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

Night sweats are severe hot flashes that occur at night and result in a drenching sweat. The causes of night sweats in most people are not serious, like menopause in women, sleep apnea, medications, alcohol withdrawal, and thyroid problems. However, more serious diseases like cancer and HIV also can cause night sweats. Your doctor will treat your night sweats depending upon the cause. You may experience other signs and symptoms that are associated with night sweats, which depend upon the cause, but may include, shaking, and chills with a fever caused by an infection like the flu or pneumonia; unexplained weight loss due to lymphoma; women in perimenopause or menopause may also have vaginal dryness, mood swings, and hot flashes during the day; and low blood sugar in people with diabetes. Other causes of night sweats include medications like NSAIDs (aspirin, acetaminophen, ibuprofen (Motrin, Advil), and naproxen (Aleve, Naprosyn), antidepressants, sildenafil (Viagra), and abuse of prescription or illegal drugs and drug withdrawal; hormone disorders like pheochromocytoma and carcinoid syndrome; idiopathic hyperhidrosis; infections like endocarditis, AIDs, and abscesses; alcoholism and alcohol withdrawal; drug abuse, addiction, and withdrawal; and stroke. A doctor or other health care professional can treat your night sweats after the cause has been diagnosed.

black cohosh

Black cohosh is an herb also known as Actaea racemosa, Actée à Grappes Noires, Actée Noire, Aristolochiaceae Noire, Baie d’actée, Baneberry, Black Snakeroot, Bugwort, Cimicaire à Grappes, Cimicifuga, Cytise, Herbe aux Punaises, Macrotys, Phytoestrogen, Racine de Serpent, Rattlesnake Root, Rhizoma Cimicifugae, Sheng Ma, Squaw Root, and many other names.

Black cohosh should not be confused with blue cohosh or white cohosh. Blue cohosh can have harmful effects on the heart.

Black cohosh has been used in alternative medicine in a specific preparation called Remifemin as a possibly effective aid in REDUCING the frequency of hot flashes caused by menopause.

Other uses not proven with research have included premenstrual syndrome (PMS), infertility, breast cancer, heart disease, osteoporosis, arthritis, rheumatism, migraine headaches, mental function, and many other conditions.

It is not certain whether black cohosh is effective in treating any medical condition. Medicinal use of this product has not been approved by the FDA. Black cohosh should not be used in place of medication prescribed for you by your doctor.

Pre-tax flexible spending accounts (FSAs) are often touted as the answer to high out-of-pocket medical costs, but many FSAs have “use it or lose it” rules. FSA holders lose $50 to $100 per year on average, CBS News reported, but since you’re allowed to contribute up to $2,650, you could risk losing thousands of dollars if you don’t spend your FSA money in time.

Black cohosh is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Black cohosh may also be used for purposes not listed in this product guide.

What is the most important information I should know about black cohosh?

Follow all directions on the product label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

What should I discuss with my health care provider before taking black cohosh?

Before using black cohosh, talk to your healthcare provider. You may not be able to use black cohosh if you have certain medical conditions, especially.

• liver disease;
• past or present cancer of the breast, ovary, or uterus;
• a history of endometriosis or uterine fibroids;
• a genetic blood-clotting disorder; or
• if you have ever had a kidney transplant.

It is not known whether black cohosh will harm an unborn baby. However, this product may increase your risk of having a miscarriage. Do not use this product without medical advice if you are pregnant.

It is not known whether black cohosh passes into breast milk or if it could harm a nursing baby. Do not use this product without medical advice if you are breast-feeding a baby.

Do not give any herbal/health supplement to a child without medical advice.

How should I take black cohosh?

When considering the use of herbal supplements, seek the advice of your doctor. You may also consider consulting a practitioner who is trained in the use of herbal/health supplements.

If you choose to use black cohosh, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. Do not use more of this product than is recommended on the label.

Do not use different forms (tablets, liquid, tincture, teas, etc) of black cohosh at the same time without medical advice. Using different formulations together increases the risk of an overdose.

Call your doctor if the condition you are treating with black cohosh does not improve, or if it gets worse while using this product.

Store black cohosh as directed on the package. In general, black cohosh should be protected from light and moisture.

What happens if I miss a dose?

Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra black cohosh to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking black cohosh?

Avoid using black cohosh together with other herbal/health supplements that can harm your liver. This includes androstenedione, chaparral, comfrey, DHEA, germander, kava, niacin (vitamin B3), pennyroyal oil, or red yeast.

Black cohosh side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Although not all side effects are known, black cohosh is thought to be possibly safe when taken for a short period of time (up to 1 year).

