Black Cohosh

October 3, 2020

Overview

Black cohosh is an herb. The root is used for medicinal purposes. Black cohosh was first used for medicinal purposes by Native American Indians, who introduced it to European colonists. Black cohosh became a popular treatment for women's health issues in Europe in the mid-1950s.

Since that time, black cohosh has commonly been used to treat symptoms of menopause, and also conditions such as premenstrual syndrome (PMS), painful menstruation, weak and brittle bones (osteoporosis), and many others. However, there is no good scientific evidence to support these uses.

Black cohosh also goes by the name "bugbane" because it was once used as an insect repellent. It is no longer used for this purpose. Frontiersmen had said that black cohosh was useful for rattlesnake bites, but no modern researchers have tested this.

Do not confuse black cohosh with blue cohosh or white cohosh. These are unrelated plants. The blue and white cohosh plants do not have the same effects as black cohosh, and may not be safe.

Classification

Is a Form of:

Herb

Primary Functions:

Symptoms of menopause

Also Known As:

Actaea macrotys, Actaea racemosa, Actée à Grappes, Actée à Grappes Noires

How Does It Work?

The root of black cohosh is used for medicinal purposes. Black cohosh root contains several chemicals that might have effects in the body. Some of these chemicals work on the immune system and might affect the body’s defenses against diseases. Some might help the body to reduce inflammation. Other chemicals in black cohosh root might work in nerves and in the brain. These chemicals might work similar to another chemical in the brain called serotonin. Scientists call this type of chemical a neurotransmitter because it helps the brain send messages to other parts of the body.

Black cohosh root also seems to have some effects similar to the female hormone, estrogen. In some parts of the body, black cohosh might increase the effects of estrogen. In other parts of the body, black cohosh might decrease the effects of estrogen. Estrogen itself has various effects in different parts of the body. Estrogen also has different effects in people at different stages of life. Black cohosh should not be thought of as an “herbal estrogen” or a substitute for estrogen. It is more accurate to think of it as an herb that acts similar to estrogen in some people.

Uses

Symptoms of menopause. Research shows that some black cohosh extracts can reduce some symptoms of menopause when taken by mouth. Most of this research is for a specific commercial black cohosh product, Remifemin. Research shows that the effects of Remifemin on menopausal symptoms are comparable to hormone therapy. The benefits may not occur with all products that contain black cohosh. Research using black cohosh products other than Remifemin has not always shown benefits for menopausal symptoms. Some studies show that other black cohosh products do not reduce hot flashes or menopausal symptoms any better than a sugar pill ("placebo"). In some studies, products containing black cohosh and other ingredients have been investigated. Products containing black cohosh plus St. John's wort seem to reduce menopausal symptoms. Similar results have been observed for products containing black cohosh, Panax ginseng, soy, and green tea extract or black cohosh, kava, hops, and valerian extract. However, a homeopathic product containing black cohosh doesn't seem to be effective at reducing overall menopausal symptoms, although it may reduce hot flashes.

Recommended Dosing

The following doses have been studied in scientific research:

BY MOUTH:

Symptoms of menopause: 20-80 mg of black cohosh extract once or twice daily for up to 6 months. Also black cohosh extract equivalent to 40-127 mg of black cohosh rootstock has been taken in one or two divided doses per day for 12 weeks. Specific products used in research include CR BNO 1055 (Bionorica), Remifemin (Schaper & Brümmer GmbH & Co.), and Remixin (Mikro-Gen).

Black Cohosh Supplements Frequently Asked Questions

What are the side effects of black cohosh?

Black cohosh can cause some mild side effects, such as stomach upset, cramping, headache, rash, a feeling of heaviness, vaginal spotting or bleeding, and weight gain.

What are the benefits of black cohosh?

Black cohosh is most often used to control the symptoms of menopause, such as:

Hot flashes.
Mood changes.
Sleep problems.
Heart palpitations.
Night sweats.
Vaginal dryness.

How long does it take for black cohosh to work?

How long does black cohosh take to work? Women who claim taking black cohosh works usually report improvements within a few weeks of taking the substance. As so little is known about its effects long-term, it is not recommended to take it for more than one year.

Does black cohosh increase estrogen?

