Research table: Black cohosh for relief of menopausal symptoms

This summary table contains detailed information about research studies. Summary tables are a useful way to look at the science behind many breast cancer guidelines and recommendations. However, to get the most out of the tables, it’s important to understand some key concepts. Learn how to read a research table.

Introduction: Taking black cohosh (an herb) has been suggested as a way to relieve menopausal symptoms.

However, most randomized controlled trials don’t show a benefit for women, including those who’ve had breast cancer.

Although studies haven’t shown any harmful side effects of black cohosh for women who’ve had breast cancer, there are no long-term safety data.

Learn more about black cohosh.

Learn more about ways to treat menopausal symptoms.

Learn about the strengths and weaknesses of different types of studies.

Study selection criteria: Randomized controlled trials with at least 80 participants and meta-analyses.

Table note: Relative risk above 1 indicates increased risk. Relative risk below 1 indicates decreased risk.

Study	Study Population (number of participants)	Treatment Duration	Menopausal Symptoms Studied	Black Cohosh Reduced Menopausal Symptoms Better Than Placebo?
Randomized controlled trials
Herbal Alternatives for Menopause Study [1-2]	351 women never diagnosed with cancer	1 year	Hot flashes	No
			Vaginal dryness	No
Osmers et al. [3]	304 women never diagnosed with cancer	12 weeks	Hot flashes and sleep problems	Yes
			Vaginal dryness	Yes
Uebelhack et al. [4]*	294 women never diagnosed with cancer	16 weeks	Hot flashes	Yes
Pockaj et al. [5]	132 women who’ve had breast cancer and women at high risk	9 weeks	Hot flashes	No
Frei-Kleiner et al. [6]	122 women never diagnosed with cancer	12 weeks	Hot flashes	No
van der Sluijs et al. [7]†	93 women never diagnosed with cancer	20 weeks	Hot flashes	No
Jacobson et al. [8]	85 women who’ve had breast cancer	57-60 days	Hot flashes	No
Meta-analyses
Franco et al. [9]	4 studies	Various	Hot flashes	No
Cochrane Collaboration [10]	16 studies	Various	Hot flashes	No

* Supplement contained black cohosh and St. John’s wort.

† Supplement contained black cohosh and Chinese herbs.

References  

1. 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. 145(12):869-79, 2006.
2. 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. 15(1):51-8, 2008.
3. 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. 105(5 Pt 1):1074-83, 2005.
4. Uebelhack R, Blohmer JU, Graubaum HJ, Busch R, Gruenwalk J, Wernecke KD. Black cohosh and St. John’s wort for climacteric complaints: a randomized trial. Obstet Gynecol. 107(2 Pt 1):247-55, 2006.
5. Pockaj BA, Gallagher JG, Loprinzi CL, et al. Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1. J Clin Oncol. 24(18):2836-41, 2006.
6. Frei-Kleiner S, Schaffner W, Rahlfs VW, Bodmer Ch, Birhuäser M. Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial. Maturitas. 51(4):397-404, 2005.
7. 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. 16(2):336-44, 2009.
8. Jacobson JS, Troxel AB, Evans J, et al. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol. 19(10):2739-45, 2001.
9. Franco OH, Chowdhury R, Troup J, et al. Use of plant-based therapies and menopausal symptoms: a systematic review and meta-analysis. JAMA. 315(23):2554-63, 2016. 
10. Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 9:CD007244, 2012.

Updated 04/19/23