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.

Black cohosh, a plant steeped in history and tradition, has been a staple in herbal medicine, particularly among Native American communities. Known scientifically as Actaea racemosa, this plant is recognized for its towering white flowers and its use in treating a variety of conditions. Let’s explore the sensory attributes and historical background of black cohosh.

Sensory Profile

Black cohosh has a distinct sensory profile. The roots and rhizomes, which are the parts most commonly used in herbal remedies, have an earthy and slightly bitter taste. This strong, somewhat bitter flavor is often masked when consumed in the form of capsules or tinctures in modern herbal supplements.

The smell of black cohosh is not particularly strong or distinctive, leaning more towards a mildly earthy aroma. It’s the taste rather than the smell that makes black cohosh recognizable in herbal preparations.

Historical Background

Black cohosh has a rich history, particularly within Native American medicinal practices. It was commonly used by various tribes for several health issues, especially in women’s health. Native Americans used black cohosh to help with menstrual irregularities, menopause symptoms, and to ease childbirth. They were the first to recognize its potential in treating gynecological disorders.

With the arrival of European settlers in North America, the use of black cohosh spread. It became a part of American folk medicine and was eventually adopted into the practice of conventional medicine in the 19th century. By the mid-20th century, black cohosh was listed in the U.S. Pharmacopeia and was widely used for treating symptoms related to menopause and menstruation.

Modern Uses

Today, black cohosh continues to be a popular herbal supplement, particularly among women seeking natural remedies for menopausal symptoms such as hot flashes, night sweats, mood swings, and sleep disturbances. While its efficacy and mode of action are subjects of ongoing research, many women report relief from using black cohosh preparations.

It’s important to note that while black cohosh is generally considered safe for short-term use, it should be used with caution. As with any supplement, there can be side effects and interactions with other medications. Therefore, it’s always advisable to consult with a healthcare provider before starting any new herbal treatment.

Black cohosh stands as a testament to the enduring wisdom of traditional herbal remedies. Its journey from Native American medicine to modern herbal supplements highlights the importance of understanding and respecting the healing properties of plants. As research continues to uncover the mysteries of this herb, black cohosh remains a symbol of nature’s untapped potential in contributing to human health and wellness.

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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