Black Cohosh For Menopause: Does Black Cohosh Work?

Menopause is a significant life transition that affects women both physically and emotionally. Hot flashes, night sweats, mood swings, and sleep disturbances are just a few of the symptoms that women experience during this stage. While hormonal replacement therapy (HRT) has been the go-to treatment for menopause, some women are seeking natural alternatives. One such alternative is black cohosh, a flowering plant native to North America. 

What is Black Cohosh?

Black cohosh, scientifically known as Actaea racemosa or Cimicifuga racemosa, [1] is a plant that has been used for centuries in traditional Native American medicine. It is also commonly referred to as black bugbane, black snakeroot, baneberry, or fairy candle. The roots and flowers of black cohosh are utilized for their medicinal properties. Today, black cohosh is recognized as a popular women's health supplement and is often found in products aimed at alleviating menopause symptoms, promoting fertility, and balancing hormones.

The Benefits of Black Cohosh for Menopause Symptoms

One of the primary reasons people turn to black cohosh is its ability to relieve menopause symptoms. Numerous studies have shown that black cohosh can effectively reduce the frequency and severity of hot flashes and night sweats. [2] In a study involving 120 menopausal women, black cohosh was found to be more effective than the antidepressant fluoxetine (Prozac) in relieving hot flashes and night sweats. [3] These results were supported by a 2010 review that reported a 26% reduction in vasomotor symptoms (hot flashes and night sweats) with black cohosh use. Furthermore, recent studies have indicated that black cohosh can also improve sleep disturbances associated with menopause. [4]

It is important to note that there is still some disagreement among experts regarding the effectiveness and safety of black cohosh for menopause symptoms. While the American College of Obstetricians and Gynecologists (ACOG) acknowledges, the value of black cohosh, they highlight the need for further research and caution against long-term use. Therefore, it is generally recommended to use black cohosh for short term relief (less than 6 months) of hot flashes and other menopause symptoms. [5]

Additional Uses of Black Cohosh

Apart from its benefits for menopause symptoms, black cohosh has been suggested to have other potential uses. Some studies have indicated that black cohosh may help ease premenstrual syndrome (PMS) and menstrual pain. However, more research, is needed to confirm these findings.

There is also some interest in the use of black cohosh for managing hot flashes related to breast cancer treatments. Breast cancer medications such as tamoxifen can cause hot flashes, and black cohosh has been commonly used by breast cancer patients to reduce their frequency and intensity. [6]

However, two well-designed studies have found that black cohosh is no more effective than a placebo in relieving hot flashes in this specific population. Furthermore, there are concerns that herbal medicines like black cohosh may interfere with conventional breast cancer treatments such as radiation and chemotherapy drugs. Therefore, it is crucial for breast cancer patients to consult with their healthcare providers before using black cohosh.

Research on Black Cohosh for Arthritis and Osteoporosis

Preliminary studies have suggested that black cohosh may have potential benefits for reducing inflammation associated with osteoarthritis and rheumatoid arthritis. However, more research is needed to establish its efficacy in these conditions. Additionally, laboratory studies have shown that the plant-based estrogens (phytoestrogens) present in black cohosh may help inhibit bone loss associated with osteoporosis. However, further research is required to determine the extent of these effects. [7]

Black Cohosh and Fertility

While there are claims that black cohosh can improve fertility and increase the chances of getting pregnant, the scientific evidence supporting these claims is limited. However, studies suggest that black cohosh may enhance the effectiveness of the fertility drug Clomid (clomiphene citrate) in women who are struggling with infertility. [8]

Several small-scale studies have shown improved pregnancy rates and ovulation in women with infertility who took black cohosh supplements alongside Clomid. However, further research is needed to confirm these findings and understand the exact mechanism behind the potential benefits of black cohosh for fertility.

