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46 The safety of black cohosh has been established in multiple clinical trials showing it does not have mutagenic effects in breast or endometrial tissue, does not impede treatment effects of tamoxifen (Soltamox) (a selective estrogen receptor modulator [SERM]) in breast cancer patients, and does not have liver toxicity

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It is well-tolerated by most people, and it does not interact with other medications

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And so I think we have to think about, as youre saying, this ecosystem, the digestive system, is not separate from the autonomic nervous system, from the gut microbiome, from the nervous system in general, from the immune system