Black cohosh root also seems to have some effects similar to the female hormone, estrogen. In some parts of the body, black cohosh might increase the effects of estrogen. In other parts of the body, black cohosh might decrease the effects of estrogen. Estrogen itself has various effects in different parts of the body.

Who should not take black cohosh?

The U.S. Pharmacopeia advises that individuals with liver disorders should also avoid black cohosh [30]. It adds that users who develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice, while taking the supplement should discontinue use and contact their doctor.

Does black cohosh make you gain weight?

Menopausal women may be at an increased risk of unwanted weight gain, as their estrogen levels naturally decrease. Theoretically, because black cohosh may exhibit estrogenic effects, it may have a small beneficial effect on weight management in menopausal women.

Why is black cohosh bad for you?

It can cause some mild side effects such as stomach upset, cramping, headache, rash, a feeling of heaviness, vaginal spotting or bleeding, and weight gain. There is also some concern that black cohosh may be associated with liver damage. It is not known for sure if black cohosh actually causes liver damage.

Should you take black cohosh in the morning or at night?

For menopausal symptoms, the dose of black cohosh used in studies has been 20-40 milligram tablets of a standardized extract taken twice a day. Directions for taking black cohosh in other forms will vary. Some experts say that no one should take black cohosh for more than six months at a time.

Does black cohosh really work?

Studies on black cohosh have had mixed results. Some studies have shown that black cohosh can relieve menopause symptoms such as hot flashes. But other studies have shown that black cohosh does not relieve symptoms. Be sure to talk to your doctor before you take it.

Does black cohosh help you lose weight?

Weight loss

Theoretically, because black cohosh may exhibit estrogenic effects, it may have a small beneficial effect on weight management in menopausal women.

How much black cohosh should I take for menopause?

For menopausal symptoms, the dose of black cohosh used in studies is 20-40 milligram tablets of a standardized extract taken twice a day. More than 900 milligrams a day of black cohosh is considered an overdose.

Does black cohosh help you sleep?

Research shows black cohosh may alleviate night sweats and hot flashes, as well as lowering anxiety, and reducing vaginal dryness. It's also been shown to improve sleep, likely because of its stress and anxiety lowering capabilities.

Does black cohosh balance hormones?

Based on current research, black cohosh is most likely to relieve symptoms related to reductions or imbalances in the hormone estrogen. A 2010 review concluded menopausal women experienced a 26 percent reduction in night sweats and hot flashes when using black cohosh supplements.

How does black cohosh affect hormones?

Black cohosh seems to help decrease menopausal symptoms because it contains phytoestrogens, substances that act a lot like estrogen. When you go through menopause, your estrogen levels drop significantly. This is why many women experience hot flashes. Phytoestrogens also can have anti-estrogen effects.

Can you drink alcohol while taking black cohosh?

Alcohol (Ethanol) ↔ black cohosh

Products containing black cohosh have been reported to cause liver damage in rare cases, and taking it with other medications that can also affect the liver such as ethanol may increase that risk. You should avoid or limit the use of alcohol while being treated with these medications.

Is black cohosh good for anxiety?

CONCLUSIONS: All of the RCT and Clinical Trial demonstrate that Black Cohosh use is effective at reducing anxiety/depression. Black Cohosh seems to be the same effectiveness as Hormonal therapy available for anxiety/depression in postmenopausal women.

Does black cohosh cause water retention?

Black cohosh is one of the most popular herbal therapies for premenstrual discomfort, hot flushes and other climacteric and menopausal symptoms. Therefore, black cohosh-induced fluid retention and coagulation activation should be considered in differential diagnosis, especially if thrombosis has been excluded.

Will black cohosh start my period?

Black cohosh is another herbal supplement that you can buy to help regulate the menstrual cycle. It's said to help tone the uterus and promote the shedding of the uterine lining. Black cohosh is known to interact with many medications. If it's safe for you to take, you can purchase black cohosh online.

How safe is black cohosh?

When taken by mouth: Black cohosh is POSSIBLY SAFE when taken appropriately by adults for up to one year. It can cause some mild side effects such as stomach upset, cramping, headache, rash, a feeling of heaviness, vaginal spotting or bleeding, and weight gain.

