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Nutrition and Diet in Menopause pp 377–392Cite as

Black Cohosh for the Menopausal Transition: Issues of Safety and Efficacy

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Part of the book series: Nutrition and Health ((NH))

Key Points

  • Black cohosh is an alternative therapy used for the management of menopausal symptoms by ­perimenopausal and postmenopausal women.

  • Data from the clinical trials are, at best, conflicted with many older clinical trials of poor quality showing beneficial effects in reducing vasomotor symptoms and the Kupperman Index.

  • However, the most recent, rigorous National Institutes of Health funded clinical studies have failed to note any benefit in reducing hot flashes and in fact have show that black cohosh alone, or in combination with soy may actually be worse than placebo.

  • The published clinical data for black cohosh has shown few adverse events, including the most recent trials. In particular, there was no evidence for hepatotoxicity of black cohosh during the 12-month intervention.

  • However, there are now well over 75 case reports of hepatotoxicity associated with the ingestion of black cohosh products. While reviews of these data have not completely proven causality, this combined with the conflicting data for efficacy from the clinical indicates that at this point in time black cohosh cannot be recommended for management of the menopausal transition.

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Abbreviations

BMI:

Body mass index

CAM:

Complementary and alternative medicine

CE:

Conjugated estrogen

CEE:

Conjugated equine estrogens

FSH:

Follicle stimulating hormone

HALT:

Herbal alternatives for menopause

HAMA:

Hamilton anxiety rating scale

HT:

Hormone therapy

KI:

Kupperman index

LH:

Luteinizing hormone

MPA:

Medroxyprogesterone acetate

MRS:

Menopause rating scale

NIH:

National Institutes of Health

RCT:

Randomized controlled clinical trial

SDS:

Self-assessment depression scale

USP-NF:

United States Pharmacopeia–National Formulary

WHI:

Women’s health initiative

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Authors and Affiliations

  1. Department of Pharmacy Practice, PAHO/WHO Collaborating Centre for Traditional Medicine, College of Pharmacy, University of Illinois, Rm 122, 833S. Wood Street, MC 886, Chicago, IL, 60612, USA

    Gail B. Mahady Ph.C., Ph.D.

Authors
  1. Gail B. Mahady Ph.C., Ph.D.
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Correspondence to Gail B. Mahady Ph.C., Ph.D. .

Editor information

Editors and Affiliations

  1. School of Nursing, Midwifery and Social, College of Health and Social Care, Department of Midwifery, University of Salford, Salford, M5 4WT, United Kingdom

    Caroline J. Hollins Martin

  2. Mel and Enid Zuckerman College of Public, Health, and School of Medicine, University of Arizona, Arizona Health Sciences Center, Tucson, 85724-5155, Arizona, USA

    Ronald Ross Watson

  3. Dept. Nutrition & Dietetics, King's College, Stamford St. 150, London, SE1 9NH, United Kingdom

    Victor R. Preedy

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Mahady, G.B. (2013). Black Cohosh for the Menopausal Transition: Issues of Safety and Efficacy. In: Hollins Martin, C., Watson, R., Preedy, V. (eds) Nutrition and Diet in Menopause. Nutrition and Health. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-373-2_28

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  • DOI: https://doi.org/10.1007/978-1-62703-373-2_28

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