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Black Cohosh for Hot Flashes, Menopause and More


Black cohosh benefits - Dr. Axe

With research revealing the dangers of HRT (Hormone Replacement Therapy) in treating hormonal issues, health-conscious women are looking elsewhere for safer, natural treatments for hormonal problems like menopause symptoms. One surprising treatment is black cohosh, a herbal remedy that studies indicate relieve symptoms of menopause (especially hot flashes) among other significant health benefits. (1)

I encourage women to understand the transitional period of life known as menopause as well as you can, which will allow you to embrace the changes it brings. When prepared with knowledge about what menopause really is, you can make informed, educated decisions on the best avenues of treatment that don’t put your health further at risk (as many hormone-based drugs may do). In fact, this can be one of the best times of your life!

Recent studies have shown links between black cohosh and relief of multiple other hormonal problems, not just menopause. One such systematic review (a long-term study of multiple research trials) is being conducted as of August 2015 to review the effects of this herbal supplement as an intervention in breast and prostate cancer patients, male and female, managing hot flashes after endocrine therapy and chemotherapy. (2)

What Is Black Cohosh?

Part of the family Ranunculaceae, black cohosh, or Actaea racemosa (also known as Cimicifuga racemosa) is also called by several nicknames, including “black bugbane,” “black snakeroot” and “fairy candle.” This flowering plant is native to North America, growing in a variety of woodland habitats.

The underground parts of the plant, the roots and rhizomes, are the sections used for medicinal purposes. They are made up of glycosides (sugar compounds), isoferulic acids (anti-inflammatory substances), and (possibly) phytoestrogens (plant-based estrogens), as well as other active substances. The leaves and other external parts of black cohosh aren’t used for food or nutrition.

The specific preparation of black cohosh supplements affects what it will treat. One such manufacturer, Remifemin, is one of the most researched compounds in the reduction of hot flashes caused by menopause. (3)

Guide to black cohosh - Dr. Axe


1. Reduces Hot Flashes

A great number of studies have been done on the effect black cohosh has on menopause symptoms, such as hot flashes. While some research is inconclusive, this is generally due to the fact that many of them have been based on a scale, rather than placebo-based observation. In addition, the specific compounds and dosages of the supplement have been inconsistent in many studies.

However, there is little doubt that black cohosh is an effective treatment for hot flashes and a natural remedy for menopause relief in general. Taking it regularly reduces the number and severity of hot flashes, greatly decreasing the negative symptoms that often overwhelm women with hormone problems.

And there’s more good news! Menopausal women aren’t the only ones who suffer hot flashes. Breast cancer survivors who have completed treatment have shown a decrease in hot flashes and sweating when using black cohosh. (4) As I mentioned earlier, a current study is also examining the management of hot flashes in men who have had treatment for prostate cancer.

2. Aids Sleep

One factor that worsens other symptoms of menopause is the sleep disturbance that often accompanies this transition. Sleep is vital to balancing hormones naturally, as lack of sleep disturbs hormone production and management, even in normal periods of life.

A recent medical trial for postmenopausal women with sleep complaints found supplementing their diet with black cohosh effectively improved sleep and may be a safe measure in managing menopausal sleep disturbance. (5)

If you find that you frequently can’t sleep in the midst of menopause, it’s also important to sleep at the right time. To sleep best, endocrinologists (hormone experts) suggest sleeping at least 7–8 hours a night and ensuring that four of those hours fall between 10 p.m. and 2 a.m. This will ensure the most effective and hormonally balanced sleep.

3. Promising for Treatment of Diabetes

A breakthrough study recently showed positive impact of an extract of this plant, Ze 450, on type II diabetes. While this was a pilot study, the results indicated that Ze 450 may help reduce body weight and improve the processing of insulin within the body of a diabetic patient. (6)

Black cohosh benefits - Dr. Axe

4. Helps Manage PCOS (Polycystic Ovary Syndrome)

Maybe related to its effects in potentially treating diabetes, black cohosh has also been studied regarding PCOS and the benefits it may give to women with the disorder. Initial results suggest black cohosh had a positive impact on the disorder and could match the treatment of the pharmaceutical agent it was tested against. (7)

PCOS patients should do their best to use natural remedies that balance hormones without chemicals or medication, including using essential oils for hormones.

5. Provides a Safe Alternative to HRT (Hormone Replacement Therapy)

HRT is a dangerous therapy to choose for menopause relief, including making one more likely to develop breast cancer in women when used for over 10 years. (8) I understand that menopause is dreaded by most women, as the side effects often become debilitating. However, I don’t see the bright side of treating this drop in estrogen with drugs that are likely to cause even more health problems.

