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What is Black Cohosh & Can It Relieve Menopause Symptoms?

Black Cohosh growing in a field

Table of Contents

Black cohosh (Cimicifuga racemosa) is a plant in the buttercup family, native to North America. Medicinal use of black cohosh is recorded as far back as prehistoric times. 

Black cohosh root and rhizomes are used today to treat various women’s hormonal health conditions. Most often, women in menopause report fewer hot flashes when they use this supplement. It can also relieve additional symptoms of menopause and other estrogen-related conditions. 

Some women opt to use black cohosh as an alternative medicine to traditional hormone replacement therapy (HRT) to avoid unwanted side effects of traditional medications. 

Not to be confused with white or blue cohosh, black cohosh is a flower that blooms white, as opposed to black. Black cohosh can be found in the woodlands of eastern North America and Canada.

Black cohosh also goes by the following names:

  • Actaea racemosa
  • Bugbane
  • Black snakeroot
  • Fairy candle
  • Rheumatism weed
  • Rattleweed

Western, Chinese, European, and Native American doctors and healers historically used black cohosh root to treat a wide range of health conditions including pain, cough, fever, and female health concerns. 

Today, black cohosh is an active ingredient in many modern women’s health supplements, including the popular Remifemin.

The Benefits of Black Cohosh

Black cohosh combats symptoms of menopause, including:

  • Hot flashes
  • Body aches
  • Weight gain
  • Night sweats
  • Vaginal dryness
  • Vasomotor symptoms (hot flashes and night sweats occurring together)

The most common reason women in menopause use black cohosh is to reduce hot flashes (also called hot flushes). Up to 80% of women in menopause suffer from hot flashes that cause symptoms including anxiety, sweating, heart palpitations, and feeling hot.

According to a 2010 systematic review, menopause symptoms improved by 26% in 7 clinical trials compared to a placebo. 

The use of black cohosh for cancer treatment-associated hot flashes is supported by weaker evidence than for menopausal hot flashes.

This herbal supplement is also linked to alleviating osteoporosis and arthritis symptoms.

By supporting hormonal balance, black cohosh is beneficial for women’s health conditions, including:

  • Perimenopause, menopause, and post-menopause
  • Premenstrual syndrome (PMS)
  • Menstrual cycle regulation
  • Menstruation cramping
  • Hormonal infertility
  • PCOS
  • Premenstrual dysphoric disorder
  • Fibroids
  • Mental health in menopausal women
  • Hormonal weight gain and obesity
  • Sleep

How Can it Relieve Menopause Symptoms?

Black cohosh root and black cohosh extract may act as phytoestrogens, chemical structures that mimics estrogen. Menopausal and postmenopausal women whose symptoms are caused by a decrease in estrogen and progesterone levels may benefit from phytoestrogens.Black cohosh is a natural option compared to traditional HRT which may have undesireable side effects. 

Black cohosh can bind to opioid receptors in the brain, which may be one reason it offers pain relief and calms the nervous system.

Supplement Guidance for Black Cohosh

The standard dosage of black cohosh for menopause is 40-128 mg daily for up to 12 months. For estrogen-deficient women who haven’t yet entered perimenopause, a smaller amount may be useful to increase estrogen levels.

How long does it take for black cohosh to work for menopause? Black cohosh may work for menopause symptom relief within 4 weeks, with more significant benefits after 8 weeks of treatment.

Common forms of black cohosh include capsules, tablets, powders, teas, and tinctures. Most supplements are standardized to provide at least 1 milligram of triterpene glycosides, the main component in black cohosh, per daily dose.

Consult your doctor when determining the best dose for your unique needs.

What is the best way to take black cohosh for menopause? The best way to take black cohosh for menopause is in a supplement or tincture. Traditionally, it was brewed and drank as tea, although this may not be the most effective way to consume it. 

What is the best black cohosh supplement for menopause? Our providers often recommend FemGuard + Balance by Designs for Health. This supplement contains not only black cohosh, but a great blend of other ingredients to support a healthier menopause. 

How to Brew Black Cohosh Tea

  1. Bring 1 cup of water to a simmer.
  2. Add ½ to 1 teaspoon of black cohosh root.
  3. Allow mixture to brew for 20-30 minutes.
  4. Strain the mixture.
  5. Sweeten the brew with honey or sugar.
  6. Drink up to 3 cups daily. 

Safety Concerns

Black cohosh shouldn’t be taken for more than 12 months at a time. Some evidence suggests long-term use may lead to complications like hepatitis, liver damage, or increased liver enzymes.

Don’t take black cohosh if you… 

  • … are allergic to plants in the buttercup plant family.
  • … are pregnant. It may cause uterine contractions and increase the likelihood of miscarriage.
  • … are breastfeeding.
  • … have diagnosed hormone-sensitive conditions. It may interfere with treatment for endometriosis, fibroids, or ovarian cancer.
  • … also take progesterone.
  • … have liver disease. Unconfirmed reports suggest it may interfere with liver function, but this may not be the case.
  • … are prone to blood clots, seizures, or stroke.

Black cohosh may have drug interactions with hormone medications such as birth control pills and HRT. If you’re on prescription medications, don’t take this supplement without talking to your trusted healthcare provider first.

Contrary to what some people used to think, black cohosh supplementation does not increase the risk of breast cancer.

The most commonly reported side effects of black cohosh are gastrointestinal upset and rashes, both of which are mild and transient. 

Mild side effects of black cohosh may include:

  • Weight gain
  • Sleep disturbances
  • Headache
  • Upset stomach
  • Rash
  • Low blood pressure
  • Indigestion

The FDA does not regulate black cohosh supplements, so it’s important to purchase organic supplements from a reputable company. You can also check whether a supplement is verified by a third-party testing organization such as NSF International, U.S. Pharmacopeia, or ConsumerLab.

Other Supplements That May Help

Dietary supplements that could help with the effects of menopause include the following:

  • Red clover may have estrogen-like effects, similar to black cohosh, that reduce symptoms of menopause.
  • Flaxseed contains lignans, which can aid in balancing hormones.
  • Calcium aids in preventing bone loss.
  • Vitamin D helps the body optimally absorb calcium. 
  • Soy helps rein in hot flashes. Soy nuts and tofu contain phytoestrogens, estrogen-like compounds that can help with hot flashes.
  • St. John’s wort reduces mood swings, especially when paired with black cohosh.

Is Black Cohosh Right for You?

Many women find menopause symptom relief by adding black cohosh into their routine. Talk to your doctor about whether or not you should give it a try.

Consider a holistic approach to healthcare — Our team at Sano Health Club digs deep to find the root cause of your symptoms and helps you select more natural treatment options. Schedule a free intro call with a care team member to learn how we can help.


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