If you are going through menopause, you may be looking for natural ways to ease your hot flashes, night sweats, mood swings, and other bothersome symptoms. You may have heard of black cohosh, a herbal supplement that some people claim can help with menopausal symptoms. But before you rush to buy a bottle of black cohosh, you should know the facts and the risks of this herb.
What is black cohosh?
Black cohosh (Cimicifuga racemosa) is a plant that grows in North America. It has been used for centuries by indigenous peoples for various health conditions, such as menstrual cramps, arthritis, and sore throat. In modern times, black cohosh has become popular as a natural remedy for menopausal symptoms, especially hot flashes. It is sold as capsules, tablets, liquid extracts, or tea.
Does black cohosh work for menopause?
Although more study is warranted, so far the answer is mixed. According to the Office of Dietary Supplements (ODS) of the National Institutes of Health (NIH), there is no conclusive evidence that black cohosh can relieve menopausal symptoms. The ODS reviewed several clinical trials that tested the effects of black cohosh on menopausal symptoms and found that most of them showed no benefit compared to placebo (a dummy pill). Some studies even suggested that black cohosh may worsen some symptoms, such as vaginal dryness and headaches.
On the other hand, a 2021 systemic review and meta-analysis by Castelo-Branco et al., comprising over 40,000 women, did find that supplementation with black cohosh was significantly superior to placebo in treating vasomotor symptoms (hot flashes & night sweats) and the psychological effects of menopause.
Is black cohosh safe?
The safety of black cohosh is also questionable. The ODS warns that black cohosh may cause serious liver damage in some people. There have been reports of women who developed hepatitis, jaundice, or liver failure after taking black cohosh supplements. Some of these cases required liver transplantation or resulted in death. The likelihood is that these supplements were tainted, but we can't say that with any certainty at this time. The ODS advises anyone who experiences symptoms of liver damage, such as dark urine, yellowing of the skin or eyes, or abdominal pain, to stop taking black cohosh and seek medical attention immediately.
The clinical data in the Castelo-Branco et al. review did not show evidence of liver toxicity, nor were there changes in estrogen levels, breast density, or endometrial thickness. Therefore, the review comes to the conclusion that black cohosh has an overall good safety profile, particularly in those with estrogen-sensitive diseases such as breast and endometrial cancer. Similarly, examine.com reports that black cohosh is generally considered safe, and that courses up to 6 months do not seem to impact liver function.
Black cohosh may interact with other medications or supplements that you are taking. For example, it may increase the risk of bleeding if you are taking blood thinners, such as warfarin or aspirin. It may also interfere with the effectiveness of hormone therapy or birth control pills. You should always consult your provider before taking black cohosh or any other herbal supplement.
So... should I take it?
There are other choices to manage the symptoms of menopause that don't come with major concerns for liver disease, so this is not a go-to for me. But if you've tried other options without success, I think that it's reasonable to try black cohosh in collaboration with your healthcare team.
What are the alternatives to black cohosh?
If you are looking for safe and effective ways to manage your menopausal symptoms, you have several options. At Phases Clinic, we offer evidence-based treatments that can help you feel better and improve your quality of life. Some of these treatments include:
Hormone therapy: This is the most effective treatment for hot flashes and other menopausal symptoms. It involves taking estrogen and/or progesterone in pills, patches, creams, or gels. Hormone therapy can also prevent osteoporosis and reduce the risk of heart disease and diabetes in some women. However, hormone therapy is not suitable for everyone and may have some side effects or risks. You should talk to your provider about the benefits and risks of hormone therapy and whether it is right for you.
Non-hormonal medications: There are some prescription drugs that can help with hot flashes and mood swings without affecting your hormones. These include antidepressants, such as venlafaxine or paroxetine; anti-seizure drugs, such as gabapentin; and newly approved fezolinetant (Veozah). These medications may have some side effects or interactions with other drugs. You should discuss with your provider the pros and cons of these medications and how to use them safely.
Mind-body techniques, including certified Clinical Hypnotherapy with clinic owner Vanessa Weiland, NP, HT.
Other supplements that show efficacy for hot flashes have lower potential risk of harm than black cohosh. These include red clover, soy isoflavones, sage, and Swedish flower pollen extract.
Lifestyle changes: There are some simple things that you can do to reduce your menopausal symptoms and improve your overall health. These include:
Eating a balanced diet that is rich in fruits, vegetables, whole grains, lean protein, and high-protein dairy products.
Avoiding foods and drinks that may trigger hot flashes, such as spicy foods, alcohol, caffeine, and hot beverages.
Drinking plenty of water to stay hydrated and prevent dryness.
Exercising regularly to maintain a healthy weight, strengthen your bones and muscles, boost your mood and energy levels, and relieve stress.
Quitting smoking if you are a smoker. Smoking can worsen your menopausal symptoms and increase your risk of many diseases.
Practicing relaxation techniques, such as deep breathing, meditation, and yoga.
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