Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment and selective reporting).
A Cochrane review «Black cohosh (Cimicifuga spp.) for menopausal symptoms»1 «Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) ...»1 included 16 studies with a total of 2027 subjects. All studies used oral monopreparations of black cohosh at a median daily dose of 40 mg, for a mean duration of 23 weeks. There was no significant difference between black cohosh and placebo in the frequency of hot flushes (mean difference (MD) 0.07 flushes per day; 95% CI -0.43 to 0.56 flushes per day; 3 trials, n=393) or in menopausal symptom scores (SMD -0.10; 95% CI -0.32 to 0.11; 4 trials, n=35). Compared to black cohosh, hormone therapy significantly reduced daily hot flush frequency (3 trials; data not pooled) and menopausal symptom scores (SMD 0.32; 95% CI 0.13 to 0.51; 5 trials, n=468).
A meta-analysis «Franco OH, Chowdhury R, Troup J et al. Use of Plan...»2 assessed plant-based therapies on menopausal symptoms. 4 RCTs on black cohosh showed that overall black cohosh was not associated with changes in the rate of hot flushes, night sweats frequency, or menopausal symptom score.