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Jean-Jacques Dugoua
Dugald Seely
Daniel Perri
Gideon Koren Koren
Edward Mills


Black Cohosh, cimicifuga racemosa, pregnancy, lactation, breastfeeding, systematic review



There is a lack of basic knowledge on the part of both clinicians and patients as to the indications for use and  safety  of  herbal  medicines  in  pregnancy  and  lactation.  This  is  one  article  in  a  series  that systematically reviews the evidence for commonly used herbs during pregnancy and lactation.


To systematically review the literature for evidence on the use, safety, and pharmacology of black cohosh focusing on issues pertaining to pregnancy and lactation.


We searched 7 electronic databases and compiled data according to the grade of evidence found.


Black cohosh, alone or in combination with other medicinal herbs as “mother’s cordial”, has a long traditional use and is frequently used by midwifes as a uterine stimulant and labour-inducing aid. Low- level evidence based on theory and expert opinion shows the following concerns with respect to black cohosh  use  during  pregnancy:  1)  labour-inducing  effects,  2)  hormonal  effects,  3)  emmenagogue properties and, 4) anovulatory effects. During lactation, there is low -level evidence from theoretical and expert opinion of black cohosh having hormonal properties.


Black cohosh should be used with caution during pregnancy, particularly during the first trimester where its purported labour-inducing effects could be of concern, and during lactation. Black cohosh should undergo rigorous high quality human studies to determine its safety in pregnancy and lactation.

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1. Foster S. Black cohosh: Cimicifuga racemosa: a literature review. Herbalgram 1999; 45:35-50.
2. Kligler B. Black cohosh. Am Fam Physician 2003;68:114- 6.
3. Liske E, Hanggi W, Henneicke-von Zepelin HH, Boblitz N, Wustenberg P, Rahlfs VW. Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med 2002; 11:163-74.
4. Mahady GB. Is black cohosh estrogenic? Nutr Rev 2003; 61:183-6.
5. Mahady GB, Pendland SL, Stoia A, Chadwick LR. In vitro susceptibility of Helicobacter pylori to isoquinoline alkaloids from Sanguinaria canadensis and Hydrastis canadensis. Phytother Res 2003; 17:217-21.
6. Beck V, Unterrieder E, Krenn L, Kubelka W, Jungbauer A. Comparison of hormonal activity (estrogen, androgen and progestin) of standardized plant extracts for large scale use in hormone replacement therapy. J Steroid Biochem Mol Biol 2003; 84:259-68.
7. Gunn TR, Wright IM. The use of black and blue cohosh in labour. N Z Med J 1996; 109:410-1.
8. McFarlin BL, Gibson MH, O'Rear J, Harman P. A national survey of herbal preparation use by nurse- midwives for labor stimulation. Review of the literature and recommendations for practice. J Nurse Midwifery 1999; 44:205- 16.
9. Jellin JM, Batz F, Hitchens K. Natural medicines comprehensive database. Stockton, CA: Therapeutic Research Faculty, 2004:1530.
10. Brinker F. The toxicology of botanical medicines. Sandy, Oregon: Eclectic Medical Publications, 2000:296.
11. Stoll W. [Phytopharmaceutical influences on atrophic vaginal epithelium. Double-blind study on Cimicifuga vs. an estrogen preparation]. Therapeutickon 1987; 1:23-32.
12. Warnecke G. Using phyto-treatment to influence menopause symptoms. Med Welt 1985; 36:871-4.
13. Lehmann-Willenbrock E, Riedel HH. [Clinical and endocrinologic studies of the treatment of ovarian insufficiency manifestations following hysterectomy with intact adnexa]. Zentralbl Gynakol 1988; 110:611- 8.
14. Mills SY, Jacoby RK, Chacksfield M, Willoughby M. Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: a double-blind study. Br J Rheumatol 1996; 35:874-8.
15. Mahady GB, Fabricant D, Chadwick LR, Dietz B.
Black cohosh: an alternative therapy for menopause? Nutr Clin Care 2002; 5:283- 9.
16. Farnsworth NR, Bingel AS, Cordell GA, Crane FA, Fong HH. Potential value of plants as sources of new antifertility agents I. J Pharm Sci 1975; 64:535- 98.
17. Jarry H, Harnischfeger G, Duker E. [The endocrine effects of constituents of Cimicifuga racemosa. 2. In vitro binding of constituents to estrogen receptors]. Planta Med 1985:316-9.
18. Liu Z, Yang Z, Zhu M, Huo J. [Estrogenicity of black cohosh (Cimicifuga racemosa) and its effect on estrogen receptor level in human breast cancer MCF- 7 cells]. Wei Sheng Yan Jiu 2001; 30:77-80.
19. Duker EM, Kopanski L, Jarry H, Wuttke W. Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats. Planta Med 1991; 57:420- 4.
20. Kruse SO, Lohning A, Pauli GF, Winterhoff H, Nahrstedt A. Fukiic and piscidic acid esters from the rhizome of Cimicifuga racemosa and the in vitro estrogenic activity of fukinolic acid. Planta Med 1999; 65:763- 4.
21. Liu J, Burdette JE, Xu H, et al. Evaluation of estrogenic activity of plant extracts for the potential treatment of menopausal symptoms. J Agric Food Chem 2001; 49:2472-9.
22. Einer-Jensen N, Zhao J, Andersen KP, Kristoffersen K. Cimicifuga and Melbrosia lack oestrogenic effects in mice and rats. Maturitas 1996; 25:149- 53.
23. Zierau O, Bodinet C, Kolba S, Wulf M, Vollmer G. Antiestrogenic activities of Cimicifuga racemosa extracts. J Steroid Biochem Mol Biol 2002; 80:125- 30.
24. Bodinet C, Freudenstein J. Influence of Cimicifuga racemosa on the proliferation of estrogen receptor- positive human breast cancer cells. Breast Cancer Res Treat 2002; 76:1 -10.
25. Dixon- Shanies D, Shaikh N. Growth inhibition of human breast cancer cells by herbs and phytoestrogens. Oncol Rep 1999; 6:1383 -7.
26. Loser B, Kruse SO, Melzig MF, Nahrstedt A. Inhibition of neutrophil elastase activit y by cinnamic acid derivatives from Cimicifuga racemosa. Planta Med 2000; 66:751 -3.

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