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Black Cohosh
(Cimicifuga racemosa)

Experts believe black cohosh is a suitable alternative for those women who would like to take the natural approach to controlling menopause symptoms. It is suitable alternative for those who do not want to take prescription based hormone replacement therapy (HRT).

One recent clinical studies show that this herb may not work as was shown in previous clinical studies.

Start with the lower recommended dose first and increase as needed to control the symptoms. Stay within the recommended doses if possible as higher doses may cause unwanted side effects.

For treating prostate cancer, lab and animal studies show promising results as this supplement was able to kill prostate cancer cells. However, it's too early to tell if taking this supplement would prevent or treat any forms of cancer.

Table of Contents

Evidence of Benefits (Leaf Rating System)

	Hot flashes / Menopause Symptoms Many clinical trials confirm that black cohosh is effective in reducing hot flashes. It is also shown to help reduce anxiety. However, a recent well-designed clinical trial lasting 12 months showed that taking this herb was not better than taking placebo. Ironically, the placebo pill gave women relief from hot flashes more than taking this herb. Some studies show that combining this herb with St. John's wort significantly reduces menopause symptoms (such as depression, anxiety and insomnia). Click here to get the answer to "How long does menopause last?"
	Rheumatoid Arthritis / Osteoarthritis Research studies show that taking this supplement may reduce the inflammation from rheumatoid arthritis and osteoarthritis. However, the experts suggest you'll get a better effect if it is combined with other herbal supplements such as bark willow. Click here for a list of herbs used to treat osteoarthritis.
	Breast Cancer In a study done in 10,121 German women, this herb seems to protect against certain types of invasive breast cancer. At worst, it did not increase the risk of breast cancer like prescription hormone replacement therapy (HRT) does.
	Prostate Cancer In lab studies and mice, this supplement seems to slow down the growth of prostate cancer cells. How it works is unknown as it does not change testosterone levels. (Lowering testosterone slows down the growth of prostate cancer cells.)
	Osteoporosis Phytoestrogen (contained in black cohosh) is suspected to be useful in preventing osteoporosis. Studies done in a lab setting and mice shows this benefit. Clinical studies will be needed to verify if this is the case in humans.
	Induce Labor There are no clinical studies done to verify if taking this supplement would induce labor. Midwifes commonly use this herb as part of their practice to induce labor in women past their due date.

Suggested Benefits and Traditional Uses

Oral

anti-inflammatory benefits
anxiety and nervousness
breast cancer
cough
depression (mild)
painful menstruation (dysmenorrhea)
fever
high blood pressure
hot flashes
induce labor during pregnancy
menopause symptoms
migraine (related to menstruation)
muscle relaxant
osteoporosis
premenstrual syndrome (PMS)
prostate cancer
rheumatoid arthritis
ringing in the ear (tinnitus)
sedative
vaginal dryness

Facts and Frequently Asked Questions (FAQ's)

What is black cohosh traditionally used to treat?

This herb has been used for centuries in Chinese medicine to treat ailments such as reproductive problems, gingivitis, headaches and measles.

As well, black cohosh is used extensively for over four decades in Europe. It is approved in Germany for use to treat menopause symptoms and pain from premenstrual syndrome (PMS).

Because this herb contains chemicals that have similar properties to natural estrogens (phytoestrogens), it can be used instead of prescription estrogen pills for treating menopause symptoms.

Does this supplement help with hot flashes?

Yes, many clinical trials show that this supplement seems to help with symptoms of menopause such as hot flashes. It is not as effective as prescription estrogen replacement therapy but was significantly better than placebo (sugar pills).

Can this supplement be used to induce labor?

There is no clinical study to show whether taking this herb would help with inducing labor at term. It is a common practice for some midwifes to use this herb to help induce labor.

There is no study to show that taking this supplement during pregnancy is safe. However, there are no reports that it is unsafe either.

What about blue cohosh?

Blue cohosh has been combined with black cohosh to induce labor. Blue cohosh contains compounds suspected to cause birth defects and it may be toxic to the infant. As well, blue cohosh seems to reduce blood flow to the heart.

Do not use blue cohosh to induce labor.

Is it safe to use black cohosh if you have breast cancer?

Because this herb shows estrogen-like activities, some researchers suspect it might promote breast cancer. (Estrogen promotes the growth of many forms of breast cancer cells.) However, in research studies done on post-menopausal women, taking this supplement did not affect estrogen levels in the blood.

Studies done with cancer cells show that this supplement does not promote cancer cells growth. Studies done in mice show that black cohosh does not affect breast cancer growth. However, in animals with cancer, this supplement did increase cancer growth.

If you have a history of breast cancer, consult your physician and discuss with him or her that you intend to take this supplement.

Side Effects, Toxicity, Warnings and Interactions

This supplement does not cause too much unwanted side effects at the recommended doses. Higher doses will increase the side effects.

Reported side effects when taken at higher doses include:

stomach upset
rash
headache
constipation
lowered blood pressure
a feeling of heaviness in the legs
weight gain
cramping

Overdose may cause nausea, vomiting, dizziness, lowered heart beat, sweating and vision problems.

There have been some reported dangers that using this supplement caused damage to the liver. However, a recently study completed in June 2009 shows that taking this supplement does not affect any liver function even after a year of using it. However, as a precaution, let your healthcare professional know that you intend to take this supplement if you have a history of liver problems.

Safety - Clinical studies have shown black cohosh to be safe to use. Many of these studies lasted up to six months (with some studies lasting up to 1 year).

Pregnancy and Lactation - Using this herb during pregnancy may be unsafe as it may have stimulation and estrogen-like effects. Until we know more about the safety profile of this supplement, avoid using if possible.

Dosage & How to Take It

Capsules

Dose ranging from 40 to 80 mg twice daily have been used in research studies.

Remifemin is the brand used in the research studies. It contains
20 mg of the extract standardized to contain 1 mg of triterpenes saponins.

Powder

Take 1 to 2 grams of the powdered rhizome daily (divided into two or three times daily).

Tea formulation (Decoction)

Use 1.5 to 9 grams of the powdered rhizome.

Dried Root or Rhizome

Dosage of 40 to 200 mg per day (divided into two doses) have been used and suggested by the British Herbal Compendium. Doses up to 1 gram three times daily have been used historically.

Liquid Extract (1:1)

Take 3 to 4 mL per day.

Tincture (1:10 in alcohol)

Take 0.4 to 2 mL per day.

Selected References for Black Cohosh
Revised: February 5, 2010

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Black Cohosh (Cimicifuga racemosa)