Supplement Safety: Black Cohosh & Menopausal Symptoms

A non-drug approach to dealing with menopause symptoms

by The North American Menopause Society
black cohosh in a white bowl image

Many women use botanical supplements like black cohosh during menopause. In this post, I'm going to briefly summarize research, possible risks, and how to be a smart consumer regarding this herb. Black cohosh (Actaea racemosa, also called Cimicifuga racemosa) is a popular non-drug treatment for menopause symptoms. Evidence about the effectiveness and safety of black cohosh for treatment of hot flashes is mixed: some studies show improvement of menopause symptoms and some show no benefit. There are no long-term safety studies yet, and most are shorter than 6 months. Future black cohosh studies should give us more information about the proper and safe use of this herb.

Meanwhile, there have been over 50 reports of liver damage such as hepatitis and liver failure with use of black cohosh-containing products. Cause and effect is difficult to prove in these situations, but the number of similar reports is concerning. Because black cohosh is harvested from plants grown in the wild, there is a risk of use of the wrong plant species and adulteration with harmful materials from other wild plants. The US Pharmacopeia states that any product containing black cohosh should carry the following statement: "In rare cases, black cohosh has been reported to affect the liver. Discontinue use and consult a healthcare practitioner if you have a liver disorder or develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice."

NAMS recommends that you buy black cohosh from a reputable company and use it for a short time if it lessens your menopause symptoms. If it is not effective for you, do not use it. The most common side effects of black cohosh are stomach upset and headache.

How can you find the safest source of black cohosh? The US Food and Drug Administration (FDA) is unfortunately not required to inspect supplements. It is up to all of us to look out for our safety when using them. Can seals of approval help? For an interesting discussion of the potential value of seals of approval for supplements, read Kaiser Permanente's message to its members. Additionally, the National Center for Complementary and Alternative Medicineis a wonderful source of accurate information about alternative therapies. I encourage you to check it out. Note that there is an entire section on herbal products entitled "Herbs at a Glance," including specific information about black cohosh. Other excellent resources for consumers are the Office of Dietary Supplementsand the FDA's overview of supplements and safety. For more on menopause matters, visit us at

Next: 10 Menopause Myths—Busted!

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Jessica Parker09.10.2013

Thanks for this informative share. Black cohosh has been used for centuries to treat the reproduction issues in women.It is an active ingredient present in most of the menopause relief supplements. you can view more information on:

Deta 06.09.2013

I have an allergy to aspirin and didn't realize that this also would cause an allergic reaction because it contains salicylics as well so no I wouldn't recommend it.

TamekaM 02.26.2013

This post was very helpful. Thank you. Sometimes when searching for alternative treatments it can be hard to get detailed informtiona about products such as this.

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