Black Cohosh for Menopause
Black cohosh has not reliably outperformed placebo for menopausal symptoms in the highest-quality trials, and it carries a rare but serious risk of liver injury, so the evidence is weak and use warrants caution.
Why this grade7-layer evidence engine
The grade is weak because the strongest studies came up empty. The NIH-funded HALT trial (PMID 17179056, n=351) found black cohosh no better than placebo at 3, 6, or 12 months, with hormone therapy clearly superior, and the 2012 Cochrane review (PMID 22972105, n=2027) reported essentially no difference in hot-flush frequency (MD 0.07/day). These high- and moderate-quality results anchor the conclusion that a general benefit is not established.
The evidence is genuinely mixed rather than uniformly negative. Two meta-analyses found significant relief, but both center on one standardized isopropanolic extract (iCR/Remifemin): PMID 33021111 (SMD -0.694) carries a manufacturer conflict of interest, and PMID 37192826 (Hedges' g 0.575) showed benefit for hot flushes but none for anxiety or depression. Any real effect appears limited to specific extracts, not generic black cohosh.
The decisive factor for caution is safety, not just efficacy. Mayo Clinic notes 'mixed results' and a possible link to liver damage, the UK NHS says benefit is 'not supported by scientific evidence,' and EU and UK regulators mandate liver-injury warnings. Specialty and Harvard sources do not recommend it. Hence a weak grade flagged for safety review.
Scoring transparency
All scores computed by a 7-layer evidence engine — fully auditable▸View the full decision path (audit trail)
- compute_raw_score — 加權公式: L2×0.30 + L3×0.25 + L5×0.25 + L11×0.10 + L1×0.10 = 0.428
- tier_from_score — 依分數區間映射至 tier letter
- apply_hec_rules — 高階證據未達主導 (1 positive vs 1 negative)，由 raw_score 決定
- tier_strict_requirement_check — Tier 條件達標，未降階
- detect_disputes — 偵測到 0 個 hard + 0 個 soft dispute
- decide_status — 依 tier + dispute 結果決定 status