Black cohosh: uses, benefits, and side effects

Menopause may be one of the most intimidating life phases for women thanks to symptoms like hot flashes, mood swings, and night sweats. 

If you’re seeking a natural remedy for menopause, black cohosh supplements may be an option. Extract from the flowering plant is said to maintain hormone balance and alleviate menopause symptoms like hot flashes. But it’s important to keep in mind that natural supplements are not regulated, and there is no guarantee that it contains effective doses of the substance. 

Modern Fertility

Get proactive about your reproductive health

Learn more

Black cohosh is an herb scientifically known as Actaea racemosa or Cimicifuga racemosa. Native to North America, black cohosh has historically been referred to as black snakeroot, rattleweed, and black bugbane. 

The black cohosh plant has been used by Native Americans to remedy fevers, cough, pneumonia, muscle pain, sluggishness, and irregular menstruation. European settlers then adopted the herb as a women's health tonic (USDHHS, n.d).

Today, black cohosh is typically found as a dietary supplement. The roots and underground stems (rhizomes) of the plant are dried and powdered and then packaged into tablets or capsules. You can also get isolated black cohosh extracts, which are available as liquid drops or pills. 

Some people use black cohosh supplements to relieve menopause symptoms including hot flashes, night sweats, vaginal dryness, sleep disturbances, and mood changes (USDHHS, n.d). 

Most women experience menopause between ages 45–54. During this time there is a natural decrease in reproductive hormones, which eventually stops a woman’s menstrual cycle. It’s officially considered menopause if you’ve gone 12 full months in a row without getting a period (Mehrpooya, 2018).

This decline and overall shift of sex hormones like estrogen and progesterone can lead to changes in physical and emotional health. This includes low libido, weight gain, and fatigue (Mehrpooya, 2018). 

Hot flashes are the most prevalent symptom. However, the severity and length of symptoms vary greatly from person to person (Santoro, 2015). 

Menopause is an unavoidable part of a woman’s life, but there are many treatments available to alleviate the symptoms. A few popular options include hormone replacement therapy (HRT), non-hormonal therapy, and alternative options like black cohosh (Santoro, 2015). 

Black cohosh is considered a complementary and alternative approach for menopause relief, meaning it’s used instead of traditional therapies like drugs. However, there is conflicting research on its effectiveness. Some studies show benefits while others do not (Leach, 2012; Castelo-Branco, 2020). 

One meta-analysis involving more than 2,000 people looked at studies that compared black cohosh to placebo, hormone replacement therapy, and other herbal supplements over the course of five months. 

The review found that black cohosh was less effective than HRT and no more effective than placebo in reducing the frequency or intensity of menopause symptoms like hot flashes (Leach, 2012). 

Another analysis suggests these types of supplements were associated with slight reductions in the frequency of hot flashes and vaginal dryness, but had no significant impact on night sweats (Franco, 2016). 

However, other studies found that while black cohosh isn’t as consistent a treatment compared to HRT, the supplement may be effective for some people during menopause (Castelo-Branco, 2020). 

It’s important to note that while these studies show promise, more research is needed, especially on standardized dosing and the duration of black cohosh treatment.

It’s unclear exactly how black cohosh benefits the body. However, certain compounds in the herb might work on some of the same receptors estrogen binds to. This could potentially lessen menopause symptoms associated with declining estrogen levels (Ruhlen, 2008). 

Black cohosh may also work by acting (Ruhlen, 2008): 

• On serotonin pathways (hormones related to mood regulation)

• As an antioxidant

• On inflammatory pathways 

Some studies also suggest that black cohosh binds to the body’s opioid receptors, which could have a pain-killing effect and ease muscle aches and body pains linked to menopause (Reame, 2008).

There’s no consensus on a general best dose of black cohosh to take. Doses can range anywhere from 8–160 mg per day, depending on the supplement you take (USDHHS, n.d; Leach, 2012). 

It’s important to keep in mind that natural supplements are not regulated, and there is no guarantee that it contains effective or safe doses of the substance. If you decide black cohosh is appropriate for you, a healthcare provider can help figure out the best dosage. 

Studies indicate that women begin to experience symptom relief four weeks after starting black cohosh supplements. Eight weeks showed even more noticeable benefits (Mohammad-Alizadeh-Charandabi, 2013; Mehrpooya, 2018). 

Keep in mind that everyone's response to supplements is different and there’s always a chance black cohosh may not be effective for you.

The following adverse reactions have been reported by people taking black cohosh supplements (Leach 2008): 

• Breast pain

• Breast enlargement

• Digestive upset

• Infection

• Vaginal spotting or bleeding

There have been rare reports of liver damage associated with taking black cohosh, but research so far has found no evidence of adverse effects on liver function (Naser, 2011). The long-term effects of supplementing with black cohosh aren’t fully known. The safety of use during pregnancy or breastfeeding is not known either (USDHHS, n.d.).

There is some scientific evidence that black cohosh can alleviate common symptoms associated with menopause. However, there are lots of factors to consider when deciding on the right therapy to help you through this hormonal shift. There is no one-size-fits-all approach.

If you’re interested in learning more about your options for managing menopause symptoms, talk with a healthcare provider who can guide you on treatments that are safe and effective for you. 

---

How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Editorial Guidelines | Medical Review Process

Current version

March 16, 2022

Written by

Molly Knudsen, MS, RDN

Fact checked by

Felix Gussone, MD

---

About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.