Black cohosh (Actaea racemosa, formerly known as Cimicifuga racemosa) has been used by Native Americans for more than two hundred years, after they discovered the root of the plant helped relieve menstrual cramps and symptoms of menopause, such as hot flashes, irritability, mood swings, and sleep disturbances. It is a tall, flowering plant found in rich, shady woods in eastern areas of North America. A member of the buttercup family, black cohosh is also known as black snakeroot, bugbane, bugwort, and squawroot. Its rhizomes and roots (both underground parts of the plant) are used for medicinal purposes.
It has been used to treat muscular pain, stomach issues, arthritis, mood, sore throat, coughing and to induce labor. For this reason, pregnant women are strongly cautioned not to take black cohosh. Today, people use black cohosh for these same reasons. In fact, the herb has been widely used for more than 40 years in Europe and is approved in Germany for premenstrual discomfort, painful menstruation, and menopausal symptoms.
If you have ache -- whether from menstrual cramps, an injury, or a condition such as arthritis -- black cohosh may be the herb you need. Black cohosh acts as an antispasmodic to muscles, nerves, and blood vessels and as a muscle anti-inflammatory. It contains the anti-inflammatory salicylic acid (the base for the active ingredient in aspirin), among several other constituents such as triterpene glycosides (for example, acetin and 27 deoxyactein), isoflavones (for example, formononetin), aromatic acids, tannins, resins, fatty acids, starches, and sugars, and has been used for an assortment of muscular, pelvic, and rheumatic pains.
Black cohosh seems particularly effective for uterine cramps and muscle pain caused by nervous tension, as well as pains accompanied by stiffness, soreness, and tight sensations or contractions. Native Americans used it for female and muscular conditions as well as fatigue, sore throat, arthritis, and rattlesnake bites. Early American physicians used black cohosh for female reproductive problems, including menstrual cramps and bleeding irregularities, as well as uterine and ovarian pain.
Black cohosh is used as an emmenagogue, an agent that promotes menstrual or uterine bleeding. Herbalists consider it a sedative emmenagogue, meaning it promotes menses when uterine tension, cramps, and congestion hinder flow. Black cohosh relaxes the uterus, especially when tension is caused by anxiety. Black cohosh is believed to act on the uterus by improving muscle tone, so it is useful for preventing miscarriage and premature labor. The herb also is recommended for women who have had difficult labors; in those cases it is administered in small doses in the last trimester of pregnancy to prepare the uterus for delivery. It decreases labor pain while at the same time promoting more efficient contractions. Black cohosh also can be helpful when contractions during labor are weak, or for severe after pains following labor.
The herb is thought to have an estrogenic effect because its constituents bind to estrogen receptors in the body. The binding of a plant constituent to an estrogen receptor can increase estrogen activity in the affected tissues. Women who take water extracts of black cohosh have not demonstrated the side effects usually associated with hormone replacement therapy (HRT), leading researchers to believe that this herb could be a safe alternative to traditional HRT. Black cohosh can improve many symptoms of menopause, including uterine problems, such as poor uterine tone, menstrual cramps, and postmenopausal vaginal dryness.
One recent study evaluated the effects of black cohosh and a placebo in 110 menopausal women. The women were given 8 milligrams of black cohosh or the placebo every day for eight weeks, and then blood levels of the hormones FSH and LH were checked. The results showed that black cohosh decreased the levels of LH -- an effect that could particularly benefit postmenopausal women. Several German clinical trials support the usefulness of black cohosh for relieving hot flashes in menopausal women. Other symptoms of menopause also improved after the women took black cohosh; they experienced decreased night sweats, improved sleep, and less nervous tension during the day.
Black cohosh is also a mild stomach tonic credited with alterative action. (An alterative is an agent capable of improving the absorption of nutrients and the elimination of wastes by the digestive tract.) Its sweet and bitter flavors stimulate digestion. Black cohosh has been shown to dilate peripheral blood vessels and sometimes improve elevated blood pressure. Early physicians also used black cohosh for serious infectious diseases, including whooping cough, scarlet fever, and smallpox.
Other benefits of black cohosh:
Black cohosh balances hormone levels in both men and women.
Black cohosh has natural anti-inflammatory effect. This makes it helpful in reducing pain, stiffness, and soreness associated with all types of arthritis.
Black cohosh is one of the best natural therapies a woman can use to relieve menopausal symptoms. At least eight studies have shown that is can relieve menopausal symptoms, including hot flashes.
Black cohosh helps to reduce menstrual cramps by relaxing the smooth muscles of the uterus. It is advisable to start drinking black cohosh tea a day before the onset of the menstrual period and drink it once daily until the symptoms fade away.
