Black Cohosh for Menopause: What to Know

Taking black cohosh for menopause could tackle your symptoms, but it might have some nasty side effects.

Here’s all you need to know about this controversial remedy.

Menopause is a completely normal and natural stage that everyone who has a period will go through.

But the symptoms can really get in the way of your day-to-day life.

Hormone replacement therapy (HRT) can be a helpful treatment.

But it’s not an option that everyone can (or wants to) take.

So what about taking black cohosh for menopause?

Well, this is a yes, but situation:

Yes, this herbal supplement seems to help a lot of people manage their menopause symptoms.

But because of the scientific evidence of its negative side effects, it has to carry a warning label in some countries.

As always, you should talk to your doctor before you start any treatments for menopause symptoms.

Here’s why black cohosh might work — and why it should also be treated with caution.

In this article: 📝

What is black cohosh?

Black cohosh is a plant from the buttercup family.

For those who like Latin with their flora, it’s also known as Actaea racemosa.

Other names include bugbane, snakeroot, and the adorable fairy candles 🧚.

Black cohosh grows in the woodlands of North America.

So if your menopause exercise regimen includes long hikes in hardwood forests, you might have seen it growing in the wild.

The roots have been used in Native American medicine for centuries.

Since the 1950s, it’s been on the radar as a bit of a menopause all-rounder.

Like clary sage oil and other natural remedies, some people see it as a cure for fatigue, hot flashes, mood swings, sleep problems, and just about every other menopause symptom you can think of.

What does black cohosh do for menopause?

There’s lots of anecdotal evidence about the benefits of black cohosh for menopause.

It seems to help to make some unpleasant menopause symptoms less severe and easier to deal with.

Some scientific studies, like this one comparing black cohosh to evening primrose oil and this one reviewing the relevant data we currently have available, agree that it’s particularly useful against hot flashes.

How long does it take for black cohosh to work for menopause?

While it’s not an instant cure, it seems that many people have noticed a difference within four weeks of starting on the supplements.

So now for the big question:

Is black cohosh good for menopause?

Unfortunately, for every promising study, there’s another that doesn’t find any difference between black cohosh and a placebo.

The other problem is that no one has been able to put their finger on exactly why black cohosh supposedly works.

It might be that it increases the effect of the estrogen your body produces.

In theory, this should help with the hormone drop-off you go through during perimenopause.

In essence, black cohosh can’t make your ovaries produce more of their own estrogen.

But it could make the smaller amount of estrogen they do produce pack a bigger punch.

It also seems that black cohosh can be anti-inflammatory, which would help to reduce any pain or swelling that might be making your experience of menopause less enjoyable.

And that it includes being a possible therapeutic alternative for postmenopausal-mediated osteoporosis.

Plus, it might have a sedative effect, which can help to soften the impact of any menopause sleep problems.

And there’s more.

Black cohosh might act on the serotonin receptors in your brain, which could improve mood swings, anxiety, or depression associated with menopause.

But while this all sounds very promising, we just don’t have enough evidence or information about the long-term effects of black cohosh to say for sure.

What are side effects of black cohosh on menopause?

Unfortunately, even though many people have found it useful, some side effects of black cohosh are less than ideal:

1. GI symptoms

Many people have an upset stomach, cramping, or a general feeling of heaviness when they first start to take black cohosh tea for menopause or the supplement in tablet form.

2. Headaches

A sore head is also pretty common in the first weeks after you start taking this supplement.

3. Bleeding and spotting

Some people have vaginal bleeding or spotting, even if their periods have started to taper off.

4. Rash

And some people get a skin rash when they first take black cohosh.

If you get a rash, it’s best to stop taking the supplement, as it might be a sign of an allergic reaction.

And although it’s rare, some people are extremely allergic to this plant.

So if you have any symptoms like swelling around your mouth and face, hives, or difficulty breathing, get medical help straight away.

While none of these black cohosh side effects are pleasant, the one that the experts are most worried about is:

5. Liver damage

Whether black cohosh can cause liver damage is still up for debate.

One 2014 study exploring a case of potential liver toxicity by black cohosh could not limit liver injury to the herb alone.

And a wider study of black cohosh hepatotoxicity showed very little (if any) risk.

Equally, a separate study found little evidence that C. racemosa rhizome herbal extract could be considered a hazard for liver damage.

At best, we can say possibly.

We do know it can interact with other drugs to increase the chance that they’ll damage your liver.

For example, black cohosh doesn’t play nicely with duloxetine (an antidepressant).

It might also be best to avoid alcohol if you choose to take black cohosh.

Even though it’s a “natural” remedy, all black cohosh supplements sold in Australia carry the statement:

“Warning: Black cohosh may harm the liver in some individuals. Use under the supervision of a healthcare professional”.

And the US Pharmacopeia has recommended that the bottles read:

“Discontinue use and consult a healthcare practitioner if you have a liver disorder or develop symptoms of liver trouble such as abdominal pain, dark urine, or jaundice.”

Other considerations

It’s important to know that black cohosh might exacerbate any conditions related to high levels of estrogen, like PCOS or endometriosis.

It’s also been thought that taking black cohosh can increase your chance of developing breast cancer, especially if you have a family history.

Some more recent studies haven’t backed this up, but they also haven’t been able to prove that it’s completely safe to take.

Black cohosh dose for menopause

If you do decide to take this supplement, your next question might be: how much black cohosh should I take for menopause?

The problem with menopause supplements is that they’re not regulated, which makes it tricky to know how much you’re actually taking.

Some studies have used a dose of 40mg of black cohosh per day.

This is usually based on Remifemin tablets, which are somewhat more standardized than black cohosh tea or powder.

If you want to take black cohosh, ask your doctor about the proper dose.

And, just to be safe, make sure you know the symptoms of liver damage before you start:

• Dark urine
  
• Yellow skin
  
• Fatigue
  
• Upper abdominal pain
  
• Nausea

Stop taking the supplements and get medical help if you notice any of these symptoms.

Who can’t take black cohosh?

It seems pretty clear that anyone with a history of liver problems and people on certain medications should steer clear of black cohosh.

There may be some other natural menopause remedies that suit you better or some lifestyle changes you can make to help manage your symptoms.

And until we know more about why (and whether) black cohosh works for menopause symptoms, this is a remedy that everyone should treat with extra caution.

As always, your healthcare team knows your situation and medical history and can give you the best medical advice.

And for support, friendship, and a space to talk openly about your menopause experience, check in with the Peanut Menopause Community.