Black cohosh (Cimicifuga racemosa) is the most popular natural approach to menopausal symptoms. Its popularity has increased in part due to the negative press on Hormone Replacement Therapy. The mechanism of action for black cohosh is thought to be via action on control centers in the brain and vascular system rather than through any estrogenic effect. According to detailed review of clinical and pre-clinical data black cohosh appears to be safe even in women at risk for breast cancer as well as breast cancer survivors. This position was bolstered even further as a study in human breast cancer cell lines showed black cohosh extract exerts no proliferative activity on these cells, but actually promotes both estrogen receptor positive and estrogen receptor negative breast cancer cells to commit cellular suicide (apoptosis).