Black cohosh can help increase the motility and viability of sperm cells by protecting their cell walls from oxidation by compounds released from environmental toxins, helping in cases of infertility.
Black cohosh has a mild sedative activity that can help in the treatment of headaches caused by anxiety, stress and depression. Just drink one cup of Black cohosh tea before the onset of severe headache or migraine.
Black cohosh can also help with respiratory tract infections, asthma, bronchitis, nasal congestion, colds and flu. Drinking a cup of black choosy tea twice daily may help relieve the symptoms of such sinus and respiratory conditions.
Menopausal Symptoms
Quite a few clinical studies confirm that the use of black cohosh is effective for improving menopausal symptoms, although some have found no improvement. Early German studies found black cohosh improved physical and psychological menopausal symptoms, including anxiety, hot flashes, night sweats, and vaginal dryness.
In a clinical study of 120 women with the menopausal symptoms, black cohosh was more effective in relieving hot flashes and night sweats than the antidepressant fluxetine (Prozac).
Given the results of most clinical studies, many experts conclude that black cohosh may be a safe and effective alternative for women who cannot or will not take hormonal replacement therapy (HRT) for menopause. However, in a recent review of six studies, researchers concluded that the evidence does not consistently demonstrate an effect of black cohosh on menopausal symptoms.
Hot Flashes Related to Breast Cancer Treatments
Breast cancer medications such as tamoxifen (Nolvadex) can cause hot flashes. While many breast cancer patients may take black cohosh to reduce the number and intensity of hot flashes, two well designed studies concluded that the herb is no more effective than placebo. In addition, Yale researchers report that herbal medicines such as black cohosh may interfere with common breast cancer treatments, such as radiation and cancer therapy drugs.
There has been some concern that black cohosh may contain plant based estrogens, or phytoestrogens, which can stimulate the growth of breast tumors. However, a case-control clinical study of 949 breast cancer cases and 1,524 controls found that black cohosh use had significant protective effects against breast cancer development. More research is needed. Patients with a history of breast cancer, risk factors for breast cancer, or who are actively engaged in breast cancer treatment, should talk to their doctor before taking black cohosh.
Arthritis
Preliminary studies suggest that black cohosh may help reduce inflammation associated osteoarthritis and rheumatoid arthritis. In a review of scientific studies, researchers concluded that a combination of black cohosh, willow bark (Salix spp.), sarsaparilla (Smilax spp.), guaiacum (Guaiacum officinale) resin, and poplar bark (Populus tremuloides) may help relieve symptoms of osteoarthritis. However, there is not enough human research to make a clear recommendation about the use of black cohosh alone for arthritis.
Osteoporosis
Laboratory studies have found that plant based estrogens (called phytoestrogens) in black cohosh may inhibit bone loss, such as seen with osteoporosis. More research is needed.
The root of black cohosh is used for medicinal purposes. Black cohosh root contains several chemicals that might have effects in the body. Black cohosh root contains glycosides (sugar compounds), isoferulic acids (substances with anti-inflammatory effects), and, possibly, phytoestrogens (plant based estrogens), among several other active substances. Some of these chemicals work on the immune system and might affect the body's defenses against diseases. Some might help the body to reduce inflammation. Other chemicals in black cohosh root might work in nerves and in the brain. These chemicals might work similar to another chemical in the brain called serotonin. Scientists call this type of chemical a neurotransmitter because it helps the brain send messages to other parts of the body.
Black cohosh root also seems to have some effects similar to the female hormone, estrogen. In some parts of the body, black cohosh might increase the effects of estrogen. In other parts of the body, black cohosh might decrease the effects of estrogen. Estrogen itself has various effects in different parts of the body. Estrogen also has different effects in people at different stages of life. Black cohosh should not be thought of as an "herbal estrogen" or a substitute for estrogen. It is more accurate to think of it as an herb that acts similar to estrogen in some people.
Black cohosh is available in capsules, tablets, liquid tincture and extracts that can be mixed in water, and dried root for a tea. A standardized preparation of black cohosh is recommended for use in menopause.
Black cohosh should not be confused with blue cohosh, a nicotine like herb that has similar effects but has not been thoroughly tested for its safety and effectiveness.
Pediatric
There are no known scientific reports on the pediatric use of black cohosh, and it is not currently recommended for children.
Adult
The recommended dose of black cohosh ranges from 40 - 80 mg per day. The tablets should be standardized to contain 1 mg of 27-deoxyactein.
For black cohosh tincture, that equals 2 - 4 ml, 3 times per day in water or tea. Two capsules or tablets will likely provide the recommended daily dose.
