Black cohosh in menopause: take or skip?

Variety of spices, including black cohosh in menopause

Can taking black cohosh in menopause or perimenopause help with symptoms? For some women, it definitely does. We answer some common questions we hear from women thinking about starting black cohosh as a supplement.

What exactly is black cohosh and how does it work?

Black cohosh is a plant. It’s also called bugbane, and it belongs to the buttercup family. For years its roots and flowers have been used in Native American culture and in Eastern medicine—but its mainstream popularity really grew in the 1950s.

Black cohosh has earned quite the reputation over the years and might help with premenstrual syndrome (PMS), bone health, infertility, some hormone imbalances, PCOS, and yes: menopause symptoms. Exactly how black cohosh works is a little less clear. It’s possible that black cohosh works because it’s a phytoestrogen. Phytoestrogens are plant compounds that have a similar function and composition to the natural estrogen you produce. These similarities let phytoestrogens act like weak estrogen in your body (and in some ways counteract it). In menopause, natural estrogen levels reach new lows. The estrogen-like properties of phytoestrogens can step in and offer some relief. You might start to notice your hot flashes, night sweats, insomnia, mood swings, anxiety, vaginal dryness, headaches, and other symptoms are bothering you less and less.

Is black cohosh worth trying in menopause?

If your symptoms of menopause are severe enough to start googling supplements, black cohosh is worth considering. There aren’t a ton of studies out there on black cohosh and not all providers recommend it, but some research has had promising results. One study showed a reduction in hot flashes and night sweats by more than 25%. Another reported that women taking black cohosh in menopause were almost 60% less likely to develop breast cancer than those who didn’t.

What type of black cohosh supplement is best?

This is a great question because quality reliability and ingredient formulations are dizzying across products and brands. Supplements aren’t regulated like prescription medications. It pays to check with your doctor and pharmacist and also do your research about whatever you take, including black cohosh. With black cohosh, you’ll want to look specifically at:

  • Brand quality and reviews
  • Whether the product contains powder or extract (extract is the way to go)
  • Amount of active ingredient
  • Common allergens in the product

A good black cohosh product that’s been available for years is Remifemin. Sold over the counter, Remifemin makes for a reliable choice because it’s one of the few black cohosh products that’s been included in studies. An extract-based product, Remifemin contains 20 mg black cohosh root in each tablet. (A standard Remifemin dose equals two tablets per day.) It’s been shown to be more effective than soy at relieving menopause symptoms. While Remifemin does have lactose, it’s free from yeast, gluten, corn, soy, colorings, and preservatives.

How much should I take and for how long?

The average dosage of black cohosh is 20­–40 mg twice a day. But, like with any supplement, run black cohosh by your healthcare provider to talk dosage and interactions. It might take a few weeks to see if it’s helping you. However, black cohosh isn’t a long-term thing, like your multivitamin. In fact, The National Institute of Health recommends limiting use to fewer than 12 months.

Can everyone take black cohosh?

No. We can’t stress this enough: just because something is natural or herbal doesn’t mean it’s safe for everyone. If you get the green light to try black cohosh, stop right away if you experience stomach pain or upset, spotting, rashes, or headaches. Don’t give black cohosh to a child and don’t take it yourself if you:

  • are pregnant or breast-feeding
  • have had any type of hormone-sensitive cancer
  • are diagnosed with or suspect endometriosis
  • have a kidney or liver issue or take medications that affect the liver

It’s really important to know black cohosh can cause liver issues for some people. Also, steer clear if you’re already dealing with a liver issue, as it could make it worse. This is a good example of why you always want to talk to your physician before starting a new supplement. You might get advised not to take black cohosh if you’re on another medication or supplement that affects the liver. A few of these include:

  • methotrexate (used in low doses for several autoimmune disorders)
  • certain antibiotics, like erythromycin
  • trazadone and other antidepressants or antipsychotics
  • blood pressure and cholesterol-lowering medications
  • Tylenol
  • oral anti-fungal medications

Can black cohosh make me gain weight?

Unfortunately, there’s no clear answer here. Maintaining weight gets harder as we age. For some women, black cohosh makes that even more of a challenge. That said, some menopausal women report finding it easier to maintain their weight.

What else should I know?

Perimenopause and menopause can be really difficult times of life. If you’re feeling like that’s true for you, you’re not alone. We have estrogen receptors all over our bodies. When estrogen levels decline, that means there’s the potential for all kinds of uncomfortable and disruptive symptoms. In fact, about 85% of women have experienced at least one symptom of menopause.

Black cohosh isn’t the only non-pharmaceutical that might help. Red clover, flaxseeds, wild yam, and other options exist (but chat them over with your provider first). Also, discussing hormone replacement therapy (HRT) is a good idea. It’s not for everyone either, but some women find the benefits outweight the risks.