Black Cohosh (Actaea racemosa) Research

Latin Name: Actaea racemosa

Family: Ranunculaceae

Black cohosh has shown in some human studies to help with menopausal symptoms, menstrual complaints, and arthritis.

RESEARCH

The listings of research below represent a compilation of scientific articles found on the species, with a very brief overview description of each article/study. Research found is catalogued by therapeutic action. This categorized compilation of research articles does not necessarily imply that there are adequate results to demonstrate safe and/or effective human use.

Safety and Quality

• ​Based on a meta-review of research, black cohosh is not appropriate for use during pregnancy and lactation for the following reasons: it has a potential labour-inducing effects, hormonal effects, emmenagogue effects, and anovulatory effects.  From:  Dugoua, J. J., Seely, D., Perri, D., Koren, G., & Mills, E. (2006). Safety and efficacy of black cohosh (Cimicifuga racemosa) during pregnancy and lactation. Can J Clin Pharmacol, 13(3), e257-e261.
• May interfere with the following medications:  tamoxifen, chemotherapy drugs, blood pressure medications, lipitor, aspirin, blood thinners, hepatotoxic drugs, and cytochrome P450 3A4. (Petersen, 2016 & Natural Medicines, 2017).
• May cause gastrointestinal upset (Natural Medicines, 2017).
• Related to an interaction with human cytochrome P450 in vivo: goldenseal strongly inhibited CYP2D6 and CYP3A4/5, kava inhibited CYP2E1, and black cohosh weakly inhibited CYP2D6.  From:  Gurley, B. J., Gardner, S. F., Hubbard, M. A., Williams, D. K., Gentry, W. B., Khan, I. A., & Shah, A. (2005). In vivo effects of goldenseal, kava kava, black cohosh, and valerian on human cytochrome P450 1A2, 2D6, 2E1, and 3A4/5 phenotypes. Clinical Pharmacology & Therapeutics, 77(5), 415-426.
• ​There is a possibility that excessive use of black cohosh may be associated with liver toxicity.  From:  Mahady, G. B., Dog, T. L., Barrett, M. L., Chavez, M. L., Gardiner, P., Ko, R., … & Sarma, D. N. (2008). United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause, 15(4), 628-638.

GENERAL

• Natural Medicines (2017).  Black Cohosh Monograph.  Retrieved in June, 2017.  Retrieved from www.naturalmedicines.com
• Petersen, D. (2016).  HERB503 Course Material.  Materia Medica.  American College of Healthcare Sciences.  www.achs.org.

