Black Cohosh for Menopause: Safety and Efficacy Issues and Future Perspectives

(L.) Nutt.] is an herb-al medicine that has been used in the United States for over 100 years for the treatment of many conditions, including menopausal symptoms. To date the clinical data remain controversial. While there are over 20 posi-tive clinical trials, all of the recent NIH-fund-ed studies are negative, casting doubt on its efficacy. In addition, the cases of hepatoxicity are replete, although direct causality to the ingestion of black cohosh has not been dem-onstrated. In vitro studies have suggested possible chemopreventative effects; however, the in vivo studies to date do not support this hypothesis and suggest enhanced metastases. Unresolved issues of quality, safety, and effi-cacy remain and until these issues are re-solved, the use of black cohosh products can-not be recommended.