The Benefits of Black Cohosh

Black cohosh (Cimicifuga racemosa) is a plant used in herbal medicine. A member of the buttercup family, it has a long history of use in the treatment of arthritis and muscle pain. Today, however, black cohosh is commonly taken for relief of symptoms associated with menopause.

Fukinolic acid (a compound found in black cohosh) appears to have estrogen-like activity. Proponents suggest that black cohosh's potentially estrogen-like effects may be beneficial to women as they experience menopause-related declines in their estrogen levels (a key factor in the development of menopausal symptoms). To that end, black cohosh is sometimes touted as a natural alternative to hormone replacement therapy.

Black cohosh is used as a natural remedy for a number of menopause-related symptoms, including hot flashes, night sweats, disturbances in mood, and vaginal dryness.

In addition, black cohosh is sometimes used to treat menstrual irregularities and alleviate symptoms of premenstrual syndrome.

While black cohosh is among the most popular natural remedies for menopausal symptoms, studies testing its effectiveness have produced conflicting results.

The most comprehensive research on black cohosh and menopausal symptoms include a report published in the Cochrane Database of Systematic Reviews in 2012. For this report, scientists looked at 16 previously published clinical trials (with a total of 2,027 women) that compared the effects of black cohosh to those of a placebo, hormone replacement therapy, red clover, and other interventions in the treatment of menopausal symptoms.

In their analysis, the review's authors found no significant difference between black cohosh and placebo in the relief of hot flashes. What's more, hormone replacement therapy appeared to be more effective than black cohosh for hot flash relief. Due to insufficient data, no firm conclusions could be drawn as to black cohosh's effectiveness in treating symptoms such as vaginal dryness and night sweats.

Since the reviewed studies were of "uncertain quality," the report's authors concluded that further research on the use of black cohosh in the treatment of menopausal symptoms is warranted.

It should also be noted that very few studies have evaluated black cohosh's effectiveness as a treatment for menstrual problems. Still, some preliminary research (including a rat-based study published in the Journal of Steroid Biochemistry and Molecular Biology in 2007) indicates that black cohosh may help reduce menstrual pain.

Use of black cohosh may trigger a range of side effects, such as a headache, heaviness in the legs, indigestion, low blood pressure, nausea, perspiration, vomiting, and weight gain.

Excessive doses of black cohosh may cause seizures, visual disturbances, and slow or irregular heartbeat.

There have been several case reports of hepatitis and liver failure among women taking black cohosh. Although it's not known whether black cohosh contributed to the development of these conditions, United States Pharmacopeia experts urge women to discontinue use of black cohosh and seek medical attention if they experience symptoms such as abdominal pain, dark urine, and jaundice.

Additionally, black cohosh should be avoided by people with hormone-sensitive conditions (such as breast cancer, prostate cancer, endometriosis, and uterine fibroids), as well as by those with a history of blood clots, stroke, seizures, and/or liver disease. Individuals taking medications for high blood pressure should also avoid black cohosh.

Due to its possible estrogen-like activity, there's some concern that black cohosh could interfere with the effectiveness of hormone replacement therapy or oral contraceptives.

The safety of black cohosh in pregnant or breastfeeding women or children hasn't been established. Black cohosh could stimulate uterine contractions and result in miscarriage.

In August 2006, Health Canada advised consumers of the possible link between black cohosh and liver damage. In June 2007, the United States Pharmacopeia proposed that black cohosh product labels contain a cautionary statement. The American Botanical Council has countered that there is insufficient evidence to warrant the proposed caution.

Black cohosh should not be confused with the herb blue cohosh (Caulophyllum thalictroides), white cohosh, bugbane, Cimicifuga foetida, sheng ma or white baneberry. These species have different effects, and blue cohosh and white cohosh, in particular, can be toxic. There is a case report of neurological complications in a post-term baby after labor induction with a herbal blend of black cohosh and blue cohosh.

People with allergies to plants in the buttercup (Ranunculaceae) family should avoid black cohosh.

Black cohosh contains small amounts of salicylic acid, so people with allergies to aspirin or salicylates should avoid black cohosh.

People with a history of blood clots or stroke, seizures, liver disease and those who are taking medications for high blood pressure should not use black cohosh.

Black cohosh may interfere with the effectiveness of the chemotherapy drug cisplatin.

Black cohosh supplements haven't been tested for safety and keep in mind that the safety of supplements in pregnant women, nursing mothers, children, and those with medical conditions or who are taking medications have not been established. If you're considering the use of black cohosh, talk with your primary care provider first. 

There's some evidence that alternative therapies like acupuncture may be of some benefit to women going through menopause. Studies suggest that acupuncture may help reduce hot flashes and improve sleep quality in menopausal women.

Natural remedies such as red clover, soy, St. John's wort, progesterone cream, and evening primrose oil also show promise in the treatment of menopause-related symptoms. However, as in the case of black cohosh, more research is needed to determine the effectiveness of these remedies.