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June 2013

Black Cohosh and St. John's Wort May Improve Menopausal Symptoms

A combination of black cohosh and St. John's wort may have positive effects on hot flashes and other menopausal symptoms, a study reports.

Black cohosh is popular as an alternative to hormonal therapy in the treatment of menopausal symptoms such as hot flashes, mood disturbances, excessive sweating, palpitations, and vaginal dryness. Several studies have reported black cohosh may improve menopausal symptoms for up to one year, although the evidence is mixed. The mechanism of action of black cohosh remains unclear. Research suggests that there may be no direct effects on estrogen receptors, although this is an area of active controversy.

Extracts of Hypericum perforatum L. (St. John's wort) have been recommended traditionally for a wide range of medical conditions. The most common modern-day use of St. John's wort is the treatment of depression. Numerous studies report St. John's wort to be more effective than placebo and equally effective as tricyclic antidepressant drugs in the short-term treatment of mild-to-moderate major depression (1-3 months). It is not clear if St. John's wort is as effective as selective serotonin reuptake inhibitor (SSRI) antidepressants such as sertraline (Zoloft®).

In the current study, the researchers evaluated the possible benefits of black cohosh alone, St. John's wort alone, or the two in combination on menopausal symptoms such as hot flashes. They analyzed data from the available literature and reviewed the findings of each. Included studies looked at concentration, sleep, psychological problems, and vaginal dryness, and researched a number of other herbs in addition to black cohosh and St. John's wort.

The results suggested that black cohosh may lack benefit in comparison to placebo. However, the combination of black cohosh and St. John's wort appeared to improve menopausal symptoms when compared to placebo. Some trials revealed that significant differences were lacking between black cohosh and hormone replacement therapy for menopausal complaints.

The researchers concluded that the available data appears to support the use of black cohosh and St. John's wort together for treating menopausal symptoms. Further study is needed to confirm and better understand these findings.

Calcium, phytoestrogens, rose hip, and vitamin B6 have all been studied for use in improving symptoms of menopause. There is good scientific evidence supporting the effectiveness of these integrative therapies for this purpose.

For more information about black cohosh or St. John's wort, please visit Natural Standard's Foods, Herbs & Supplements Database.


  1. Laakmann E, Grajecki D, Doege K, et al. Efficacy of Cimicifuga racemosa, Hypericum perforatum and Agnus castus in the treatment of climacteric complaints: a systematic review. Gynecol Endocrinol. 2012 Sep;28(9):703-9. doi: 10.3109/09513590.2011.650772. Epub 2012 Mar 2. 
  2. Natural Standard: The Authority on Integrative Medicine. 

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