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Black Cohosh for Menopausal Symptoms?

Black Cohosh for Menopausal Symptoms?

Though menopause itself is not a disease but a physiological phase in a woman’s life, the symptoms of menopause including hot flashes and night sweats can be especially bothersome.  Many women choose to take dietary supplements containing extracts from the Actaea racemosa plant black cohosh to treat these symptoms in particular.  However, two recent controversies surround the use of black cohosh for menopausal symptoms.

First, there are questions about the safety of black cohosh with specific concerns regarding potential liver damage. Secondly, there are questions about the efficacy of black cohosh for treating menopausal symptoms.

Does Black Cohosh Cause Liver Damage?

To answer the first question, well, the jury’s still out as there is no consensus of whether or not black cohosh causes hepatotoxicity (liver damage).  A very recent article in the journal, Menopause, concluded the following:

“The presented data do not support the concept of hepatotoxicity in a primarily suspected causal relationship to the use of BC (black cohosh) and failure to provide a signal of safety concern, but further efforts have to be undertaken to dismiss or to substantiate the existence of BC hepatotoxicity as a special disease entity (Teschke, 2010).”

With the number of case reports of liver damage in the literature, it would be advisable to avoid or not use black cohosh until further research is available.

Does Black Cohosh Really Work?

With respect to the second question, a recent meta analysis (review analysis of other studies), concluded:

“Preparations containing black cohosh improved these symptoms (vasomotor symptoms–hot flashes, night sweats) overall by 26% (95% confidence interval 11%-40%); there was, however, significant heterogeneity between these trials. Given that black cohosh is one of the most frequently used herbal medications for menopausal vasomotor symptoms in North America, more data are warranted on its effectiveness and safety (Shams et al, 2010).”

In short, this study suggested that black cohosh has potential to relieve symptoms such as hot flashes or night sweats (vasomotor symptoms), however, the studies that they reviewed had inconsistent results.

Key Points:

  • Further research is necessary to assess the effectiveness of black cohosh at treating menopausal symptoms.
  • Further research is necessary as well to study the safety of black cohosh particularly with respect to potential liver damage.
  • Given these requirements, black cohosh use should be avoided in favor of other treatment options until further information is available.


  1. Teschke R.  Black cohosh and suspected hepatotoxicity: inconsistencies, confounding variables, and prospective use of a diagnostic causality algorithm. A critical review.  Menopause. 2010 Mar;17(2):426-40.
  2. Shams T, Setia MS, Hemmings R, McCusker J, Sewitch M, Ciampi A.  Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis.  Menopause. 2009 Nov-Dec;16(6):1156-66.
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