What Is Black Cohosh?

Black cohosh (Cimicifuga racemosa or Actaea racemosa) is a member of the buttercup family and a perennial herb native to North America. Traditionally, it was used by Native Americans for medicinal purposes.

As an herbal remedy, black cohosh is now commonly used for hot flashes, night sweats, and other menopausal symptoms. However, research on these and other uses of black cohosh is limited and conflicting.

This article explores some scientific evidence on black cohosh and its potential uses. It also covers dosage, side effects, precautions, interactions, and storage information.

Uses of Black Cohosh

Supplement use should be individualized and vetted by a healthcare professional, such as a registered dietitian (RD), pharmacist, or healthcare provider. No supplement is intended to treat, cure, or prevent disease. 

Although mixed, some research shows that black cohosh may be used to treat certain health conditions. The herb is probably best known as a potential treatment for symptoms of menopause and other ailments that affect the female reproductive system.

Below is a look at scientific evidence surrounding various potential uses of black cohosh.

Menopausal Symptoms

It's not exactly known why or how black cohosh may alleviate menopausal symptoms. While some studies have shown positive effects of the herb, others have found black cohosh to have little to no use in treating symptoms of menopause.

In one study, researchers compared black cohosh with evening primrose oil to see which (if any) was able to relieve hot flashes, a common vasomotor side effect of menopause. At the end of eight weeks, both herbs showed beneficial effects. However, black cohosh was said to improve both hot flashes and quality of life better than evening primrose oil.

However, other research has found no association between black cohosh use and the relief of symptoms such as hot flashes.

The North American Menopause Society advises against using unproven remedies like black cohosh for alleviating vasomotor symptoms due to insufficient evidence.

Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common hormonal imbalance that affects many women and can cause acne, infertility, mood swings, and other issues.

Although research is lacking in this area, some studies have evaluated the potential use of black cohosh in PCOS, specifically when it comes to infertility.

One systematic review looked at whether black cohosh could be used to induce ovulation and improve pregnancy rates in people assigned female at birth with PCOS. The researchers determined there was not enough high-quality data to support black cohosh's use for this purpose.

More thorough and better-designed research is needed to understand the relationship between black cohosh and PCOS.

Other Uses

Other common uses of the herb include:

• Night sweats
• Vaginal dryness
• Heart palpitations
• Tinnitus (ringing or other noises in the ears)
• Vertigo (spinning, dizzying sensation)
• Sleep disturbances
• Nervousness
• Irritability

Although people may use black cohosh for these and other health issues, there is not enough supportive research. Higher-quality studies are needed before determining whether black cohosh is an effective treatment for these conditions.

What Are the Side Effects of Black Cohosh?

Although rare, you may experience side effects when using black cohosh. These side effects may be mild or severe.

Common Side Effects

Generally, black cohosh is thought to be safe. But mild side effects are possible.

Common side effects of black cohosh may include:

• Upset stomach
• Cramping
• Headache
• Rash
• A feeling of heaviness
• Vaginal spotting or bleeding
• Unintended weight gain

Typically, side effects go away once you stop taking the substance. However, if side effects persist or are concerning, you should speak with a healthcare provider.

Severe Side Effects

In extremely rare cases, black cohosh use has been reported to cause liver damage (including hepatitis). However, there is some thought that black cohosh itself may not be to blame, as some products that caused liver damage may have been contaminated.

Signs of liver damage may include:

• Abdominal pain
• Dark urine
• Jaundice (yellowing of the skin and whites of the eyes)

You should stop using black cohosh and seek medical attention if you notice these and other signs of liver damage.

Precautions

Some people may need to take extra precautions when using black cohosh.

There is not enough information available to know if black cohosh is safe for people who are pregnant or nursing. If you are pregnant or nursing, talk with your healthcare provider before using black cohosh.

You should also avoid black cohosh if you:

• Have a liver disorder
• Have a hormone-sensitive condition (like breast cancer)
• Have an allergy to plants in the buttercup (Ranunculaceae) family

It should also be noted that long-term studies on black cohosh are lacking. Not enough is known about the safety of taking black cohosh for longer than six months.

Be sure to talk with your healthcare provider before using black cohosh if you have these or other health conditions. It's always best to take precautions and be safe when using supplements.

Dosage: How Much Black Cohosh Should I Take?

Black cohosh dosage has not been standardized. This means that there are varying doses of black cohosh, and how much you take may depend on the reason you're using it or the brand you use.

