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27th October, 20214 min read

Black cohosh for menopause: uses, benefits and side effects

Medical reviewer:Dr Ann Nainan
Author:Lynette Eyb
Last reviewed: 26/10/2021
Medically reviewed

All of Healthily's articles undergo medical safety checks to verify that the information is medically safe. View more details in our safety page, or read our editorial policy.

What is black cohosh?

Black cohosh is a plant that grows in North America. Also known as black snakeroot, bugbane, bugwort, rattleroot or rattleweed, it’s a member of the buttercup family of plants.

The roots of back cohosh are used to make herbal medicine. Traditionally, Native Americans used it to treat a range of conditions, including muscle and joint pain, coughs and fevers, and period (menstrual) problems.

Today, it’s also used to help with symptoms of the menopause – when you stop having periods – although its effectiveness is unproven. So read on to learn more about black cohosh and menopause.

Can black cohosh have benefits for menopause?

Black cohosh is marketed as a herbal remedy for the common symptoms of the menopause.

In menopause and the time leading up to it (perimenopause), your body goes through hormonal changes that can cause various symptoms, including hot flushes and night sweats, sleep problems (insomnia), vaginal dryness and mood swings.

However, there’s a lack of scientific evidence that black cohosh definitely helps with menopause symptoms, or any other condition.

Some research suggests that certain black cohosh extracts may reduce some menopause symptoms. But the studies haven’t always been good quality, and have had varied (inconsistent) results. They’ve also looked at different types (species) of the plant and different doses, so it’s still unclear exactly how black cohosh might work for menopause.

How to take black cohosh

Dietary supplements containing black cohosh extracts are available as tablets and liquids, and you can also get the whole herb as a powder.

Because herbal medicines don‘t have to be regulated in the same way as regular medicines, they can vary in how they're made and what they contain, and there’s no standard dose.

If you want to try black cohosh, it’s a good idea to look for a product licence or registration number, to check you’re buying from a reliable company. In the UK, herbal supplement companies can apply for a Traditional Herbal Registration (THR) number to put on the label. You could also ask a pharmacist for advice.

Woman holding her head with a headache

Black cohosh side effects

In scientific trials, people have taken black cohosh for up to 12 months without any serious problems.

However, black cohosh can cause side effects. The most common are tummy upsets and rashes, but these are usually mild.

Other reported side effects include:

  • headaches
  • cramps
  • a feeling of heaviness
  • spotting or bleeding from the vagina
  • weight gain

There have also been reports of serious liver damage in people who have taken black cohosh. This is rare, and it’s unclear if it’s caused by black cohosh. But if you have liver problems, don’t take black cohosh without speaking to a doctor first.

Again, because herbal remedies aren’t licensed in the same way as medicines, there’s no guarantee of their quality or safety. For example, companies that sell black cohosh don’t always label their products correctly.

It’s unclear how black cohosh reacts with other medication, because it hasn’t been studied. It’s not known, for example, whether black cohosh interferes with menopause treatment such as hormone replacement therapy (HRT), or medications for conditions such as breast cancer, heart disease, asthma or epilepsy.

When to see a doctor

You should always speak to a doctor before trying any herbal medicine, including black cohosh. This is particularly important if you're taking any other medication or you have liver problems, as discussed above.

You should also see a doctor if you’re concerned about any side effects after taking black cohosh.

You should contact a doctor straight away if you have any of these symptoms after taking black cohosh, as they can be signs of liver problems:

  • tummy (abdominal) swelling or pain
  • very dark pee (urine)
  • jaundice

Your health questions answered

  • Can I take black cohosh if I’m also taking HRT?

    You should always speak to a doctor before taking black cohosh – or any other herbal product – while taking hormone replacement therapy (HRT). Black cohosh is sometimes used as an alternative to HRT, but there’s no conclusive evidence to support its effectiveness.

Key takeaways

  • black cohosh is a plant that grows in North America
  • it’s sometimes used as a herbal remedy for menopause symptoms, such as hot flushes
  • studies of black cohosh for menopause have had mixed results, and its effectiveness is unproven
  • there’s no standard or recommended dose, and black cohosh products can vary in what they contain
  • speak to a doctor before taking black cohosh or any other herbal medicine
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Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.