Understanding Black Cohosh for Menopause: What Is It and How Does It Work?

Understanding Black Cohosh for Menopause: What Is It and How Does It Work?

Black cohosh has been used for centuries to treat women’s health issues related to hormone imbalance. However, scientific studies remain inconclusive about exactly how it works or if it works at all. 


What is Black Cohosh? 
Black cohosh (actaea racemosa or cimicifuga racemosa) is a perennial plant native to the eastern United States (1). Although often grown in gardens for its ornamental white flowers, it has also been used worldwide for centuries as a medicinal herb.  
Black cohosh can grow to more than 6 feet and is characterized by its large, toothy leaves. It is also known by several other names, including: 
  • bugbane 
  • snakeroot 
  • macrotys 
  • baneberry 
  • rattleweed 
  • rheumatism weed 

Indigenous North American cultures and colonists relied on the root of the black cohosh plant to treat a number of health concerns, including menstrual discomfort and difficult childbirth (2).  
There is little evidence, however, that black cohosh was traditionally used to treat women’s menopausal symptoms.  


Benefits of Black Cohosh for Menopause 
Many individuals experiencing menopause turn to black cohosh as a natural form of relief from discomfort and pain caused by menopause. The following are benefits black cohosh claims, however there is lack of consistent evidence that black cohosh will help alleviate symptoms of menopause.
  • Reduced hot flashes 
  • Fewer muscle aches 
  • Improvement mood swings 
  • Better sleep 
Today, black cohosh is often combined with other herbs and ground into capsules or made into teas and marketed as an effective remedy for menopausal symptoms.  


How does black cohosh treat menopause symptoms? 

There is still much we don’t know about black cohosh.  

In 2008, a clinical trial showed that black cohosh causes a reaction in the hypothalamus of the brain, which is where the body controls temperature, causing researchers to believe there may be a tie between black cohosh and reducing hot flashes. The women in the same study also reported experiencing fewer hot flashes. However, because this study was very preliminary, there was no control group and the women were self-reporting, so there could have been a placebo effect influencing the results (3).  

The first investigations into black cohosh benefits were launched in the 1950s (4).  
 Unfortunately, due to inconsistencies in testing methodology, early clinical trials remain both contradictory and inconclusive as to the efficacy of black cohosh for treating menopause symptoms.  

Guidelines by the Endocrine Society issued in 2015 report that black cohosh provides no benefit for the relief of menopause symptoms (5).  

In fact, some studies indicate that individuals given black cohosh experienced no more benefit than those who received placebos.  

Some black cohosh plants may also contain a phytochemical that produces a calming effect that can regulate body temperature, thus reducing hot flashes (6).

The bottom line is that black cohosh remains a bit of a mystery. Although it might be helpful in reducing menopausal complaints, the evidence is still too inconclusive to say for certain.  


Balancing Your Hormones 
Traditionally, black cohosh was used to address a number of women’s health issues related to hormone imbalance, but not necessarily menopause (7). 
  • Even if black cohosh isn’t an ideal solution for menopausal changes, it could be useful for Premenstrual Syndrome (PMS), Polycystic Ovarian Disorder (PCOS), and Fibroids. However, there is little research to support these findings and more evidence is needed before coming to a conclusion about the efficacy of black cohosh in these scenarios (8).  


Risks & Side Effects of Black Cohosh 
Side effects that have been associated with using black cohosh include the following (8):   
  • Upset stomach or gastrointestinal distress 
  • Skin rashes 
  • Muscle pain 
  • Breast pain  
  • Irregular vaginal bleeding 
  • Liver damage (rare) 
Black cohosh is not known to have interactions with other medications, but please note that this hasn’t been systematically studied (1).  


Key Takeaways 
Black cohosh has been a traditional remedy for many ailments, including women’s health issues, for centuries.  
While scientific evidence suggests that it may be safe to take black cohosh and that it can help alleviate some menopausal concerns, the evidence remains inconclusive overall.   
So, if you’re looking to alleviate symptoms effectively, black cohosh may not be the solution.  



  1. U.S. Department of Health and Human Services. (2020). Black cohosh. National Center for Complementary and Integrative Health. Retrieved October 31, 2022, from https://www.nccih.nih.gov/health/black-cohosh 
  1. Combes, W. L. (2000, December). Black Cohosh. Pharmacists Manitoba. Retrieved October 31, 2022, from https://www.pharmacistsmb.ca/ 
  1. Reame, N., Lucaks, J., Padmanabhan, V., Eyvazzadeh, A., Smith, Y., & Zubieta, J.-K. (2008). Black cohosh has central opioid activity in postmenopausal women: Evidence from naloxone blockade and positron emission tomography neuroimaging. Menopause (New York, N.Y.). Retrieved October 31, 2022, from https://pubmed.ncbi.nlm.nih.gov/18521048/ 
  1. U.S. Department of Health and Human Services. (2020, June 20). Office of dietary supplements - black cohosh. NIH Office of Dietary Supplements. Retrieved October 31, 2022, from https://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/ 
  1. Stuenkel, C., Davis, S. R., Santen, R. J., Pinkerton, J. A. V., Murad, M. H., Lumsden, M. A., & Gompel, A. (2015, November 1). Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice GuidelineR. Academic.oup.com. Retrieved October 31, 2022, from https://academic.oup.com/jcem/article/100/11/3975/2836060?login=false 
  1. Kaputk. (2022, October 20). Black Cohosh: Uses, benefits and side effects. Cleveland Clinic. Retrieved October 31, 2022, from https://health.clevelandclinic.org/what-is-black-cohosh/ 
  2. Wobser, R. W., & Takov, V. (2021, November 26). Black Cohosh. National Center for Biotechnology Information. Retrieved October 31, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK470187 
Shoemaker, S. V. (2020, May 27). Black cohosh: Benefits, dosage, side effects, and more. Healthline. Retrieved October 31, 2022, from https://www.healthline.com/health/food-nutrition/black-cohosh