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Hormones An unbalance of female hormones caused by periods, period irregularity, pregnancy, menopause, birth control pills can cause pigmentation

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In contrast to phytoestrogens such as soy isoflavones, black cohosh does not seem to produce estrogenic type stimulation of breast or uterine tissues and its effects may be mediated by serotonergic and dopaminergic pathways, antioxidant sources, or anti-inflammatory actions (98)

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The absence of large-scale human trials makes the true frequency of allergic responses across broader populations unknown

Chen X, Liao B, Cheng L, Peng X, Xu X, Li Y, et al