Black Cohosh Extract for the Management of Moderate to Severe Menopausal Symptoms in Thai Women

Inclusion Criteria: * Thai women, aged ≥ 40 years * Peri- or postmenopause * Moderate to severe menopausal symptoms from Kupperman menopausal index score at least 20 Exclusion Criteria: * Using any drugs or hormonal treatment within 1 month before enrollment * BMI ≥ 30 kg/m2 * Allergic to drugs or any ingredient * Liver disease or AST ≥ 37 U/L or ALT ≥ 40 U/L or total bilirubin ≥ 1 mg/dL or direct bilirubin ≥ 0.3 mg/dL * Psychiatric disease * Alcohol consumption or any elicit drug use * Vegetarian (may consume more phytoestrogen)