Although used traditionally, teas may not be as effective in relieving menopausal symptoms as the standardized extract of black cohosh. To make a black cohosh drink, put 20 g of dried root in 34 oz of water. Bring to a boil and then simmer 20 - 30 minutes until the liquid is reduced by a third. Strain, cover, and store in the refrigerator or a cool, dry place. The liquid keeps for up to 48 hours. Drink one cup 3 times daily.
Safety Concerns:
Black cohosh is POSSIBLY SAFE when used appropriately by adults.
People with allergies to plants in the buttercup (Ranunculaceae) family should avoid black cohosh.
Black cohosh contains small amounts of salicylic acid, so people with allergies to aspirin or salicylates should avoid black cohosh.
People with a history of blood clots or stroke, seizures, liver disease and those who are taking medications for high blood pressure should not use black cohosh.
Black cohosh should not be confused with the herb blue cohosh (Caulophyllum thalictroides), white cohosh, bugbane, Cimicifuga foetida, sheng ma or white baneberry. These species have different effects, and blue cohosh and white cohosh, in particular, can be toxic. There is a case report of neurological complications in a post-term baby after labor induction with a herbal blend of black cohosh and blue cohosh.
Side Effects:
Some individuals who take high doses of black cohosh report side effects, including stomach upset, abdominal pain, cramping, diarrhea, dizziness, headaches, rash, joint pains, nausea., slow heart rate, tremors, visual dimness, vomiting, a feeling of heaviness, vaginal spotting or bleeding, and weight gain.
You should not use black cohosh if you have a hormone-sensitive condition, such as breast cancer, endometriosis, ovarian cancer, uterine cancer, or fibroid tumors. It is not clear whether black cohosh stimulates the growth of breast cancer cells or inhibits their growth. Research has been limited and has produced mixed results. Women with a history of breast cancer, and those at a high risk for developing breast cancer (for example, a strong family history like a mother or sister with breast cancer), should not take black cohosh without talking to a health care provider.
Special Precautions & Warnings:
Pregnancy or breast-feeding: Black cohosh is POSSIBLY UNSAFE when used during pregnancy or breast-feeding. Since black cohosh acts somewhat like a female hormone it might increase the risk of miscarriage.
Breast cancer: There is some concern that black cohosh might worsen existing breast cancer. Women who have breast cancer or who have had breast cancer in the past, and women at high-risk for breast cancer, should avoid black cohosh.
Endometriosis, fibroids, cancer, and other conditions: Black cohosh acts somewhat like the female hormone, estrogen, in the body. There is some concern that it could worsen conditions that are sensitive to female hormones. Do not take black cohosh if you have a condition that could be affected by female hormones. These conditions include ovarian cancer, uterine cancer, endometriosis, fibroids, and other hormone-sensitive conditions.
Liver disease: There have been a number of cases of liver damage suspected to be associated with black cohosh use. In most of the cases, there were other medical problems present and other medications used that may have contributed to the liver damage. Also, the quality and purity of the black cohosh products used isn't known. Some black cohosh products, for instance, have been found to contain a Chinese cimicifuga (Cimicifuga foetida) instead of black cohosh. Until more is known, people who take black cohosh should watch for symptoms of liver damage. Some symptoms that may suggest liver damage are yellowing of the skin and eyes (jaundice), unusual fatigue, or dark urine. If these symptoms develop, black cohosh should be stopped and a health provider should be contacted. People who take black cohosh should talk with their health provider about getting tests to make sure their liver is working well.
Kidney transplant: Taking a product containing black cohosh plus alfalfa has been linked to a report of kidney transplant rejection. It is not known if black cohosh is the cause of this rejection. Until more is known, people who have received a transplant should avoid black cohosh.
Protein S deficiency: People with a condition called protein S deficiency have an increased risk of blood clots. Due to the hormone-like effects of black cohosh, there is some concern that black cohosh might also increase the risk of blood clots. There is a report linking blood clots in someone with protein S deficiency after taking black cohosh along with several other herbal products. Until more is known, people with protein S deficiency should avoid black cohosh.
There are no known scientific reports of interactions between black cohosh and conventional medications. However, taking black cohosh can interact with other medicines, vitamins, and certain foods. Talk to your health care provider about possible interactions. Yale researchers also report that herbal medicines such as black cohosh may interfere with common breast cancer treatments such as radiation and cancer therapy drugs.
The use of herbs is a time honored approach to strengthening the body and treating disease. However, herbs contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.
The following doses have been studied in scientific research:
BY MOUTH:
Menopausal symptoms: 20-80 mg once or twice daily.
Weak bones (Osteoporosis): 40 mg daily.
