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August 2022

Black Cohosh and St. John's Wort for Menopausal Symptoms

Interest in using natural medicines for menopausal symptoms continues to grow. Some patients might ask about black cohosh and St. John’s wort. What should you tell them?

When it comes to black cohosh (Actaea racemosa), there’s evidence that using one specific product (Remifemin) might help with hot flashes, and it seems to be comparable to hormonal therapy. But it’s not clear if other black cohosh products help – the evidence is fairly mixed. This may be due to the way the black cohosh in these products is cultivated and processed. Remifemin is standardized to triterpene glycosides, whereas the contents of other products are not clearly defined. Additionally, some black cohosh products have been found to contain other species of Actaea, which may have different effects. 

As for St. John’s wort (Hypericum perforatum), most research shows that it can reduce menopausal symptoms such as hot flashes. It might also improve quality of life and psychological symptoms. It’s likely safe when used for up to 12 weeks, but keep in mind that St. John’s wort interacts with many drugs. Make sure to review any drugs or supplements a patient is taking before use.

To learn more about other natural medicines for menopausal symptoms, check out our Comparative Effectiveness Chart.

The information in this brief report is intended for informational purposes only, and is meant to help users better understand health concerns. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions. Copyright © 2022 Natural Medicines Inc. Commercial distribution or reproduction prohibited. Natural Medicines is the leading provider of high-quality, evidence-based, clinically-relevant information on natural medicine, dietary supplements, herbs, vitamins, minerals, functional foods, diets, complementary practices, CAM modalities, exercises and medical conditions. Monograph sections include interactions with herbs, drugs, foods and labs, contraindications, depletions, dosing, toxicology, adverse effects, pregnancy and lactation data, synonyms, safety and effectiveness.