What Black Cohosh Can (and Can’t) Do for Menopause Symptoms

If menopause has you all hot and bothered, you may have heard that taking black cohosh can help reduce vasomotor symptoms (more commonly known as hot flashes and night sweats). This herbal supplement has been used since ancient times, but only recently has it come to be known as a possible combatant of this common and uncomfortable symptom of menopause.

Integrative medicine specialist Yufang Lin, MD, explains what black cohosh is, how it’s used and what it can — and can’t — do for your menopause.

What is black cohosh?

Black cohosh (scientifically known as actaea racemosa or cimicifuga racemosa) is a flowering perennial plant with fragrant white blooms on a stem, forming a spike-like structure of up to 5 feet tall. A member of the buttercup family, it grows in the woodlands of the eastern United States and Canada.

Black cohosh goes by other names, too:

• Black bugbane
• Black snakeroot
• Fairy candle
• Macrotys
• Rattlewee
• Rheumatism weed.

The benefits of black cohosh

Studies show that black cohosh binds to your body’s opioid receptors, giving it a painkilling effect. Today, it’s sometimes used to reduce the muscle aches and body pains associated with menopause, perimenopause and postmenopause.

But while you may think it’s a new trend in wellness circles, it has actually been used since ancient times by healers and medical practitioners all over the world.

“In recent years, black cohosh has been touted as a treatment for hot flashes, but this is not the way it has been traditionally used,” Dr. Lin says. “Both traditional Chinese medicine and Western herbal tradition have long used black cohosh to reduce pain and calm the nervous system.”

Traditional Chinese medicine has turned to black cohosh to:

• Reduce musculoskeletal pain and spasms
• Support liver function
• Support the nervous system
• Tonify the kidney and uterus

Western herbal tradition uses black cohosh in similar ways, specifically to reduce pain associated with:

• Arthritis and muscle problems
• Menstruation, including cramps
• Nervous spasms and related pain
• Symptoms of premenstrual syndrome (PMS), including headaches and body aches

North American Indigenous peoples have also long used black cohosh to treat the pain associated with periods, childbirth and menopause symptoms. And in the 20th century, some physicians began using black cohosh for pain associated with gynecological disorders.

Taking black cohosh for hot flashes

Today, the roots and underground stems of black cohosh are turned into herbal supplements — in the form of capsules, powders and teas — and marketed as a way to reduce hot flashes.

Hot flashes, which are due in part to estrogen withdrawal, are the most common complaint during menopause, impacting up to 80% of women. Symptoms can range from mild to severe and include:

• Anxiety
• Feeling hot
• Palpitations
• Profuse sweating

But can black cohosh actually help get rid of hot flashes? Researchers aren’t convinced. “The application of black cohosh for hot flashes is relatively new to the 20th century, but research as a whole has not been supportive of this use,” Dr. Lin says.

One of the phytochemicals in black cohosh has a serotonin-like effect, which may impact your body’s ability to regulate temperature and ultimately help to reduce hot flashes — but it’s not a sure thing. “Not all black cohosh plants express the gene-encoding enzyme required to make this phytochemical,” Dr. Lin explains.

One study found no significant difference between participants who took black cohosh and those who took a placebo.

Black cohosh for other symptoms of menopause

Hot flashes aren’t the only unpleasant aspect of menopause and perimenopause — but the good news is that black cohosh may help reduce some of those other symptoms, including:

• Depressed mood
• Fatigue
• Increased body pain

“Black cohosh is an excellent herb to support those experiencing menopausal symptoms — just not consistently for hot flashes,” Dr. Lin says.

Is black cohosh safe to use?

“Black cohosh is generally safe when taken appropriately, but there are some people who should avoid it or use it very carefully,” Dr. Lin says.

Side effects of black cohosh are uncommon but may include:

• Breast pain or enlargement
• Cramping
• Headache
• Mild weight gain
• Muscle pain
• Rash
• Upset stomach
• Vaginal spotting

Cases of liver failure have been reported following the use of black cohosh, though researchers aren’t sure whether that’s actually a result of the supplement. “Still, if you have liver disease, you should stay away from black cohosh or use it with caution and have your liver function periodically monitored,” Dr. Lin advises.

Don't use black cohosh if you're pregnant or breastfeeding, due to its impact on the hormones.

How to take black cohosh

The standard black cohosh dosage is 40 mg to 128 mg of extract daily for up to 12 months. “The most common preparations are tinctures and capsules, but motivated individuals can make their own,” Dr. Lin says. To brew it at home:

• Simmer 1 cup of water with 1/2 to 1 teaspoon of dried black cohosh root
• Keep on stove top for 10 minutes to 15 minutes
• Strain and drink up to three cups per day

To ensure that you’re buying a safe, quality product, Dr. Lin recommends purchasing only organic black cohosh from reputable companies that have been independently verified by a third party such as ConsumerLab, U.S. Pharmacopeia or NSF International.