Document Type : Original Article


1 Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran,

2 Department of Obstetrics and Gynecology, School of Medicine, Hamadan University of Medical Science, Hamadan, Iran

3 Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Science, Hamadan, Iran,

4 Department of Social Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

5 MSc. of Midwifery consulting, Department of Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran


INTRODUCTION: Hot flashes are considered to be a common experience for menopausal women
and they can compromise the quality of life. The objective of this study is to assess the efficacy of
Cimicifuga racemosa in comparison with evening primrose oil (EPO) in postmenopausal women
with menopause‑related symptoms.
MATERIALS AND METHODS: This study was performed on 80 postmenopausal women with hot
flashes. The participants were randomly divided into two groups by blocked randomization. The
participants of one group received black cohosh and the other group received EPO for 8 weeks.
The severity and number of hot flashes and quality of life were measured by four‑point scale, and the
Menopause‑Specific Quality of Life (MENQOL) questionnaire at pre‑intervention, 1st, 4th, and 8th weeks
after treatment. Data were analyzed in SPSS Version 16 using independent t‑test, Chi‑square, and
Fisher’s exact test.
RESULTS: Average severity of hot flashes in both groups and number of hot flashes in black cohosh
group in 8th week were significantly lower than 1st week (P < 0.001), but number of hot flashes in
primrose oil group in 8th week showed no significant differences (P = 0.32). The number of hot flashes
and quality of life score in black cohosh arm compared to EPO showed a significant decrease in
the 8th week (P < 0.05). All MENQOL scores were significantly improved in two groups (P < 0.05),
but the percentage of improvement in black cohosh arm was significantly superior to EPO group.
CONCLUSION: Both herbs were effective in reduction of severity of hot flashes and improvement of
the quality of life, but it seems that black cohosh is more effective than primrose oil because it was
able to reduce the number of hot flashes too.


