Black cohosh and 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 do not show a benefit for breast cancer survivors or women without cancer.
Although studies have not shown any harmful side effects of black cohosh for breast cancer survivors, 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.
Menopausal Symptoms Studied
Black Cohosh Reduced Menopausal Symptoms More Than Placebo?
Randomized controlled trials
Herbal Alternatives for Menopause Study [1-2]
Osmers et al. 
Hot flashes and
Uebelhack et al. *
Pockaj et al. 
Frei-Kleiner et al. 
van der Sluijs et al. †
Jacobson et al. 
Franco et al. 
Cochrane Collaboration 
* Supplement contained black cohosh and St. John’s wort.
† Supplement contained black cohosh and Chinese herbs.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 9:CD007244, 2012.