Black Cohosh - American Family Physician

Uses and Efficacy Currently, the primary use of black cohosh extract is for alleviation of menopausal symptoms. The American College of Obstetrics and Gynecology guidelines on the use of botanicals for the management of menopausal symptoms support this use for up to six months, especially in treating the symptoms of sleep and mood disturbance, and hot flushes. [Evidence level C, consensus/expert guidelines] At least eight studies of black cohosh therapy for menopausal symptoms, involving approximately 2,000 women, have been published, most of them in German. Many of these studies used an estrogen product in the control group, and most of the trials used standardized outcome measures such as the Kupperman Menopause Index and the Hamilton Anxiety Scale. Almost all of these studies demonstrate efficacy in patients taking black cohosh extract similar to that of estrogen in the treatment of neurovegetative menopausal symptoms. Unfortunately, most of these studies are open trials and lack blinding and long-term followup, making it difficult to draw definitive conclusions from their results. As with other herbal medicines believed to have potential estrogenic effects, there has been T he herb black cohosh, or Actaea racemosa (formerly named Cimicifuga racemosa), is native to North America. The roots and rhizomes are widely used in the treatment of menopausal symptoms and menstrual dysfunction. Black cohosh was originally used by Native American peoples in the treatment of many conditions, especially gynecologic disorders. The most widely used and best studied commercial formulation available in the United States is Remifemin, an extract of the rhizome that is produced by a German company. Numerous other brands of black cohosh are available, but not all are standardized extracts. Black cohosh should not be confused with the blue cohosh herb (also known as Caulophyllum thalictroides), which is used for different indications and has a greater potential for toxicity.