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Can Black Cohosh Actually Help Menopause Symptoms?

The plant has been touted for its ability to improve hot flashes and night sweats. We asked two experts whether it really works.
Can Black Cohosh Actually Help Menopause Symptoms?

Perimenopause and menopause symptoms are far-ranging, but all have the ability to cause anything from discomfort to intense pain. So it’s not surprising that people experiencing menopausal symptoms might turn to dietary supplements, like black cohosh for menopause relief.

Menopause hormone therapy (MHT) is the gold standard for symptoms like hot flashes and genitourinary syndrome of menopause. But not all menopausal people can use it. Breast cancer patients and survivors, for example, shouldn’t take MHT because of the risk of breast cancer recurrence.

So, does black cohosh really work for menopausal symptoms?

black cohosh for menopause (Photo: iStock)

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What is black cohosh?

Black cohosh is a tall, flowering plant indigenous to the eastern part of North America that comes from the buttercup family.

Black cohosh grows in the shady woodlands in this part of the continent. It’s also sometimes called black snakeroot, bugbane or bugwort.

What does it purport to do?

Black cohosh was traditionally used by Indigenous communities in North America. It was used to treat a number of ailments including muscle and joint pain, fever, cough, pneumonia and irregular periods.

Today, black cohosh is most commonly found in supplements that help treat vasomotor symptoms of menopause (a.k.a. hot flashes and night sweats). Black cohosh supplements come in many formats, including capsules, tablets, tinctures, extracts and teas.

Does it really work?

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There’s just no evidence that black cohosh is helpful in relieving menopause symptoms. “It’s one of those things that claims it can make magical things," says Dr. Taryl Felhaber, a clinical instructor at UBC’s Department of Family Practice and a Menopause Society certified menopause practitioner. "But there is no magic in menopause.”

According to Felhaber, studies of black cohosh’s effectiveness against menopause symptoms like hot flashes are “not definitive. They don’t show significant improvements in any of the symptoms that they’ve studied so far,” she says.

There have been several randomized controlled trials, which are the gold standard in medicine, looking into black cohosh and its effects on menopausal symptoms.

What the studies have to say

One of the first, published in 2006, found that there was no difference in the number and intensity of vasomotor symptoms between the group taking black cohosh and those taking a placebo at three and six months. At 12 months, however, those taking the herbal supplements had significantly worse symptoms.

Another study, published in 2009, had similar outcomes, with the group taking this supplement experiencing worse symptoms at six and nine months than those taking a placebo. The effect of black cohosh roots was not favourable for menopausal symptoms.

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In 2012, the Cochrane Review (a systematic review of randomized controlled trials that aims to synthesize evidence from research around the world) evaluated 16 randomized controlled trials looking at black cohosh’s effectiveness at reducing symptoms in menopausal women.

It found that there was “insufficient evidence” from these trials—they couldn’t support the use of the herb for menopausal symptoms. (The review does say that black cohosh should be studied further to determine its usefulness.)

Finally, in its 2023 position statement on non-hormonal therapy for menopause symptoms, the Menopause Society does not recommend using black cohosh because there’s “no demonstrated evidence of benefit.”

But what about the people who swear black cohosh has provided some relief?

Felhaber says this is most likely a placebo effect—believing that a treatment is working even if it isn’t. She adds that for hot flashes in particular, the placebo effect is especially common. Up to 50 to 60 percent of postmenopausal women experiencing hot flashes will say, at first, that a placebo is working.

Does black cohosh have any side effects?

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There are a few common side effects caused by doses of black cohosh such as upset stomach, cramps, headaches, rash, a feeling of heaviness, spotting or vaginal bleeding, vaginal dryness, weight gain and other potentially adverse effects. There have also been some cases of liver damage, liver injury and even long-term issues like liver failure linked to some commercial black cohosh products.

Is it safe to use for menopause symptoms?

Not only is the research into black cohosh’s ability to treat menopause symptoms inconclusive, but many black cohosh supplements sold in Canada actually don’t contain the correct species of plant.

Instead, plant-based supplements like cimicifuga, another member of the buttercup family, are often used in black cohosh products. “But there’s no trial to show that [that] actually has a positive effect on symptoms,” Felhaber says.

Supplements sold in Canada are not well regulated. As a result, supplement ingredient lists are often found to be inaccurate. This means it’s hard to know exactly how much black cohosh you’re getting in each capsule (if the product is indeed black cohosh).

“So, you could be getting many times what is considered a treatment dose,” warns Felhaber of cohosh for menopausal symptoms. “Or you could be getting nothing.”

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