Is black cohosh good for high blood pressure?

Some studies have found evidence that black cohosh does help with these symptoms. Black cohosh has also been used to relieve arthritis pain and help lower blood pressure.

Which is better black cohosh or evening primrose?

According to the results of this study, both black cohosh and primrose oil can be used as an effective alternative treatment in relieving of severity of hot flashes and improvement of quality of life in menopausal period, but it seems that black cohosh is more effective than primrose oil because it was able to reduce.

How much black cohosh is too much?

How much black cohosh should you take? For menopausal symptoms, the dose of black cohosh used in studies is 20-40 milligram tablets of a standardized extract taken twice a day. More than 900 milligrams a day of black cohosh is considered an overdose. Directions for taking black cohosh in other forms will vary.

Clinical Studies

^ a b c Sammartino A, et al. Short-term effects of a combination of isoflavones, lignans and Cimicifuga racemosa on climacteric-related symptoms in postmenopausal women: a double-blind, randomized, placebo-controlled trial. Gynecol Endocrinol. (2006)
^ a b Verhoeven MO, et al. Effect of a combination of isoflavones and Actaea racemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind study. Menopause. (2005)
^ a b Rotem C, Kaplan B. Phyto-Female Complex for the relief of hot flushes, night sweats and quality of sleep: randomized, controlled, double-blind pilot study. Gynecol Endocrinol. (2007)
^ a b WHO Monograph: Rhizoma Cimicifugae Racemosae.
^ a b c Jiang B, et al. Phytochemical fingerprinting to thwart black cohosh adulteration: a 15 Actaea species analysis. Phytochem Anal. (2011)
^ a b c Mahady GB, et al. Black cohosh (Actaea racemosa) for the mitigation of menopausal symptoms: recent developments in clinical safety and efficacy. Womens Health (Lond Engl). (2006)
^Mahady GB. Black cohosh (Actaea/Cimicifuga racemosa): review of the clinical data for safety and efficacy in menopausal symptoms. Treat Endocrinol. (2005)
^Chen SN, et al. Isolation, structure elucidation, and absolute configuration of 26-deoxyactein from Cimicifuga racemosa and clarification of nomenclature associated with 27-deoxyactein. J Nat Prod. (2002)
^Bedir E, Khan IA. Cimiracemoside a: A new cyclolanostanol xyloside from the rhizome of Cimicifuga racemosa. Chem Pharm Bull (Tokyo). (2000)
^Bedir E, Khan IA. A new cyclolanostanol arabinoside from the rhizome of Cimicifuga racemosa. Pharmazie. (2001)
^Shao Y, et al. Triterpene glycosides from Cimicifuga racemosa. J Nat Prod. (2000)
^Watanabe K, et al. Cycloartane glycosides from the rhizomes of Cimicifuga racemosa and their cytotoxic activities. Chem Pharm Bull (Tokyo). (2002)
^Triterpene Glycosides from Cimicifuga racemosa.
^ a b c Gödecke T, et al. Guanidine alkaloids and Pictet-Spengler adducts from black cohosh (Cimicifuga racemosa). J Nat Prod. (2009)
^ a b Powell SL, et al. In vitro serotonergic activity of black cohosh and identification of N(omega)-methylserotonin as a potential active constituent. J Agric Food Chem. (2008)
^Gurley BJ, et al. Effect of milk thistle (Silybum marianum) and black cohosh (Cimicifuga racemosa) supplementation on digoxin pharmacokinetics in humans. Drug Metab Dispos. (2006)
^Gurley BJ, et al. In vivo effects of goldenseal, kava kava, black cohosh, and valerian on human cytochrome P450 1A2, 2D6, 2E1, and 3A4/5 phenotypes. Clin Pharmacol Ther. (2005)
^ a b Gurley BJ, et al. Clinical assessment of CYP2D6-mediated herb-drug interactions in humans: effects of milk thistle, black cohosh, goldenseal, kava kava, St. John's wort, and Echinacea. Mol Nutr Food Res. (2008)
^ a b Zierau O, et al. Antiestrogenic activities of Cimicifuga racemosa extracts. J Steroid Biochem Mol Biol. (2002)
^ a b Pineda B, et al. No effect of Cimicifuga racemosa extract on serum interleukin-6 levels and prostacyclin production by human endothelial cells. Eur J Obstet Gynecol Reprod Biol. (2009)
