Black Cohosh and Breastfeeding

Summary of use during lactation

Black cohosh (Cimicifuga racemosa, formerly Actaea racemosa) root was thought to have mild estrogenic activity based on its triterpene content, which is standardized based on 27-deoxyactein. However, recent studies have found no estrogenic activity.[1,2] It is primarily used for postmenopausal symptoms and has been used to promote labor.[3-8] Currently, it has no specific uses during breastfeeding, although historically it was supposedly used by native American women as a galactogogue.[9] No data exist on the safety and efficacy of black cohosh in nursing mothers or infants. In general, there is a low frequency of adverse reactions, but dizziness, nausea, headache, rash, vomiting, and rarely, hepatitis and allergic reactions have been reported.[3,10,11] Some sources recommend against its use during breastfeeding because of the lack of safety data and its potential estrogenic activity,[10] while others do not contraindicate its use.[9] Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information about dietary supplements is available elsewhere on the LactMed Web site.

Drug levels in milk and infant serum

Maternal Levels. Relevant published information was not found as of the revision date. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

Relevant published information was not found as of the revision date.

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

References

1. LiskeE HanggiW Henneicke-von ZepelinHH Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med 2002 11 163 74 11975864 PubMed
2. RuhlenRL HaubnerJ TracyJK Black cohosh does not exert an estrogenic effect on the breast. Nutr Cancer 2007 59 269 77 18001221 PubMed
3. DennehyC TsourounisC BuiL The use of herbs by California midwives. J Obstet Gynecol Neonatal Nurs 2010 39 684 93 21044150 PubMed
4. ZhangAL StoryDF LinV A population survey on the use of 24 common medicinal herbs in Australia. Pharmacoepidemiol Drug Saf 2008 17 1006 13 18816875 PubMed
5. DugouaJJ SeelyD PerriD Safety and efficacy of black cohosh (Cimicifuga racemosa) during pregnancy and lactation. Can J Clin Pharmacol 2006 13 e257 61 17085773 PubMed
6. AllaireAD MoosMK WellsSR Complementary and alternative medicine in pregnancy: A survey of North Carolina certified nurse-midwives. Obstet Gynecol 2000 95 19 23 10636495 PubMed
7. TeschBJ Herbs commonly used by women: an evidence-based review. Am J Obstet Gynecol 2003 188 5 Suppl S44 55 12748451 PubMed
8. Low DogT. The use of botanicals during pregnancy and lactation. Altern Ther Health Med 2009 15 54 8 19161049 PubMed
9. McKennaDJ JonesK HumphreyS Black cohosh: efficacy, safety, and use in clinical and preclinical applications. Altern Ther Health Med 2001 7 93 100 11347288 PubMed
10. HardyML Women's health series: Herbs of special interest to women. J Am Pharm Assoc (Wash) 2000 40 234 42 10730024 PubMed
11. MahadyGB Low DogT BarrettML United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause 2008 15 628 38 18340277 PubMed