Objective To investigate the efficacy of cimicifuga racemosa in reatment of postmenopausal vaginal atrophy. Methods Seventy 45-60 years old women, who had menopause for more than one year and symptoms of postmenopausal vaginal atrophy, were randomly divided into two groups: observation group(n=40) and placebo group(n=30). The observation group was given cimicifuga racemosa (remifemin) 20 mg twice a day for 12 weeks. The placebo group was given one calcium carbonate and vitamin D3 tablet twice a day for 12 weeks. The serum levels of follicle stimulation hormone (FSH) and estradiol (E2) and thickness of endometrium were examined before and after treatment. The vaginal pH value, maturation degree of vaginal exfoliated cells, and atrophic vaginitis evaluating score were used to assess the therapeutic effects. The adverse effects were recorded. Results In the observation group there were no significant differences in FSH and E2 levels and endometrium thickness before and after treatment (P>0.05). The vaginal pH value showed a decreasing tendency and the maturation degree of vaginal exfoliated cells showed an increasing tendency after treatment in the observation group, but there were no significant differences (P>0.05). The atrophic vaginitis evaluating score was significantly higher before treatment compared with that after treatment (6.0±0.6 vs 3.3±0.6, P<0.05). There were no adverse effects during the treatment. Conclusion The remifemin shows certain therapeutic effects for vaginal atrophy in postmenopausal women.