^ a b Lundström E, Hirschberg AL, Söderqvist G. Digitized assessment of mammographic breast density--effects of continuous combined hormone therapy, tibolone and black cohosh compared to placebo. Maturitas. (2011)
^ a b c Seidlova-Wuttke D, et al. Evidence for selective estrogen receptor modulator activity in a black cohosh (Cimicifuga racemosa) extract: comparison with estradiol-17beta. Eur J Endocrinol. (2003)
^ a b Liske E, et al. Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med. (2002)
^ a b c Reame NE, et al. Black cohosh has central opioid activity in postmenopausal women: evidence from naloxone blockade and positron emission tomography neuroimaging. Menopause. (2008)
^ a b c Reed SD, et al. Vaginal, endometrial, and reproductive hormone findings: randomized, placebo-controlled trial of black cohosh, multibotanical herbs, and dietary soy for vasomotor symptoms: the Herbal Alternatives for Menopause (HALT) Study. Menopause. (2008)
^Bodinet C, Freudenstein J. Influence of Cimicifuga racemosa on the proliferation of estrogen receptor-positive human breast cancer cells. Breast Cancer Res Treat. (2002)
^Bodinet C, Freudenstein J. Influence of marketed herbal menopause preparations on MCF-7 cell proliferation. Menopause. (2004)
^ a b Zhang L, et al. In vivo effects of black cohosh and genistein on estrogenic activity and lipid peroxidation in Japanese Medaka (Oryzias latipes). J Herb Pharmacother. (2003)
^Seidlová-Wuttke D, Thelen P, Wuttke W. Inhibitory effects of a black cohosh (Cimicifuga racemosa) extract on prostate cancer. Planta Med. (2006)
^Frei-Kleiner S, et al. Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial. Maturitas. (2005)
^Lehmann-Willenbrock E, Riedel HH. Clinical and endocrinologic studies of the treatment of ovarian insufficiency manifestations following hysterectomy with intact adnexa. Zentralbl Gynakol. (1988)
^Nappi RE, et al. Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol. Gynecol Endocrinol. (2005)
^Bai W, et al. Efficacy and tolerability of a medicinal product containing an isopropanolic black cohosh extract in Chinese women with menopausal symptoms: a randomized, double blind, parallel-controlled study versus tibolone. Maturitas. (2007)
^ a b c Wuttke W, Seidlová-Wuttke D, Gorkow C. The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers. Maturitas. (2003)
^ a b Osmers R, et al. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol. (2005)
^ a b c Shams T, et al. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Altern Ther Health Med. (2010)
^Borrelli F, Ernst E. Cimicifuga racemosa: a systematic review of its clinical efficacy. Eur J Clin Pharmacol. (2002)
^Philp HA. Hot flashes--a review of the literature on alternative and complementary treatment approaches. Altern Med Rev. (2003)
^Geller SE, et al. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause. (2009)
^MacLennan A, Lester S, Moore V. Oral oestrogen replacement therapy versus placebo for hot flushes. Cochrane Database Syst Rev. (2001)
^Newton KM, et al. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial. Ann Intern Med. (2006)
^Pockaj BA, et al. Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1. J Clin Oncol. (2006)
^ a b c Uebelhack R, et al. Black cohosh and St. John's wort for climacteric complaints: a randomized trial. Obstet Gynecol. (2006)
^ a b c Chung DJ, et al. Black cohosh and St. John's wort (GYNO-Plus) for climacteric symptoms. Yonsei Med J. (2007)
^Ma X, et al. Effects of an isopropanolic-aqueous black cohosh extract on central body temperature of ovariectomized rats. J Ethnopharmacol. (2011)
^Wuttke W, Gorkow C, Seidlová-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study. Menopause. (2006)
^García-Pérez MA, et al. Isopropanolic Cimicifuga racemosa is favorable on bone markers but neutral on an osteoblastic cell line. Fertil Steril. (2009)