That’s why I like the idea of alternative options! There are several safe, natural remedies for menopause relief, and black cohosh is an important item on that list. Recent clinical studies have sought to find other menopause treatments to replace HRT, including the use of Actaea racemosa supplementation. (9)

6. Reduces Bone Loss in Osteoporosis

Most plants, including black cohosh, contain many organic compounds with biological activity. In the tissues and organs of Actaea racemosa, there is already evidence of phytoestrogens (plant-derived estrogens).

In addition, some of the biological molecules within the plant have been proven to reduce bone loss caused by osteoporosis. One particular molecular compound (deemed ACCX) has presented an encouraging lead in a new class of treatment for osteoporosis. (10)

7. Treats Uterine Fibroids

Uterine fibroids are benign growths of the uterus, often appearing during years where a woman’s fertility is at its peak. In countries outside of the United States, these are often treated with a synthetic steroid drug, Tibolone. Inside the U.S., various other hormone-based drugs are commonly used.

However, a 2014 study compared the use of Tibolone to black cohosh to treat these fibroids, and found that the extract of Actaea racemosa tested was actually more appropriate than the synthetic alternative to treat uterine fibroids. (11)

8. May Reduce Anxiety

One historic use of this perennial herb was treatment of anxiety and depression. While it has long been considered nothing more than a false remedy, recent research has proposed that it may have significant impact on anxiety, just as studies indicate how effective essential oils for anxiety can be. This is encouraging, considering that anxiety is another intimidating symptom of menopause.

One component of Actaea racemosa was shown to have sedative side effects and greatly reduce anxiety-related behavior in rats, suggesting further studies might be promising for the treatment of anxiety with black cohosh (12).

Black Cohosh Interesting Facts

Actaea racemosa is a member of the buttercup family, native to North America. The roots and rhizomes have been used as a folk medicine for centuries to treat pain, anxiety, inflammation, malaria, rheumatism, and many other disorders. Its use as a remedy for rheumatism was especially popular in 19th century America. (13)

The spread of black cohosh across Europe took place after Native American Indians introduced the herb to European colonists. It became a common treatment for women’s health issues in Europe in the mid-20th century. Traditional Chinese medicine also shows record of the use of black cohosh to serve as an anti-inflammatory and painkiller. (14)

One of its nicknames, “Bugbane,” was coined because of its use as an insect repellent, though it’s no longer used for that purpose. Another, “snakeroot,” was derived from the habit of frontiersmen using it to treat rattlesnake bites. Its efficacy against snake bites has never been tested by modern researchers, but it’s an interesting theory!

Be careful not to confuse black cohosh with its sister plants, blue cohosh and white cohosh. These plants are similar in structure, but don’t have the same effects as black cohosh and may be dangerous to ingest.

How to Use

Black cohosh isn’t found in any food products. Therefore, to supplement your diet with it, you’ll take an herbal supplement.

As I previously mentioned, proper dosages have been debated for years, but I recommend taking 80 milligrams, one to two times per day, to relieve menopause-related symptoms. The most common brand of preparation, Remifemin, contains 20 milligrams per tablet.

You are considered to overdose on this supplement if you take more than 900 milligrams of black cohosh in one day.

In addition to supplements in capsules and tablets, you can also find black cohosh in liquid tincture and extracts that can be mixed into water, and dried black cohosh root that may be used to make tea.

Side Effects

A few side effects may exist, though most of them are generally unsupported by thorough research. Some patients have complained of stomach discomfort, headaches, seizures, diarrhea, nausea and vomiting, constipation, low blood pressure, and weight problems. (15)

Many of these complaints are more likely due to mis-identification of black cohosh in the wild by certain manufacturers. In addition, it’s suggested to inform your healthcare professional if you take this supplement for more than six months consecutively. (16)

The only potential side effect that has been consistently linked to black cohosh consumption is a negative effect on the liver. (17) While there is still no concrete evidence that black cohosh causes liver toxicity, I suggest consulting your primary care physician about consuming this supplement along with other medications or supplements that may be linked to liver damage, or if you already suffer from liver disease.

If you develop symptoms of liver illness while taking black cohosh (e.g., abdominal pain, dark urine, or jaundice), discontinue use immediately and contact your doctor.

Until further research can be completed, you should also not take black cohosh while you are pregnant or nursing, as the effects on fetuses and newborns have not been determined. Black cohosh has not been reported to have any negative drug interactions or influence laboratory tests.

Josh Axe

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