What Is Black Cohosh?

Black cohosh (Cimicifuga racemosa) is a member of the buttercup family. As an herbal remedy, it is used for hot flashes, night sweats, and other menopause symptoms. It is sometimes used as a natural alternative to hormone replacement therapy (HRT).

This article explores the research on black cohosh and its ability to treat menopause symptoms. In addition, this article discusses the potential side effects and warnings of taking black cohosh.

What Is Black Cohosh Used For?

Black cohosh contains a compound similar to estrogen known as fukinolic acid. Research suggests fukinolic acid may ease menopause symptoms caused by age-related declines in estrogen levels.

These include:

• Hot flashes
• Mood swings
• Night sweats
• Vaginal dryness

In addition, black cohosh is used to treat menstrual irregularities and ease premenstrual syndrome.

While popular, research is mixed as to whether or not black cohosh actually helps.

Menopause Symptoms

A comprehensive review of studies investigating the effect of black cohosh on menopause symptoms was published in the Cochrane Database of Systematic Reviews in 2012.

The review included 16 clinical trials and a total of 2,027 women. The studies compared black cohosh to other treatments or a placebo (sugar pill).

The data showed black cohosh did not relieve hot flashes any better than a placebo. In addition, black cohosh was found to be less effective than HRT.

The research did not show whether black cohosh can help relieve vaginal dryness and night sweats. The study authors noted that more research is needed.

Possible Side Effects

Side effects of black cohosh may include:

• Headache
• Heaviness in the legs
• Indigestion
• Low blood pressure
• Nausea
• Perspiration
• Vomiting
• Weight gain

In large doses, black cohosh may cause seizures, visual disturbances, and a slow or irregular heartbeat.

Contraindications

Do not take black cohosh if you:

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

Interactions

Black cohosh has estrogen-like activity. It may interfere with HRT or hormonal birth control pills.

Black cohosh may also interact with the cancer drug cisplatin. This could make cisplatin less effective.

Dosage and Preparation 

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

The dose used in clinical trials is 40 milligrams (mg) a day, split into two doses.

What to Look For 

Look for supplements that contain black cohosh root, the medicinal part of the plant.

The Food and Drug Administration (FDA) does not regulate supplements. As a result, the quality and amount of active ingredients in the product can vary from brand to brand.

Look for products certified by an independent third-party tester such as Consumer Labs, U.S. Pharmacopeia, or NSF International.

Other Questions 

What are other natural menopause remedies?

Acupuncture may help. A 2016 study found acupuncture can help reduce hot flashes and improve sleep quality in menopausal women.

Natural remedies such as red clover, soy, St. John's wort, and evening primrose oil also show promise in the treatment of menopause-related symptoms. However, more research is needed.

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, or white baneberry.

These plants have different effects than black cohosh. In addition, blue cohosh and white cohosh can be toxic.

Summary

Black cohosh is an herbal remedy with estrogen-like properties that is used to treat menopause symptoms.

Despite its long use in traditional medicine, there is no scientific evidence to support its use in easing hot flashes, vaginal dryness, or night sweats related to menopause.