Black cohosh can harm your liver. Stop using this product and call your doctor at once if you have signs of liver problems, such as:

• nausea, loss of appetite, upper stomach pain;
• itching, tired feeling;
• dark urine, clay-colored stools; or
• jaundice (yellowing of the skin or eyes).

Common side effects may include:

• stomach pain or upset;
• heavy feeling;
• vaginal bleeding or spotting;
• headache;
• rash; or
• weight gain.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect black cohosh?

Do not take black cohosh without medical advice if you are using any of the following medications:

• acetaminophen (Tylenol);
• cisplatin;
• donepezil;
• erythromycin;
• isoniazid;
• methotrexate;
• ondansetron;
• an antidepressant or antipsychotic medicine–amitriptyline, clozapine, desipramine, fluoxetine, olanzapine, trazodone;
• antifungal medicine–fluconazole, itraconazole;
• cholesterol medication–atorvastatin (Lipitor), simvastatin (Zocor, Vytorin), and others;
• heart or blood pressure medicine–amiodarone, flecainide, methyldopa, metoprolol;
• narcotic medicine–codeine, fentanyl, meperidine, methadone, tramadol; or
• seizure medicine–carbamazepine, phenytoin.

This list is not complete. Other drugs may interact with black cohosh, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this product guide.

Where can I get more information?

• Consult with a licensed healthcare professional before using any herbal/health supplement. Whether you are treated by a medical doctor or a practitioner trained in the use of natural medicines/supplements, make sure all your healthcare providers know about all of your medical conditions and treatments.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

More about black cohosh

• Check interactions
• Reviews (48)
• Drug class: herbal products
• Breastfeeding

Professional resources

Related treatment guides

• Postmenopausal Symptoms
• Herbal Supplementation

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2023 Cerner Multum, Inc. Version: 3.02. Revision Date: 2015-08-15, 4:25:54 AM.

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.

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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.
• Rattleweed.
• 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 and people assigned female at birth. 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 people experiencing menopausal symptoms to reduce pain, reduce fatigue and lift your mood — 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.

People who are pregnant or breastfeeding also shouldn’t use black cohosh 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.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

What Are the Side Effects of Black Cohosh?

Black cohosh is an herb that has been used for a long time throughout the US and Europe for cough, cold, infertility and menopause symptoms. The side effects of black cohosh include gastrointestinal upset, skin rash, breast pain, brain enlargement, infection, vaginal bleeding/spotting and joint or muscle pain.

People in the US and Europe have used the herb black cohosh since ancient times for a variety of illnesses ranging from cough and cold to infertility. It has been most commonly used for menopause and found to be beneficial. Other problems include menstrual cramps and menstrual irregularities. Much of the research on black cohosh has been on menopause. Some studies show black cohosh effective for relieving the following symptoms of menopause

• Hot flashes (most effective for this symptom as reported by women)
• Night sweats
• Vaginal dryness

In a study, black cohosh has worked as effectively as hormonal replacement therapy in the management of postmenopausal symptoms. But some other studies have found its effect to be similar to a placebo. The data on its efficacy are mixed.

The most comprehensive research on black cohosh to date has been the study published in the Cochrane Database of Systematic Reviews in 2012. The review concluded that there is not enough evidence to state whether black cohosh is effective or ineffective to help treat the symptoms of menopause. Given this, the reviewers suggested the need for further research on black cohosh.

The problem with these studies is the inconsistency in variations of the chemical composition of the products containing black cohosh.

Scientists have yet to find the active ingredients in black cohosh and also its potential mechanism(s) of action. It is unclear whether black cohosh has any effects on the vagina and uterus.

Based on the different compounds present in black cohosh, experts have proposed the following theories of how black cohosh works in the body.

• Estrogen-like properties: Estrogen is a female hormone, the level of which declines in menopause. Its reduced levels are responsible for all the signs and symptoms of menopause. Some experts believe that black cohosh works like estrogen in the body and helps ease menopause symptoms.
• Action on the brain: Black cohosh can work on nerves in the brain to increase serotonin levels, which can help improve mood and help treat depression and anxiety in menopause.
• Anti-inflammatory and antioxidant properties: The properties of black cohosh help the body fend off chronic illnesses.

There is insufficient evidence to recommend it for uses other than for menopause.

Black cohosh is available in the market as capsules and tinctures. The recommended dose is between 20 and 80 mg of black cohosh extract once or twice daily for up to six months.

Is black cohosh safe for everyone?

