What Is Black Cohosh?

Black cohosh (Actaea racemosa or Cimicifuga racemosa) is a perennial herb that belongs to the buttercup family. It is native to North America and has been known by various names throughout history, including snakeroot, macrotys, black bugbane, rattleweed, and bugwort.

In traditional Native American medicine, the roots of black cohosh were used to treat fever, cough, musculoskeletal pain, and complications associated with childbirth.

Today, the herb is commonly used as a dietary supplement to help improve symptoms of menopause and other conditions related to women. However, research supporting its effectiveness in treating these health issues is very limited.

Here's everything you need to know about black cohosh, including its benefits, uses, safety, and side effects.

Potential Benefits of Black Cohosh

Black cohosh offers various potential health benefits, but it is most commonly used for hot flashes and other menopausal symptoms.

Here is a look at what the research says about the potential health benefits of black cohosh.

May Relieve Menopausal Symptoms

Black cohosh shows promise in relieving menopausal symptoms, although its exact mechanism is unclear.

Menopause is a natural biological process that occurs when a woman's period stops permanently. It is characterized by hormonal changes that cause vasomotor symptoms like night sweats and hot flashes.

A recent 2022 review reported that black cohosh might be more effective than a placebo at improving vasomotor symptoms resulting from menopause. However, it does not seem to be more effective than traditional treatments like estrogen and progesterone therapy.

One study from 2018 involving 80 menopausal women discovered that taking 20 milligrams (mg) of black cohosh extract daily for eight weeks led to significant improvements in hot flash severity.

Another small study found that black cohosh may help manage menopausal sleep disturbances.

However, it's important to note that while some studies have demonstrated the potential benefits of black cohosh in reducing menopausal symptoms, others have found no significant association. Additional high-quality studies are needed to establish a clear relationship between the herb and symptoms of menopause.

May Help Prevent Breast Cancer

Some breast cancer patients and survivors have reported experiencing fewer and milder hot flashes and other menopausal symptoms when using black cohosh.

In addition, there is limited evidence that the herb may have a beneficial effect on breast cancer recurrence. Studies in women without a history of breast cancer have not shown a significant association.

It's important to note that most of the studies demonstrating these benefits have been observational, meaning they cannot establish a direct cause-and-effect relationship.

May Relieve Symptoms of PCOS

Black cohosh may offer potential benefits for individuals with polycystic ovary syndrome (PCOS), a condition characterized by an imbalance of hormones. Symptoms of PCOS often include irregular menstrual cycles, infertility, excess facial hair growth, and hair thinning.

A 2014 study in 98 patients with PCOS and infertility found that black cohosh may improve pregnancy rates when combined with Clomid, a medication commonly prescribed to treat infertility. Researchers discovered the herb may also help with menstrual cycle regulation.

However, a 2022 review concluded that there is insufficient high-quality evidence to support the effectiveness of black cohosh in improving pregnancy rates in those with PCOS-induced infertility.

Other Uses

Other uses of black cohosh include:

• Vaginal dryness
• Vertigo (an internal or external spinning sensation)
• Sleep disturbances
• Heart palpitations
• Tinnitus (a ringing sound in the ear)
• Irritability
• Nervousness
• Premenstrual syndrome (PMS)
  

There is currently a lack of solid evidence to support the effectiveness of black cohosh for these uses.

Some women also use black cohosh alone or with other herbs to stimulate labor induction. However, the use of black cohosh is discouraged during pregnancy as it isn't well studied in pregnant women and has been linked to severe adverse effects when combined with blue cohosh.

How to Take Black Cohosh

Black cohosh dietary supplements are made from the plant's roots and underground stems. They are generally sold as pills, powders, teas, and liquid extracts.

Black cohosh can generally be consumed at any time of the day. Some studies report improvements in symptoms after taking black cohosh for two to three months. However, this can greatly vary by individual.

Because its long-term safety isn't well-known, many health experts recommend limiting its use to less than six months.

Dosage

There is no standardized dosage for black cohosh supplements. Typical doses range from 20-160 milligrams per day, with 40 milligrams being a common dose.

Always talk to your healthcare provider to ensure safety and discuss your appropriate dose.

Is Black Cohosh Safe?

Black cohosh is generally considered safe for short-term use. However, there are some safety concerns to be aware of.

Potential Drug Interactions

The risk of black cohosh interacting with medications is minimal. Nevertheless, preliminary animal studies suggest that it may reduce the effectiveness of statins or cholesterol-lowering medications such as Crestor (rosuvastatin) and Lipitor (atorvastatin).

Additionally, there has been some concern that it may interact with the following medications:

• Diabeta, Glynase (glyburide)
• Paerone (amiodarone)
• Allegra (fexofenadine)

What to Look For

The FDA does not evaluate dietary supplements for safety and effectiveness before being sold. This means there is no guarantee that the label accurately reflects the ingredients in a supplement.

Some black cohosh supplements have been found to contain a different herb or a mixture of herbs that are not listed on the product label.

To ensure you get a quality supplement, choose a product from a reputable supplier that utilizes that third-party testing to verify the purity and accuracy of ingredients.

Reputable third-party testing organizations include:

• United States Pharmacopeia (USP)
• ConsumerLab
• NSF International
  

Can You Have Too Much Black Cohosh?

Taking too much black cohosh may increase the risk of side effects. There are some reports that it may also lead to liver damage. However, it is not known whether these occurrences were due to consuming too much or caused by other impurities or herbs present in the black cohosh supplements.

Additionally, because its long-term safety isn't well-known, many health experts recommend limiting its use to less than six months. Still, clinical trials have shown no serious side effects with 12 months of use.

Always take black cohosh as instructed to avoid potential safety concerns.

Side Effects of Black Cohosh

Most clinical trials to date have shown a low incidence of major side effects. However, there have been reports of mild side effects, including:

• Upset stomach
• Cramping
• Rashes
• A feeling of heaviness
• Vaginal bleeding
• Weight gain

People with liver disorders, as well as pregnant and breastfeeding women, should consult with their healthcare provider before taking black cohosh.

A Quick Review

Black cohosh is an herb traditionally used to treat various health issues, particularly those associated with women's health. While some evidence supports its effectiveness in treating hot flashes related to menopause, the research on its other uses is limited.

Short-term use of black cohosh is generally considered safe, with a low risk of severe side effects. However, it is still important to consult with a healthcare provider before taking black cohosh supplements, especially if you are taking other medications.