MENOPAUSE

• In a randomized double blind trial of 304 patients, hot flashes were reduced in menopausal women with black cohosh extracts.  From:  Osmers, R., Friede, M., Liske, E., Schnitker, J., Freudenstein, J., & Henneicke-von Zepelin, H. H. (2005). Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstetrics & Gynecology, 105(5, Part 1), 1074-1083. 
• In a review of research, the following herbs showed useful for treating menstrual complaints:  vitamins B1 and E for dysmenorrhea, and calcium, vitamin B6, and chasteberry for premenstrual syndrome.  Black cohosh showed potential for treating menopause.  From: Dennehy, C. E. (2006). The use of herbs and dietary supplements in gynecology: an evidence‐based review. Journal of Midwifery & Women’s Health, 51(6), 402-409.
• A review of eight human studies showed black cohosh to be effective and safe in treating menopausal symptoms.  From:  Lieberman, S. (1998). A review of the effectiveness of Cimicifuga racemosa (black cohosh) for the symptoms of menopause. Journal of Women’s Health, 7(5), 525-529.
• In a six month controlled, randomized, double-blinded parallel group study, Cimicifugae racemosa extract improved menopause symptoms without an estrogenlike effect.  From:  Liske, E., Hänggi, W., Henneicke-von Zepelin, H. H., Boblitz, N., Wüstenberg, P., & Rahlfs, V. W. (2002). Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect. Journal of women’s health & gender-based medicine, 11(2), 163-174.
• An herbal combination of black cohosh and St. John’s wort reduced menopausal symptoms in a double-blind randomized placebo-control study of 301 women.  From:  Uebelhack, R., Blohmer, J. U., Graubaum, H. J., Busch, R., Gruenwald, J., & Wernecke, K. D. (2006). Black cohosh and St. John’s wort for climacteric complaints: a randomized trial. Obstetrics & Gynecology, 107(2, Part 1), 247-255.
• Black cohosh reduced hot flashes in menopausal rats without an estrogenic effect.  From:  Burdette, J. E., Liu, J., Chen, S. N., Fabricant, D. S., Piersen, C. E., Barker, E. L., … & Bolton, J. L. (2003). Black cohosh acts as a mixed competitive ligand and partial agonist of the serotonin receptor. Journal of Agricultural and Food Chemistry, 51(19), 5661-5670.
• Black cohosh reduced hot flashes in women with a low level of toxicity. From:  Pockaj, B. A., Loprinzi, C. L., Sloan, J. A., Novotny, P. J., Barton, D. L., Hagenmaier, A., … & Wisbey, J. A. (2004). Pilot evaluation of black cohosh for the treatment of hot flashes in women. Cancer investigation, 22(4), 515-521.
• Nine randomized placebo controlled trials were reviewed and data showed that black cohosh improved symptoms of menopause.  More research on the effectiveness and safety of the herb is warranted.  From:  Jane McCusker MD, D. (2010). Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Alternative therapies in health and medicine, 16(1), 36.
• In a Chinese randomized double blind controlled study, Cimicifuga racemosa extract was effective and safer than the drug tibolone in treating menopausal symptoms.  From:  Bai, W., Henneicke-von Zepelin, H. H., Wang, S., Zheng, S., Liu, J., Zhang, Z., … & Liske, E. (2007). Efficacy and tolerability of a medicinal product containing an isopropanolic black cohosh extract in Chinese women with menopausal symptoms: a randomized, double blind, parallel-controlled study versus tibolone. Maturitas, 58(1), 31-41.
• A randomized trial of 82 women demonstrated that black cohosh reduced hot flashes, night sweats, and depression in menopausal women.  From:  Saghafi, N., Mahmoodinya, M., Ayati, S., Behdani, F., Shakeri, M. T., & Rakhshandeh, A. (2013). Comparison of Effects of Black Cohosh and Fluoxetine in Treatment of Menopausal Symptoms. Iranian Journal of Obstetrics, Gynecology & Infertility, 15(32).
• In this randomized, double-blind, placebo-controlled clinical trial of 84 postmenopausal women, black cohosh reduced hot flashes.  From:  Shahnazi, M., Nahaee, J., Mohammad-Alizadeh-Charandabi, S., & Bayatipayan, S. (2013). Effect of black cohosh (cimicifuga racemosa) on vasomotor symptoms in postmenopausal women: a randomized clinical trial. Journal of caring sciences, 2(2), 105.

​MENSTRUATION

• In a randomized study of forty-nine patients, a daily blend of 60 mg soy isoflavones, 100 mg dong quai, and 50 mg black cohosh, for 24 weeks reduced the frequency of menstrually associated migraine headaches.  From:  Bai, W., Henneicke-von Zepelin, H. H., Wang, S., Zheng, S., Liu, J., Zhang, Z., … & Liske, E. (2007). Efficacy and tolerability of a medicinal product containing an isopropanolic black cohosh extract in Chinese women with menopausal symptoms: a randomized, double blind, parallel-controlled study versus tibolone. Maturitas, 58(1), 31-41.

ARTHRITIS

• In this randomized two month study with 82 patients, an herbal medicine with black cohosh had a mild analgesic effect in treating arthritis.  From:  Mills, S. Y., Jacoby, R. K., Chacksfield, M., & Willoughby, M. (1996). Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: a double-blind study. Rheumatology, 35(9), 874-878.

URINARY SYSTEM

• Antioxidant activity of herbs related to the urinary system was tested in vivo. Of the 55 tested herbs, 12 were equally or more effective than the already established milk thistle seed (Silybum marianum) or tea leaf (Camellia sinensis). The top herbs were Olea europaea (olive leaf), Cimicifuga racemosa (black cohosh), Rheum palmatum (rhubarb), Glycyrrhiza glabra (licorice), and Scutellaria lateriflora (Virginia skullcap). From: Wojcikowski, K., Stevenson, L., Leach, D., Wohlmuth, H., & Gobe, G. (2007). Antioxidant capacity of 55 medicinal herbs traditionally used to treat the urinary system: a comparison using a sequential three-solvent extraction process. The Journal of Alternative and Complementary Medicine, 13(1), 103-110.

COMPILED BY: KATHY SADOWSKI

UPDATED: 9/13/19