The Health Benefits of Black Cohosh

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

A key component of black cohosh is fukinolic acid, a compound that has estrogen-like properties. Proponents suggest this may be beneficial to women as they experience age-related declines in estrogen levels, a key factor in the development of menopausal symptoms.

Black cohosh is sometimes touted as a natural alternative to hormone replacement therapy. It 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. Here's a look at the science:

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.

Side effects of black cohosh include headache, heaviness in the legs, indigestion, low blood pressure, nausea, perspiration, vomiting, and weight gain.

In excessive doses, black cohosh may cause seizures, visual disturbances, and slow or irregular heartbeat. Discontinue the use of black cohosh and seek medical attention if you experience symptoms such as abdominal pain, dark urine, and jaundice.

If you have any of the following conditions, do not take black cohosh:

• Hormone-sensitive conditions, such as breast cancer, prostate cancer, endometriosis, or uterine fibroids
• A history of blood clots, stroke, seizures, or liver disease
• Are taking medications for high blood pressure
• Are allergic to plants in the buttercup (Ranunculaceae) family
• Are allergic to aspirin or salicylates, as black cohosh contains small amounts of salicylic acid
• Are pregnant as black cohosh may stimulate uterine contractions

Due to its possible estrogen-like activity, black cohosh may interfere with the effectiveness of hormone replacement therapy or oral contraceptives.

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

Black cohosh is sold as capsules, gel caps, and tinctures. There is no recommended daily allowance for black cohosh.

What to Look For 

The part of the black cohosh plant used medicinally is the root and most preparations of it specify it is from the root.

When selecting a brand of supplements, look for products that have been certified by Consumer Labs, The U.S. Pharmacopeial Convention, or NSF International. 

Are there other natural remedies for menopause symptoms I could use?

There's some evidence that alternative therapies like acupuncture may be of some benefit to women going through menopause. Studies from 2016 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.

Is black cohosh the same as blue cohosh?

No. 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.