From the several studies done on black cohosh, it is found to be associated with few adverse reactions. The reported side effects include

• Gastrointestinal upset
• Skin rash
• Breast pain
• Brain enlargement
• Infection
• Vaginal bleeding/spotting
• Joint or muscle pain

The duration of all the studies conducted on black cohosh is six months or less. Safety data on the long-term use of black cohosh are lacking. Hence, physicians often recommend taking the black cohosh for no more than six months.

Black cohosh is not safe for everyone. There are several reports of patients with some bad effects on the liver such as

• Hepatitis (infection of the liver)
• Liver failure
• Abnormal liver function tests

Physicians recommend avoiding black cohosh if you have any problem with your liver. Always use it under medical supervision. Discontinue its use and consult your doctor if you develop symptoms of liver trouble, such as abdominal pain, dark urine or jaundice.

Due to its possible estrogen-like activity, black cohosh may interact with hormone replacement therapy or oral contraceptive pills. Black cohosh may also interact with other drugs such as

• Cholesterol-lowering drugs
• Drugs that can cause hepatotoxicity (harmful for liver), such as
  • Acetaminophen
  • Amiodarone
  • Carbamazepine
  • Isoniazid (INH)
  • Methotrexate
  • Methyldopa
  • Fluconazole
  • Itraconazole
  • Erythromycin
  • Phenytoin
  • Amitriptyline
  • Clozapine
  • Codeine
  • Desipramine
  • Donepezil
  • Fentanyl
  • Prozac (fluoxetine)
  • Metoprolol
  • Olanzapine
  • Ondansetron
  • Tramadol

  Black cohosh differs from blue cohosh and white cohosh concerning its actions. Do not confuse these drugs. Unlike black cohosh, blue cohosh and white cohosh are toxic.

  Remember to look for certifications provided by Consumer Labs, The U.S. Pharmacopeial Convention or NSF International while choosing preparations of black cohosh and all other supplements in general.

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  Medically Reviewed on 2/24/2021
  References

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  Hot flashes (or flushing) is the most common symptom experienced by a woman prior to and during the early stages of menopause, and often is described as the feeling of warmth that spreads over the body, often starting at the head accompanied by sweating. Symptoms of hot flashes include flushing, excessive sweating, anxiety, and palpitations.

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  Night Sweats

  Night sweats are severe hot flashes that occur at night and result in a drenching sweat. The causes of night sweats in most people are not serious, like menopause in women, sleep apnea, medications, alcohol withdrawal, and thyroid problems. However, more serious diseases like cancer and HIV also can cause night sweats. Your doctor will treat your night sweats depending upon the cause. You may experience other signs and symptoms that are associated with night sweats, which depend upon the cause, but may include, shaking, and chills with a fever caused by an infection like the flu or pneumonia; unexplained weight loss due to lymphoma; women in perimenopause or menopause may also have vaginal dryness, mood swings, and hot flashes during the day; and low blood sugar in people with diabetes. Other causes of night sweats include medications like NSAIDs (aspirin, acetaminophen, ibuprofen (Motrin, Advil), and naproxen (Aleve, Naprosyn), antidepressants, sildenafil (Viagra), and abuse of prescription or illegal drugs and drug withdrawal; hormone disorders like pheochromocytoma and carcinoid syndrome; idiopathic hyperhidrosis; infections like endocarditis, AIDs, and abscesses; alcoholism and alcohol withdrawal; drug abuse, addiction, and withdrawal; and stroke. A doctor or other health care professional can treat your night sweats after the cause has been diagnosed.

  Perimenopause

  Perimenopause is the time in a woman’s life when she is approaching menopause. During this time a woman starts to develop symptoms of declining estrogen levels that may include mood swings, painful sex, night sweats, hot flashes, and weight gain. Every adult woman eventually will experience perimenopause.

  Premature Menopause

  Premature menopause is when menopause occurs in a woman before the age of 40. Causes of premature menopause include premature ovarian failure, treatments for cancer and other conditions, surgical removal of the ovaries, or chronic diseases of the pituitary or thyroid gland, or psychiatric disorders. Treatment is directed at menopausal symptoms.

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  Vaginal dryness and vaginal atrophy occurs in women during perimenopause, menopause, and postmenopause. With vaginal atrophy, the lining of the vaginal wall becomes thinner, drier, less elastic, and light pink to bluish in color. Symptoms of vaginal atrophy include vaginal dryness, itching, irritation, and/or pain during intercourse. Treatment options for vaginal dryness and vaginal atrophy include hormone treatment and over-the-counter vaginal lubricating and moisturizing products.

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