Black Cohosh Appears Safe, but May Not Benefit Women With PCOS-Related Infertility

Black cohosh is a natural phytoestrogen product occasionally used in the management of PCOS-related infertility.

While the use of black cohosh appears to be safe, there is limited evidence supporting its effectiveness in improving pregnancy rates in women with polycystic ovary syndrome (PCOS)-related infertility, according to the findings of a systematic review recently published in the Journal of Pharmacy Practice.

Black cohosh, a natural phytoestrogen product, is occasionally used in the management of PCOS-related infertility. To assess the efficacy and safety of the herbal supplement for ovulation-induction, the authors conducted a literature search that identified 5 eligible records related to the use of black cohosh in women with PCOS.

“Improvement in hormone regulation and endometrial thickness were found for black cohosh groups compared with clomiphene citrate (CC),” the authors reported. Improvement in pregnancy rates was also observed in 3 randomized controlled trials in patients using black cohosh in addition to clomiphene citrate. As for safety, no differences in adverse events were reported for the black cohosh dosing regimens included in the analysis (20mg to 120mg daily).

Despite these findings, a lack of high-quality evidence and study heterogeneity limited the ability to make definitive conclusions.  “While black cohosh appears to be safe as studied, further safety investigations, including hepatic effects, are warranted,” the authors concluded.


Fan CW, Cieri-Hutcherson NE, Hutcherson TC. Systematic review of black cohosh (Cimicifuga racemosa) for management of polycystic ovary syndrome-related infertility. [published online April 29, 2021.] Journal of Pharmacy Practice. doi: 10.1177/08971900211012244

This article originally appeared on MPR