Black cohosh studies have used a wide range of doses, anywhere from 8 milligrams (mg) to 160 milligrams or more per day.

Because dosing has varied so much in research, it's difficult to determine a recommended dosage for everyone. For this reason, you should follow dosing instructions per your healthcare provider or black cohosh supplement label.

What Happens If I Take Too Much Black Cohosh?

Even though there are no recommendations for black cohosh dosage, it is possible to take too much of the herb. Taking too much black cohosh may increase your chances of side effects or even lead to toxicity.

Hepatotoxicity (liver damage) has been reported in rare instances of black cohosh usage. Although researchers do not know exactly why liver damage may occur, it's possible that it may be caused by taking too much black cohosh.

To prevent potential side effects or liver damage, take black cohosh exactly as directed.

Interactions

Black cohosh may interact with certain medications, supplements, or foods. However, extensive research needs to be done in this area, as not enough is known regarding potential interactions with black cohosh.

There is some preliminary evidence to suggest that black cohosh may interact with the following medications:

• Pacerone (amiodarone)
• Allegra (fexofenadine)
• Diabeta, Glynase (glyburide)
• Statin medicines, such as Lipitor (atorvastatin) and Crestor (rosuvastatin)

If you're taking these medications, check with your healthcare provider before using black cohosh.

Otherwise, black cohosh is thought to have a low likelihood of interacting with other medications, supplements, or foods. Though, more research is needed.

To be safe, carefully read the ingredients list and nutrition facts panel of a supplement to learn which ingredients are in it and how much of each ingredient is included. It's best to review supplement labels with your healthcare provider to discuss any potential interactions.

How to Store Black Cohosh

Store black cohosh supplements in a cool, dry place. They should also be kept out of direct sunlight. Proper storage will help ensure shelf-life. Take precautions to keep black cohosh out of reach of small children and pets.

Discard black cohosh supplements that have passed their expiration date.

Similar Supplements

There are supplements and herbs on the market that have been researched for uses similar to black cohosh:

• Red clover: Although research results have been conflicting, red clover may help alleviate certain menopausal symptoms, like hot flashes. One meta-analysis found red clover caused a significant reduction in daily hot flashes in perimenopausal and postmenopausal women.
• Inositol: A type of sugar found in the body, inositol may also be used in supplement form to help treat PCOS. However, additional studies are needed to confirm the findings and determine an appropriate dosage.
• Sea buckthorn oil: Like black cohosh, sea buckthorn oil has been studied for its potential uses in vaginal dryness. In one study, it showed beneficial effects on vaginal health.
• Vitex: Vitex (also known as chasteberry) is an herbal remedy that may reduce the incidence of night sweats. One small study on menopausal women found that vitex supplementation alleviated certain menopause symptoms, including night sweats.

There may be additional supplements that work in ways similar to black cohosh. However, you should typically only take one supplement at a time for a given reason. Talk with your healthcare provider about which supplements are best for you.

Sources of Black Cohosh & What to Look For

The best way to get all the nutrients your body needs is through a well-balanced diet. However, sometimes supplements and herbs may be recommended to you for various reasons.

There are a few things to remember when searching for black cohosh supplements.

Food Sources of Black Cohosh

Black cohosh is not found in any foods.

However, some people use dried black cohosh to make tea.

Typically, though, certain parts of the black cohosh plant are used to make herbal remedies. You can find these remedies in many forms.

Black Cohosh Supplements

Black cohosh is sold as capsules, tablets, gummies, and tinctures. You can also find dried black cohosh roots.

It is recommended that you look for supplements that contain black cohosh roots or rhizomes as these are thought to be the medicinal parts of the plant.

Most black cohosh supplements are naturally vegan and gluten-free but check the product label regarding these and other diet restrictions you may have.

Keep in mind that the Food and Drug Administration (FDA) does not strictly regulate or test supplements in the United States. As a result, the quality and amount of active ingredients in the product may vary from brand to brand.

To ensure better quality in your supplements, look for products certified by an independent third-party agency such as ConsumerLab, USP, or NSF International.

Summary

Black cohosh is an herb that may be used to treat various health conditions, most of which affect people assigned female at birth.

Despite its long use in traditional medicine, scientific evidence is conflicting regarding its use in relieving menopause symptoms like hot flashes, vaginal dryness, and night sweats.

Side effects are rare but possible when taking black cohosh, and certain people should take extra precautions. Talk with your healthcare provider before trying black cohosh to ensure it is right for you.