The Facts on Black Cohosh and Menopause


Many women are turning to alternative therapies to help alleviate commonly reported menopausal symptoms. One of the most popular is black cohosh. In this article, we’re diving into what black cohosh is, its applications for midlife women, and what the research says about its effectiveness and safety. 

What Is Black Cohosh?

Black cohosh is a perennial herb related to the buttercup, the root of which is often used in place of traditional medicine. It was first used in this way by indigenous people and eventually introduced for various women’s health applications in Europe in the 1950s.  

Though not all supported by research, some of the most common women’s health uses for black cohosh include: 

- Menopausal symptoms

- Premenstrual syndrome (PMS) symptoms

- Painful menstruation

- Acne

- Helping to initiate labor in pregnant women

- Painful intercourse

- Moodiness, like anxiety and irritability

- Disturbances in regular sleep

- Ringing of the ears

- Vertigo, dizziness, and migraines

- Heart palpitations

-      Osteoporosis

- Bone density loss

Note that in addition to black cohosh, there is also blue and white cohosh. However, these do not have the same health applications and have not been studied for potential medical uses or, more importantly, safety.  

How Is Black Cohosh Used During Menopause? 

Black cohosh has gained popularity for the alleviation of menopausal symptoms. This is because black cohosh root appears to act similarly to estrogen, the hormone that decreases during menopause and causes the majority of symptoms women experience during midlife. 

Some of the most commonly reported menopausal symptoms, for which women use black cohosh include:

-      Hot flashes

- Night sweats or excessive sweating

- Moodiness

- Vaginal dryness

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Pros and Cons of Black Cohosh 

Research shows that black cohosh does appear to have positive impacts on specific menopausal symptoms, but they are very modest and depend on the individual.

A 2010 review of nine studies found that black cohosh was able to provide a 26% reduction in hot flash symptoms and night sweats among menopausal women in seven of the studies. Yet, a 2012 review of sixteen studies found there was insufficient evidence to support the use of black cohosh for menopausal symptoms. A 2013 review found that black cohosh use resulted in a mild, but overall improvement in menopausal women when compared to a placebo. You can see from this sampling of research that the evidence is very mixed on whether black cohosh helps relieve menopause symptoms.

It’s important to note that most of the research on black cohosh in menopause has been done with Remifemin, a specific brand of commercially sold black cohosh. In other words, the effectiveness of other black cohosh products in menopausal symptoms is largely unknown. In fact, other research indicates that many black cohosh products are about as effective as a placebo at reducing menopausal symptoms, making it impossible to know which one may or may not help you.

Much of the research that shows potential for black cohosh to help symptoms indicates that positive effects only last for six to twelve months. As a result, long-term use is not recommended as the effects are unknown. Many other studies have found insufficient evidence for its use. Overall, more research is needed on the use of black cohosh in menopause.

What’s more, because black cohosh is an herb, it is not regulated by the FDA. It could also interact with certain medications, like blood thinners. Of the potential side effects, although rare, liver damage is the most studied, and potentially the most dangerous, complication associated with black cohosh use. 

Some of the potential health consequences of using black cohosh include:

- Increased bleeding

- Abnormal vaginal discharge

- Blood clots

- Recurrence of breast cancer

- Headaches

- Moodiness

- Constipation

- Liver damage

- Nausea and vomiting

- Swelling

- Fatigue

- Mild vision impairments

Due to the mostly unknown long-term effects of black cohosh, the North American Menopause Society does not recommend its use in menopausal women, as per their 2015 position statement.

Should You Try Black Cohosh?

There are several considerations when it comes to trying black cohosh for menopausal symptoms. It may or may not be effective for your specific symptoms, especially if it’s a brand that has not been specifically studied. 

Furthermore, some studies indicate that black cohosh may not be safe for use in women with breast cancer or other conditions in their health history, like heart disease and infertility. When deciding if black cohosh is an appropriate alternative therapy for your symptoms, it’s best to speak with your gynecologist. There may be other options that are more appropriate and better studied for your specific experience.  

If you’re interested in giving black cohosh as try, it’s best to find a brand that has been third-party tested for quality, purity, and safety (a good habit to practice for any dietary supplement). 

Check out Lisa Health for personalized holistic recommendations on managing your menopause symptoms.

Lauren Panoff, MPH, RD, is a registered dietitian, freelance writer, and speaker who helps families transition to plant-based lifestyles. She can be found at or on Instagram @chronicplanet.

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