1. Bordeleau L, Pritchard K, Goodwin P, Loprinzi C. Therapeutic
options for the management of hot flashes in breast cancer
survivors: An evidence‑based review. Clin Ther 2007;29:230‑41.
2. Borrelli F, Ernst E. Black cohosh (Cimicifuga racemosa) for
menopausal symptoms: A systematic review of its efficacy.
Pharmacol Res 2008;58:8‑14.
3. Frei‑Kleiner S, SchaffnerW, RahlfsVW, BodmerCH, Birkhäuser M.
Cimicifuga racemosa dried ethanolic extract in menopausal
disorders: A double‑blind placebo‑controlled clinical trial.
Maturitas 2005;51:397‑404.
4. Freedman RR. Menopausal hot flashes: Mechanisms,
endocrinology, treatment. J Steroid Biochem Mol Biol
5. Guttuso T Jr. Effective and clinically meaningful non‑hormonal
hot flash therapies. Maturitas 2012;72:6‑12.
6. Nasr A, Nafeh H. Influence of black cohosh (Cimicifuga racemosa)
use by postmenopausal women on total hepatic perfusion and
liver functions. Fertil Steril 2009;92:1780‑2.
7. Farzaneh F, Fatehi S, Sohrabi MR, Alizadeh K. The effect of oral
evening primrose oil on menopausal hot flashes: A randomized
clinical trial. Arch Gynecol Obstet 2013;288:1075‑9.
8. Yousefi Z, Abdollahpour N, Ghazanfarpour M, Sadeghi R,
Pourmoghadam N. Impacts of herbal medicines on hot flash:
A systematic review. J Med Plants 2016;3:40‑6.
9. Borrelli F, Ernst E. Alternative and complementary therapies for
the menopause. Maturitas 2010;66:333‑43.
10. Borrelli F, Ernst E. Black cohosh (Cimicifuga racemosa):
A systematic review of adverse events. Am J Obstet Gynecol
11. Shahnazi M, Nahaee J, Mohammad‑Alizadeh‑Charandabi S,
Bayatipayan S. Effect of black cohosh (Cimicifuga racemosa) on
vasomotor symptoms in postmenopausal women: A randomized
clinical trial. J Caring Sci 2013;2:105‑13.
12. Bai W, Henneicke‑von Zepelin HH, Wang S, Zheng S, Liu J,
Zhang Z, et al. Efficacy and tolerability of a medicinal product
containing an isopropanolic black cohosh extract in chinese
women with menopausal symptoms: A randomized, double
blind, parallel‑controlled study versus tibolone. Maturitas
13. Chenoy R, Hussain S, Tayob Y, O’Brien PM, Moss MY, Morse PF,
et al. Effect of oral gamolenic acid from evening primrose oil on
menopausal flushing. BMJ 1994;308:501‑3.
14. Granica S, Czerwińska ME, Piwowarski JP, Ziaja M, Kiss AK.
Chemical composition, antioxidative and anti‑inflammatory
activity of extracts prepared from aerial parts of Oenothera
biennis L. and Oenothera paradoxa Hudziok obtained after seeds
cultivation. J Agric Food Chem 2013;61:801‑10.
15. Wathen CN. Alternatives to hormone replacement therapy:
A multi‑method study of women’s experiences. Complement
Ther Med 2006;14:185‑92.
16. Ruhlen RL, Sun GY, Sauter ER. Black cohosh: Insights into its
mechanism(s) of action. Integr Med Insights 2008;3:21‑32.
17. Dog TL. Menopause: A review of botanical dietary supplements.
Am J Med 2005;118:98‑108.
18. Mohammad‑Alizadeh‑Charandabi S, Shahnazi M, Nahaee J,
Bayatipayan S. Efficacy of black cohosh (Cimicifuga racemosa L.)
in treating early symptoms of menopause: A randomized clinical
trial. Chin Med 2013;8:20.
19. Chung DJ, Kim HY, Park KH, Jeong KA, Lee SK, Lee YI, et al.
Black cohosh and st. John’s wort (GYNO‑Plus®) for climacteric
symptoms. Yonsei Med J 2007;48:289‑94.
20. Rotem C, Kaplan B. Phyto‑female complex for the relief of hot
flushes, night sweats and quality of sleep: Randomized, controlled,
double‑blind pilot study. Gynecol Endocrinol 2007;23:117‑22.
21. SchellenbergR, SallerR, HessL, MelzerJ, ZimmermannC, Drewe J,
et al. Dose‑dependent effects of the Cimicifuga racemosa extract ze
450 in the treatment of climacteric complaints: A Randomized,
placebo‑controlled study. Evid Based Complement Alternat Med
22. Geller SE, Shulman LP, van Breemen RB, Banuvar S, Zhou Y,
Epstein G, et al. Safety and efficacy of black cohosh and red clover
for the management of vasomotor symptoms: A randomized
controlled trial. Menopause 2009;16:1156‑66.
23. Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for
menopausal symptoms. The Cochrane database of systematic
reviews. 2012(9):Cd007244.
24. Wuttke W, Seidlová‑Wuttke D, Gorkow C. The cimicifuga
preparation BNO 1055 vs. conjugated estrogens in a double‑blind
placebo‑controlled study: Effects on menopause symptoms and
bone markers. Maturitas 2003;44 Suppl 1:S67‑77.
25. Franco OH, Chowdhury R, Troup J, Voortman T, Kunutsor S,
Kavousi M, et al. Use of plant‑based therapies and menopausal
symptoms: A Systematic review and meta‑analysis. JAMA
26. Bayles B, Usatine R. Evening primrose oil. Am Fam Physician
27. van der Sluijs CP, Bensoussan A, Liyanage L, Shah S. Women’s
health during mid‑life survey: The use of complementary and
alternative medicine by symptomatic women transitioning
through menopause in sydney. Menopause 2007;14:397‑403.
28. Rouhi‑Boroujeni H, Rouhi‑Boroujeni H, Gharipour M,
Mohammadizadeh F, Ahmadi S, Rafieian‑Kopaei M, et al.
Systematic review on safety and drug interaction of herbal
therapy in hyperlipidemia: A guide for internist. Acta Biomed