Black cohosh (Cimicifuga spp.) for menopausal symptoms. Original paper

What was reviewed?

This Cochrane systematic review comprehensively assessed the clinical effectiveness and safety of black cohosh (Cimicifuga spp.) preparations for treating menopausal symptoms. The review synthesized data from randomized controlled trials comparing black cohosh to placebo, hormone therapy, red clover, fluoxetine, or other controls. It aimed to determine whether black cohosh reduces the frequency and severity of vasomotor symptoms (hot flushes, night sweats), vulvovaginal symptoms, and improves menopausal symptom scores, while evaluating its safety profile in perimenopausal and postmenopausal women.

Who was reviewed?

The review included sixteen randomized controlled trials involving a total of 2,027 women aged mostly between 50 and 56 years, all experiencing menopausal symptoms. Participants were perimenopausal or postmenopausal women recruited across various clinical and geographical settings, including the US, Germany, China, and Europe. Trials used oral monopreparations of black cohosh at doses ranging from 8 to 160 mg daily, over durations from 4 to 52 weeks. Control interventions included placebo, hormone therapy, red clover, fluoxetine, and other comparators.

Most important findings

Pooled evidence showed no statistically significant benefit of black cohosh over placebo in reducing the frequency or intensity of hot flushes or night sweats. Meta-analysis of five trials demonstrated a negligible mean difference in daily hot flush frequency and menopausal symptom scores. Comparisons of black cohosh with hormone therapy consistently favored hormone therapy, which significantly reduced vasomotor symptoms and menopausal scores. Trials comparing black cohosh to red clover or fluoxetine yielded inconclusive results due to limited data and heterogeneity. Safety data indicated no significant difference in adverse events between black cohosh and placebo, although reporting was incomplete. Data on secondary outcomes such as bone health, sexuality, quality of life, and cost-effectiveness were insufficient for conclusive analysis.

Key implications

Current evidence from randomized controlled trials does not support black cohosh as an effective treatment for menopausal vasomotor symptoms compared to placebo or hormone therapy. However, the overall quality of the evidence is moderate to low due to methodological limitations and heterogeneity among trials. Current safety data show that people generally tolerate black cohosh well, but researchers need to report findings more rigorously. Given the widespread use of black cohosh as a complementary therapy, researchers should conduct further high-quality, well-designed studies to clarify its efficacy, safety, and impact on quality of life and other clinically relevant outcomes. Understanding potential interactions with the microbiome and its influence on symptom modulation could enrich future investigations and help guide more targeted therapies for menopause.