Black cohosh (Actaea racemosa or Cimicifuga racemosa) is a flowering plant native to eastern North America that has been used for centuries in traditional medicine, particularly by Native Americans. Today, it remains a popular herbal supplement, primarily for women's health. The herb's roots and rhizomes are used to create various supplements. It is often marketed to alleviate menopause symptoms, but also for other conditions related to hormonal balance. While black cohosh is generally considered safe for most people, it's important to understand its potential benefits, side effects, and interactions before use.
What is Black Cohosh?
Black cohosh is a perennial plant that grows in the woodlands of eastern United States and Canada. It has fragrant white blooms on a stem, forming a spike-like structure of up to 5 feet tall. It belongs to the buttercup family.
The plant goes by other names, including:
- Black bugbane
- Black snakeroot
- Fairy candle
- Macrotys
- Rattleweed
- Rheumatism weed
Traditional Uses
Traditionally, black cohosh has been used for a variety of purposes:
- Native American medicine: To treat fever, cough, pain, and menstrual problems.
- Traditional Chinese medicine: To reduce musculoskeletal pain and spasms, support liver function and the nervous system, and tonify the kidney and uterus.
- Western herbal tradition: To reduce pain associated with arthritis, muscle problems, menstruation, nervous spasms, and PMS symptoms.
Active Compounds
The rhizome (underground stem) of the black cohosh plant contains several phytonutrients that may contribute to its medicinal properties:
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- Glycosides: Sugar molecules that might have antioxidant, anti-inflammatory, and blood pressure-lowering properties.
- Isoferulic acids: Substances that may help lower inflammation.
- Phytoestrogens: Hormone-like substances that may help your bones, skin, heart, and reproductive health.
Forms and Dosage
Black cohosh is available in several forms:
- Capsules
- Dried root (for tea)
- Extracts (to mix in water)
- Liquid tincture
- Powder
- Tablets
Dosage recommendations vary, with typical doses ranging from 20 to 80 mg daily. Some studies use doses between 6.5 to 160 mg. It is important to follow the directions on the product label or your doctor's recommendations. Some experts recommend using it for less than six months at a time.
Potential Benefits of Black Cohosh
Black cohosh is primarily known for its potential to alleviate menopause symptoms, but it has also been studied for other uses.
Menopause Symptoms
Alleviating menopause symptoms is the most common reason people use black cohosh. Studies suggest it may help with:
- Hot flashes: A 2018 study found that 20 mg of black cohosh daily for 8 weeks significantly reduced the frequency and severity of hot flashes in menopausal women.
- Night sweats (vasomotor symptoms): It may help relieve your hot flashes and night sweats (vasomotor symptoms).
- Mood changes: A recent review of 22 studies found it may help ease general menopause symptoms and hot flashes.
- Sleep problems: Some studies suggest it may improve sleep duration and quality in menopausal women.
- Vaginal dryness
One meta-analysis found that across nine studies, black cohosh improved symptoms of menopause by more than 25 percent. A study comparing black cohosh to a hormone therapy drug found both the drug and the supplement improved symptoms of menopause without significant differences.
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Women's Health
Black cohosh has been explored for other aspects of women's health, though the evidence is generally weaker than for menopause symptoms.
- Fertility: Some older, smaller studies suggest that black cohosh, when combined with clomiphene citrate (Clomid), may improve ovulation and pregnancy rates in women with unexplained infertility or PCOS-related fertility issues. A small study on women with PCOS found that black cohosh could positively impact hormone levels (LH and progesterone) and ratios and increase endometrial thickness to support ovulation even better than a fertility-supporting medication. In addition to the studies explicitly looking at black cohosh and fertility for women with PCOS, a few studies also found that adding black cohosh to Clomid improved the chance of getting pregnant for women with unexplained fertility.
- Menstrual cycle regulation: Black cohosh may help women with or without PCOS who are receiving fertility treatments like Clomid regulate their menstrual cycle.
- Fibroids: One 3-month study found that 40 mg of black cohosh daily may decrease the size of uterine fibroids by up to 30% in postmenopausal women. Since black cohosh may support estrogen levels in your body, it could also help with fibroids. While more research is needed, one study found that black cohosh helped shrink uterine fibroids by 30%.
- PMS and PMDD: Herbalists have used black cohosh for years to support symptoms of PMS or PMDD like cramps, headaches, breast tenderness, and mood changes. There aren't many studies to support it, but it may help because of the impacts on neurotransmitters and pain regulation mentioned above.
Mental Health
Black cohosh may have some beneficial effects on mental health, particularly in menopausal women. One review found that black cohosh was linked to significant improvements in psychological symptoms in menopausal women.
Cancer
While there was some concern that black cohosh could increase the risk of breast cancer because of its supposed estrogenic activity, several studies concluded this is not true. One study also found that black cohosh could positively impact survival time for women with breast cancer. In several animal or test-tube studies, black cohosh inhibited the expression of specific cells related to liver, colon, and prostate cancer cells.
Sleep
Black cohosh could support sleep by supporting how well you sleep while reducing sleep interruptions. The main benefits of black cohosh for better rest aren't necessarily directly related to sleep quality.
Weight Management
Since weight gain is a concern during menopause, scientists are also interested if black cohosh could help women slow or stop weight gain associated with fluctuating hormones. However, a few small studies suggest that it could help regulate appetite and support estrogen-related weight gain.
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Safety and Side Effects
Black cohosh is generally considered safe when taken as recommended and from a reputable source. However, potential side effects include:
- Digestive upset
- Skin rashes
- Infection
- Muscle pain
- Breast pain or enlargement
- Spotting or bleeding outside of your menstrual cycle
- Headache
- Mild weight gain
- Upset stomach
- Vaginal spotting
- Dizziness or lightheadedness
- Nausea or vomiting
- Excessive sweating (diaphoresis)
- High blood pressure (usually at higher doses)
Rarely, black cohosh has been linked to severe liver damage. It is important to discontinue use and consult a healthcare professional if you experience symptoms of liver problems, such as abdominal pain, jaundice (yellowing of the skin or eyes), or dark urine.
A 2018 animal study observed that high doses of black cohosh were linked to red blood cell damage, potentially leading to anemia.
If you have any concerns, consult a healthcare professional.
Precautions and Contraindications
Avoid black cohosh or use it with caution if you:
- Have liver disease
- Are pregnant or breastfeeding
- Have or have had hormone-sensitive conditions such as breast or uterine cancer, or endometriosis
- Are under 18 years old
- Have kidney disease
- Are at risk for stroke or blood clots
- Have a seizure disorder
- Have allergies to aspirin
Interactions
Black cohosh may interact with certain medications, including:
- Chemotherapy medicines (tamoxifen or irinotecan)
- High cholesterol medication (statins)
- Anti-allergy medication (fexofenadine)
- Heart medication for irregular heartbeat (amiodarone)
- Diabetes medication (glyburide)
It is crucial to discuss all medications and supplements you are taking with your doctor before starting black cohosh.
Alternatives to Black Cohosh
Some potential alternatives to black cohosh include:
- Blue cohosh: A North American flowering plant also used for women's health, but with little evidence to support its use and potential for severe side effects.
- Rhapontic rhubarb: Used for many of the same reasons as black cohosh and is the active ingredient in the popular menopause supplement Estroven.
- Red clover
- Soy isoflavones
- St. Johnâs wort
- Chasteberry
- Dong quai
- Vitamin C