Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidence

source extracted confidence: high 2026-04-09
#2-propanol #cimicifuga #female #hot-flashes #humans

Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidence

Castelo-Branco et al., 2021 | Climacteric | Meta Analysis

Citation

Castelo-Branco C, Gambacciani M, ... Pickartz S. Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidence. Climacteric. 2021-Apr;24(2):109-119. doi:10.1080/13697137.2020.1820477

Abstract

A systematic literature search revealed 35 clinical studies and one meta-analysis comprising 43,759 women, of which 13,096 were treated with isopropanolic Cimicifuga racemosa extract (iCR). Compared to placebo, iCR was significantly superior for treating neurovegetative and psychological menopausal symptoms, with a standardized mean difference of -0.694 in favor of iCR (p < 0.0001). Effect sizes were larger when higher dosages of iCR as monotherapy or in combination with St. John's wort (Hypericum perforatum [HP]) were given (-1.020 and -0.999, respectively), suggesting a dose-dependency. For psychological symptoms, the iCR+HP combination was superior to iCR monotherapy. Efficacy of iCR was comparable to low-dose transdermal estradiol or tibolone. Yet, due to its better tolerability, iCR had a significantly better benefit-risk profile than tibolone. Treatment with iCR/iCR+HP was well tolerated with few minor adverse events, with a frequency comparable to placebo. The clinical data did not reveal any evidence of hepatotoxicity. Hormone levels remained unchanged and estrogen-sensitive tissues (e.g. breast, endometrium) were unaffected by iCR treatment. As benefits clearly outweigh risks, iCR/iCR+HP should be recommended as an evidence-based treatment option for natural climacteric symptoms. With its good safety profile in general and at estrogen-sensitive organs, iCR as a non-hormonal herbal therapy can also be used in patients with hormone-dependent diseases who suffer from iatrogenic climacteric symptoms.

Key Findings

With its good safety profile in general and at estrogen-sensitive organs, iCR as a non-hormonal herbal therapy can also be used in patients with hormone-dependent diseases who suffer from iatrogenic climacteric symptoms.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population hormone
Sample Size See abstract
Age Range See abstract
Condition See abstract

MeSH Terms

  • 2-Propanol
  • Cimicifuga
  • Female
  • Hot Flashes
  • Humans
  • Menopause
  • Middle Aged
  • Phytotherapy
  • Plant Extracts
  • Treatment Outcome

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Systematic Review
  • Vertical: st.-john's-wort

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09