The black cohosh plant is full of surprises. For one, the name doesn’t match the curtains—black cohosh produces white flowers from its green stem. Other names for black cohosh include snakeroot and bugwort — so let’s just say we appreciate the non-literal approach.
Black cohosh is a bit of a celebrity supplement. As one of the most popular dietary supplements in the world, an estimated 1.2 million Americans had used black cohosh products in the past 30 days, according to the latest National Health and Nutrition Examination Survey.
If you spend your days and nights trying to figure out how to stop being at the mercy of hot flashes, you may have heard of black cohosh as an alternative treatment for vasomotor symptoms (VMS) of menopause.
There’s definitely buzz about black cohosh — but does it work? Here’s what you need to know and some surprising facts about the popular supplement.
What is black cohosh?
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The black cohosh plant is native to North America and—fun fact—is part of the buttercup family. (Adorable, right?)
The plant’s root and rhizome (underground stems) is what is used in herbal supplements, usually sold as liquid extracts or dried extracts in pill form.
Medicinal black cohosh has been around for centuries and has deep roots in traditional Native American medicine. Black cohosh is said to treat a wide range of women’s health symptoms and conditions, including VMS.
For a long time, black cohosh was considered a phytoestrogen — a plant substance that has an estrogen-like effect on the body. However, a growing body of research suggests that black cohosh may not be a phytoestrogen, but still has the ability to act like estrogen in certain parts of the body, including the brain, vagina, and bones.
Read: Should You Take Nutritional Supplements for Menopause? >>
Can taking black cohosh improve menopausal symptoms?
Thanks to its potential estrogen-like effects, black cohosh is marketed as an herbal remedy for menopausal symptoms.
Possible benefits of taking the supplement include relief from hot flashes, night sweats, and vaginal dryness.
There is some research out there to support the VMS claims: A resolution 2023 of 22 studies in more than 2,300 women found that taking black cohosh significantly improved overall menopausal symptoms, hot flashes, and genitourinary menopausal syndrome (GSM) compared to women who did not take black cohosh.
In addition to relieving VMS, black cohosh may also help relieve period cramps and PMS and induce labor in pregnant women, although it’s important to note that research on black cohosh and health conditions outside of VMS is very limited.
What are the possible side effects of black cohosh?
The risk of side effects from black cohosh is low and most people tolerate the supplement without any problems. But when there are side effects from taking black cohosh, they can include:
- Gastrointestinal problems
- Headache
- Musculoskeletal pain
- Uterine bleeding
- Rash
- Chest pain
- Elevated liver enzymes
- Liver failure
Although rare, severe liver damage has been reported in some people taking black cohosh. By 2023, there were 83 cases of liver damage reported worldwide.
Who should not take black cohosh?
Since black cohosh can affect the liver, people with liver disorders should avoid taking the supplement. Also, people who are pregnant or breastfeeding should avoid black cohosh because there is limited research on the safety of the supplement during pregnancy and breastfeeding, and as mentioned, black cohosh could induce labor.
Since black cohosh may have estrogen-like effects, it is especially important for people with hormone-positive conditions such as certain breast cancers, noncancerous breast lumps, fibrocystic breast changes, fibroids, and endometriosis to talk with their healthcare provider (HCP) before taking black cohosh.
The supplement may also interact with certain medications, including certain cancer treatments, so make sure your HCP has a complete list of all medications and supplements you are taking before you decide to take black cohosh.
Is black cohosh safe?
Black cohosh is relatively safe for most people. But it’s important to note that black cohosh products—like all dietary supplements—are not approved or reviewed by the Food and Drug Administration (FDA) before being sold to the public. This means that the product you are buying may contain the wrong herb or unknown ingredients that could be harmful to your health.
A recent one study of 320 brands of black cohosh nearly half of the sales were found to be adulterated or incorrect products. Supplements with USP (USP) Dietary Supplement Verification Program or ConsumerLab.com verification on the label mean that the supplements are of high quality and not adulterated with other ingredients.
Talk to your healthcare provider before taking any supplement
If you’re interested in taking black cohosh, the first step is to talk to your doctor about the pros and cons and any potential interactions with other medications. You don’t want any surprises when it comes to your health.
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