Further Black Cohosh Studies

Black cohosh is also used for various other purposes related to women's health, although the scientific evidence supporting these uses is not as robust as it is for menopause symptoms. Here are some ways in which black cohosh may support hormonal balance and women's health:

  • Polycystic Ovarian Syndrome (PCOS): Black cohosh supplementation may increase the chances of getting pregnant in women with PCOS who are undergoing treatment with Clomid. It may also help regulate menstrual cycles in women with PCOS. [9]
  • Fibroids: In a 3-month study involving postmenopausal women, daily supplementation with 40 mg of black cohosh was found to decrease the size of uterine fibroids by up to 30%. [10]
  • There is some evidence to suggest that black cohosh may have beneficial effects on mental health, particularly in menopausal women. A review of studies investigating the use of herbal supplements for anxiety and depression in menopausal women found that black cohosh supplementation was associated with significant improvements in psychological symptoms. [11]
  • One small study involving menopausal women found that supplementing with black cohosh improved sleep duration and quality. [12]
  • Black cohosh was historically used to increase breast milk production, there is limited scientific evidence to support its effectiveness for this purpose. Pregnant women, breastfeeding women, and infants have not been extensively studied regarding the effects of black cohosh. [13]

Black Cohosh Side Effects

When it comes to the safety of black cohosh, there have been conflicting reports. While some studies have found it to be safe, others have raised concerns about its potential adverse effects. The ACOG points out that many early studies on black cohosh were poorly designed and did not assess its safety and effectiveness beyond 6 months of use. However, a systematic review conducted in 2008 found no significant adverse events associated with black cohosh use. Nonetheless, it is important to note that individual responses to herbal supplements can vary, and some people may experience side effects such as gastrointestinal upset, dizziness, or headaches. [14]

It is worth mentioning that there have been concerns about the estrogenic activity of black cohosh, as it contains phytoestrogens, which are plant-based compounds that mimic the effects of estrogen in the body. Some worry that these phytoestrogens could stimulate the growth of breast tumors. However, a case-control study involving almost 1,500 breast cancer cases found that black cohosh use actually had significant protective effects against breast cancer development. Nevertheless, individuals with a history of breast cancer, risk factors for breast cancer, or those currently undergoing breast cancer treatment should consult with their healthcare provider before using black cohosh. [15]

Dosage and How to Take

Black cohosh is available in various forms, including capsules, liquid extracts, and teas. The recommended dosage can vary widely between brands, but typical doses range from 20-120 mg of standardized black cohosh extract or powder daily.

For menopause symptoms, a minimum daily dose of 20 mg of black cohosh is often recommended, which is available in most brands. However, it is important to note that some health professionals advise against taking black cohosh for longer than 6 months to 1 year due to the potential risk of liver damage.

Black Cohosh Interactions

Black cohosh has the potential to interact with other medications and therapies. It is important to be aware of the following interactions:

  • Hormone Replacement Therapy (HRT): Black cohosh may have effects on hormone levels, especially estrogen, which can result in unexpected effects when combined with HRT. [16]
  • Birth Control Pills: Due to its potential effects on hormone levels, black cohosh may interfere with the effectiveness of hormonal birth control pills. [17]

These are the known interactions, but there may be other potential interactions that have not yet been identified. If you are taking medications or have concerns about black cohosh interacting with other drugs, it is advisable to consult a healthcare provider before starting black cohosh supplementation.

Additionally, due to the potential for liver damage, caution should be exercised when combining black cohosh with other supplements or medications that may have hepatotoxic effects. Seek guidance from a healthcare provider if you have any concerns.

Does Black Cohosh Help Menopause Symptoms

Black cohosh is a natural remedy that has been used for centuries to alleviate menopause symptoms. While studies have shown promising results, it is important to note that there is still ongoing debate among experts regarding its effectiveness and safety. Therefore, it is crucial for individuals to consult with their healthcare providers before using black cohosh, especially if they have a history of breast cancer or are undergoing breast cancer treatment. Furthermore, black cohosh should be used for short-term relief of menopause symptoms, and its long-term effects require further investigation. 


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