A continuing education article on Medscape presents a nice summary on the use of black cohosh to treat the symptoms of menopause.

Current use

  • It’s an alternative to hormonal therapy to treat hot flashes, mood disturbances, sweating, heart palpitations, and vaginal dryness.
  • Supporting evidence is mixed, especially beyond 6 months of treatment.
  • Most studies use the black cohosh product Remifemin (Schaper & Brümmer).

What we know.

  • Black cohosh is well tolerated for up to 6 months.
  • Side effects include rash and gastrointestinal symptoms, headache, nausea, dizziness, seizures, sweating, or constipation.
  • Low blood pressure has been reported.
  • Hepatitis and liver toxicity have been reported.
  • There are reports of interactions with drugs that are metabolized via the CYP450 liver enzyme system.
    • CYP450 enzymes account for almost half of the elimination of commonly used drugs, although that does not mean they are all significantly affected.
  • Use with salicylates and medicine associated with bleeding risk, including anticoagulants or herbs such as garlic and ginkgo biloba, is not recommended.

What we don’t know.

  • The mechanism of its action is not known.
  • Safety during pregnancy and breastfeeding is not known.
  • The effect of black cohosh with estrogens, evening primrose oil, soy, and other products that have purported estrogenic properties is not known.

Now you know.

2/14/08 15:10 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at www.Vicus.com, a complementary and alternative medicine website.