Black Cohosh

Black cohosh is said to be useful for menopausal symptoms (eg, hot flushes, mood lability, tachycardia, vaginal dryness), for menstrual symptoms, and for arthralgias in rheumatoid arthritis or osteoarthritis.

Evidence regarding benefit in relieving menopausal symptoms is conflicting (1). There are few reliable data on its effectiveness for other disorders and symptoms.

12).

A 2017 network meta-analysis in women with an intact uterus found that, compared to placebo, black cohosh decreased vasomotor menopausal symptoms. However, black cohosh was not as effective as hormonal treatments (3).

A 2021 review of 35 studies and one meta-analysis (43,759 subjects) of isopropanolic black cohosh4). A lack of standardization of the supplement product used between studies indicates that more research is necessary to reach definitive conclusions.

Adverse effects are uncommon. The most likely are headache, rash, and gastrointestinal distress. Dizziness, diaphoresis, and hypotension (if high doses are taken) may occur.

Black cohosh5

Additionally, a woman developed bradycardia due to reversible complete heart block after taking an herbal supplement containing black cohosh (6).

There is little clinical evidence that black cohosh interferes with medications. However, a recent in vitro study suggests that black cohosh7).

1. 1. Leach MJ, Moore VCochrane Database Syst Rev 9:CD007244, 2012. doi: 10.1002/14651858.CD007244.pub2

2. 2. Franco OH, Chowdhury R, et al: Use of plant-based therapies and menopausal symptoms: a systematic review and meta-analysis. JAMA 315(23):2554-63, 2016. doi: 10.1001/jama.2016.8012

3. 3. Sarri G, Pedder H, Dias S, et al: Vasomotor symptoms resulting from natural menopause: a systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause. BJOG 124(10):1514-1523, 2017. doi: 10.1111/1471-0528.14619

4. 4. Castelo-Branco C, Gambacciani M, Cano A, et alClimacteric 24(2):109-119, 2021. doi:10.1080/13697137.2020.1820477

5. 5. Lim TY, Considine A, Quaglia A, et alBMJ Case Rep, Published online: 5 July 2013. doi:10.1136/bcr-2013-009325

6. 6. McKenzie SC, Rahman AMed J Aust193(8):479-481, 2010. doi:10.5694/j.1326-5377.2010.tb04006.x

7. 7. Gorman GS, Coward L, Darby A, et al: Effects of herbal supplements on the bioactivation of chemotherapeutic agents. J Pharm Pharmacol 65(7):1014-1025, 2013. doi: 10.1111/jphp.12055

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

1. National Institutes of Health (NIH)