?. Trends in Endocrinology and Metabolism, 16(5), pp.214-221.


The material on this blog is not to be used by any commercial or personal entity without expressed written consent of the blog author. The statements on this blog are not intended to diagnose, treat, cure or prevent any disease. Always consult your personal physician for specific medical advice.


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