Here are a few Black Cohosh reviews highlighting some of its health benefits:
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Reason for taking: Hot flashes
10/2/2010 3:41:20 PM
Reviewer: TrudyBird, 55-64 Female on Treatment for 1 to 6 months (Consumer)
Effectiveness: Current Rating: 5
Ease of Use: Current Rating: 5
Satisfaction: Current Rating: 4
Comment:
I had as hysterectomy when I was 26. I'll be 60 next year. I started having regular migraines when I was in my early 30's from HRT. (Didn't know the hormone replacement therapy was causing the migraines until I went off HRT and suddenly the migraines went away, but then the hot flashes consumed me about a year ago. I started Black Cohosh about a month ago, 1 pill 540 mg in the AM and it nearly took away 99% of my hot flashes. I have noticed however, I've been waking up with headaches that are borderline migraines that hang around most of the day... Perhaps if I take this supplement every other day the headaches will subside. I'll give that a try. Still, to sleep through the night without soaking the bed in perspiration is wonderful. I take no other medications except for daily vitamins. I'm basically healthy. No lightheadedness. I'm active in my community... and work full time and have had no problems with memory.
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Reason for taking: Hot flashes
7/11/2010 12:39:36 PM
Reviewer: tweetypie, 45-54 Female on Treatment for less than 1 month (Consumer)
Effectiveness: Current Rating: 5
Ease of Use: Current Rating: 5
Satisfaction: Current Rating: 5
Comment:
I was thrown into early menopause by chemotherapy. I had preventive chemo and radiation after having a lumpectomy that WAS cancer. Hot flashes became unpredictable and unbearable. Especially at night. Awoke many, many times soaking wet and sleep was constantly interrupted.I was told about Black Cohosh by a client. The nights I had the flashes were bad enough, but when I had 1 during the day at work...it was interfering with my work... I had to just stop and get cold wet towels to put on my neck, chest, face. I started taking the Black Cohosh the day I was told about it. 2 1/2 weeks ago. 1 in the AM & 1 in the PM. I have not had a single Hot Flash in 17 days. I am going to see my Physician in 2 weeks and I will ask him if he thinks it is risky 4 me because of the Breast Cancer I had in 2005. If he says yes....I am going to be devastated, because this stuff has been amazing so far!!! I am still a little moody, and I have gained a little weight....But, NO HOT FLASHES..Totally awesome!! I hope I can continue to take them!! They WORK!!!!
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Reason for taking: Other
10/30/2011 2:25:04 PM
Reviewer: HK, 45-54 Female on Treatment for 1 to less than 2 years (Consumer)
Effectiveness: Current Rating: 5
Ease of Use: Current Rating: 5
Satisfaction: Current Rating: 4
Comment:
Have had SEVERE menstrual issues since age 15. Had excess estrogen levels so never considered BC as a possible solution. I was already taking EPO and Manganese when I started BC. FINALLY NO PMS or menstrual cramping and each month less clotting and gushing. I am having gout symptoms and insomnia. Insomnia most likely due to Manganese which I am discontinuing today. If gout symptoms continue to worsen I will discontinue BC for awhile at least.
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Reason for taking: Other
5/18/2011 3:28:49 PM
Reviewer: cwright91, 19-24 Female on Treatment for 2 to less than 5 years (Consumer)
Effectiveness: Current Rating: 5
Ease of Use: Current Rating: 5
Satisfaction: Current Rating: 5
Comment:
I am a 20 years old, and I have been taking black cohosh for almost 3 years to treat the severe cramps and back pain that I experience with my menstrual cycle. When I read about black cohosh in my grandmother's herbology books, I had no idea it was used for menopause. I went to buy a supply of it, and was then informed of the menopausal uses. I bought it and used it anyway, and it was the best decision I ever made! An added bonus is that it helps with my mood swings. I am clinically depressed, and during PMS, this is exasperated, so finding out that the cohosh evened out my moods was a HUGE relief. I always keep a supply on hand, because I don't think I could go a month without it.
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Reason for taking: Other
10/31/2007 11:33:43 PM
Reviewer: val, 45-54 Female on Treatment for 2 to less than 5 years (Consumer)
Effectiveness: Current Rating: 5
Ease of Use: Current Rating: 5
Satisfaction: Current Rating: 5
Comment:
happy to use something natural black cohosh that isn't something that man has made. i had a histerectomy at age 30 and was on oral patcha and shots. now i am on natural and it seams to be working better for me. it has been 15 yrs since i had my surg.
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Reason for taking: Hot flashes
6/21/2011 4:14:28 PM
Reviewer: 45-54 Female on Treatment for 1 to 6 months (Consumer)
Effectiveness: Current Rating: 5
Ease of Use: Current Rating: 5
Satisfaction: Current Rating: 5
Comment:
I was surprised at how well black cohosh worked. When I stopped taking it for 2 months, the symptoms returned and I started back taking it.
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