^Bebenek M, et al. Effect of exercise and Cimicifuga racemosa (CR BNO 1055) on bone mineral density, 10-year coronary heart disease risk, and menopausal complaints: the randomized controlled Training and Cimicifuga racemosa Erlangen (TRACE) study. Menopause. (2010)
^Rostock M, et al. Black cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints - a prospective observational study. Gynecol Endocrinol. (2011)
^ a b Kapur P, Wuttke W, Seidlova-Wuttke D. The Cimicifuga racemosa special extract BNO 1055 prevents hot flashes in ovariectomized rats. Phytomedicine. (2010)
^Rhyu MR, et al. Black cohosh (Actaea racemosa, Cimicifuga racemosa) behaves as a mixed competitive ligand and partial agonist at the human mu opiate receptor. J Agric Food Chem. (2006)
^Hirschberg AL, et al. An isopropanolic extract of black cohosh does not increase mammographic breast density or breast cell proliferation in postmenopausal women. Menopause. (2007)
^Process for the mild reduction of germs in pharmaceutical preparations.
^Al-Akoum M, et al. Effects of Hypericum perforatum (St. John's wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial. Menopause. (2009)
^ a b Briese V, et al. Black cohosh with or without St. John's wort for symptom-specific climacteric treatment--results of a large-scale, controlled, observational study. Maturitas. (2007)
^ a b Bai WP, et al. Efficacy and safety of remifemin compared to tibolone for controlling of perimenopausal symptoms. Zhonghua Fu Chan Ke Za Zhi. (2009)
^Raus K, et al. First-time proof of endometrial safety of the special black cohosh extract (Actaea or Cimicifuga racemosa extract) CR BNO 1055. Menopause. (2006)
^Black Cohosh Hepatic Safety: Follow-Up of 107 Patients Consuming a Special Cimicifuga racemosa rhizome Herbal Extract and Review of Literature.
^Whiting PW, Clouston A, Kerlin P. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust. (2002)
^Lontos S, et al. Acute liver failure associated with the use of herbal preparations containing black cohosh. Med J Aust. (2003)
^Cohen SM, et al. Autoimmune hepatitis associated with the use of black cohosh: a case study. Menopause. (2004)
^ a b c Naser B, et al. Suspected black cohosh hepatotoxicity: no evidence by meta-analysis of randomized controlled clinical trials for isopropanolic black cohosh extract. Menopause. (2011)
^Nasr A, Nafeh H. Influence of black cohosh (Cimicifuga racemosa) use by postmenopausal women on total hepatic perfusion and liver functions. Fertil Steril. (2009)
^Jiang B, et al. Evaluation of the botanical authenticity and phytochemical profile of black cohosh products by high-performance liquid chromatography with selected ion monitoring liquid chromatography-mass spectrometry. J Agric Food Chem. (2006)
^Amsterdam JD, et al. Randomized, double-blind, placebo-controlled trial of Cimicifuga racemosa (black cohosh) in women with anxiety disorder due to menopause. J Clin Psychopharmacol. (2009)
^Borrelli F, Ernst E. Black cohosh (Cimicifuga racemosa): a systematic review of adverse events. Am J Obstet Gynecol. (2008)
^Teschke R. Black cohosh and suspected hepatotoxicity: inconsistencies, confounding variables, and prospective use of a diagnostic causality algorithm. A critical review. Menopause. (2010)
Spangler L, et al. The effects of black cohosh therapies on lipids, fibrinogen, glucose and insulin. Maturitas. (2007)
Ross SM. Menopause: a standardized isopropanolic black cohosh extract (remifemin) is found to be safe and effective for menopausal symptoms. Holist Nurs Pract. (2012)
Jacobson JS, et al. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol. (2001)
Maki PM, et al. Effects of botanicals and combined hormone therapy on cognition in postmenopausal women. Menopause. (2009)
Juliá Mollá MD, et al. Cimicifuga racemosa treatment and health related quality of life in post-menopausal Spanish women. Gynecol Endocrinol. (2009)
Verhoeven MO, et al. Effects of a supplement containing isoflavones and Actaea racemosa L. on asymmetric dimethylarginine, lipids, and C-reactive protein in menopausal women. Fertil Steril. (2007)