More and larger human studies are needed to understand the link, if any, between black cohosh and weight management. They include digestive upset, nausea , skin rashes, infection, muscle pain, breast pain or enlargement, and spotting or bleeding outside of your menstrual cycle However, black cohosh has also been linked to some severe cases of liver damage.
Moreover, a recent animal study observed that black cohosh in high doses was linked to red blood cell damage, leading to anemia. Still, more research is needed to study these potential effects in humans Because black cohosh has not been extensively studied, you may experience some side effects that are not yet widely known.
If you have any concerns, consult a healthcare provider. Dosage recommendations vary widely between black cohosh brands. Typical doses are anywhere from 20— mg of standardized black cohosh extract or powder daily For menopause symptoms, taking at least 20 mg of black cohosh daily — which most brands will provide — appears to be effective 4.
Some health professionals claim you should not take black cohosh for longer than 6 months to 1 year because of its slight potential to cause liver damage Because supplements are primarily subject to post-market regulation by the government, you should choose black cohosh supplements that have been third-party tested for quality.
Additionally, black cohosh is often sold in blends containing other herbal supplements, including:. According to existing evidence, there do not appear to be any complications associated with stopping black cohosh suddenly, nor are there any known withdrawal symptoms. Because black cohosh may potentially affect your hormones , you may experience changes to your menstrual cycle when you stop taking it. To ensure your safety and minimize your risk of liver damage, take no more than the recommended daily dose of the black cohosh supplement you choose.
If you can, purchase a supplement that has been tested by a third-party organization like ConsumerLab or USP to ensure that the ingredients in the supplement align with the claims on the label.
Black cohosh has the potential to interact with other medications and therapies. Here are its known interactions:. Black cohosh may have additional drug interactions that have not yet been identified. Additionally, because one of the most severe side effects of black cohosh is liver damage, you should be cautious of taking black cohosh in combination with any other supplements or medications that may damage your liver.
Consult your healthcare provider for guidance. Black cohosh should be kept sealed and stored at room temperature. In traditional Native American medicine, black cohosh was often used to increase breastmilk production Although most side effects are mild, little is known about the effects of black cohosh on pregnant women, breastfeeding women, and infants.
Still, the supplement has been used to induce labor and miscarriage, and although evidence is lacking to support its use for this, some people online report success. Regardless, labor should be induced only at the direction of a qualified healthcare provider.
Because it may affect hormone levels, it should only be given to adolescents at the direction of a qualified healthcare provider. Additionally, given that one of the most severe potential side effects is liver damage, you should avoid black cohosh supplements if you have liver disease. At 12 months, participants consuming the multibotanical preparation plus soy foods had significantly worse symptom intensity than those consuming the placebo.
After 3, 6, 9, and 12 months of supplementation or placebo, the number of vasomotor symptoms declined significantly in all groups. However, there were no statistically significant differences between the black cohosh and red clover groups compared to placebo, with one exception. The black cohosh group showed worse symptom intensity at 6 and 9 months.
This study also investigated secondary endpoints such as somatic symptoms e. For most of these outcomes, no significant differences were observed between any of the treatment groups at any time. A Cochrane review evaluated 16 randomized clinical trials on the effectiveness of black cohosh in reducing menopausal symptoms, including hot flushes, night sweats, vaginal dryness, and combinations of symptoms measured by validated rating scales [ 5 ].
The two trials discussed above were included in this Cochrane review. The 16 included trials randomized a total of 2, women mean age Study durations were 8 to 54 weeks, with a mean duration of The studies were highly heterogeneous with respect to such factors as design, duration, type and amount of black cohosh used, and main findings. A systematic review and meta-analysis of randomized clinical trials examined four studies of herbal and plant-based therapies that included black cohosh three of which were examined in the Cochrane review described above to treat menopausal symptoms [ 20 ].
The trials randomized a total of women to a daily dose of various formulations of 6. There were no significant associations between supplementation with black cohosh and reduction in the number of vasomotor symptoms, such as hot flashes. Furthermore, there were no beneficial associations between black cohosh use and relief of menopausal symptoms using self-reported rating scales. The American College of Obstetricians and Gynecologists, in its clinical guidelines for managing menopausal symptoms, concluded that "data do not show that" herbal dietary supplements like black cohosh "are efficacious for the treatment of vasomotor symptoms" [ 21 ].
The North American Menopause Society advises clinicians against recommending herbal therapies such as black cohosh because "they are unlikely to be beneficial" italics in original in alleviating vasomotor symptoms [ 15 ]. Its authors recommended that researchers conduct higher-quality trials with larger samples and provide more details about their experimental protocols.
Others have recommended that researchers should completely and comprehensively describe the black cohosh preparation they used so that other researchers could use the same or similar products [ 22 ]. Clinical trials using various black cohosh preparations to treat menopausal symptoms have shown that its use is associated with a low incidence of adverse effects.
The most commonly reported side effects are gastrointestinal upset and rashes, both of which are mild and transient [ 1 , 24 ]. Most studies have examined black cohosh use for short periods, typically 6 months or less, so no published studies have assessed the long-term safety of black cohosh in humans. Across the world, reports have described at least 83 cases of liver damage—including hepatitis, liver failure, elevated liver enzymes, and assorted other liver injuries—associated with black cohosh use [ 1 , 25 ].
However, there is no evidence of a causal relationship. It is possible that at least some reported cases of hepatotoxicity were due to impurities, adulterants, or incorrect Acteae species in the black cohosh products used.
However, no one independently analyzed these products to confirm the existence of these problems [ 3 , ]. In , the Australian Department of Health began requiring that products containing black cohosh carry the following label statement: "Warning: Black cohosh may harm the liver in some individuals. Use under the supervision of a healthcare professional" [ 29 ].
In , the U. Pharmacopeia a nonprofit standard-setting organization for foods and drugs recommended labeling black cohosh products with the following cautionary statement: "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" [ 30 ].
However, the U. Food and Drug Administration does not require such a warning on black cohosh product labels. The American Herbal Products Association recommends that pregnant women not take black cohosh except under the supervision of their healthcare provider because studies have not rigorously evaluated its use during pregnancy [ 1 ].
The U. Pharmacopeia advises that individuals with liver disorders should also avoid black cohosh [ 30 ]. It adds that users who develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice, while taking the supplement should discontinue use and contact their doctor.
Black cohosh is not known to have any clinically relevant interactions with medications, although this has not been systematically studied [ 1 ].
This fact sheet by the Office of Dietary Supplements ODS provides information that should not take the place of medical advice. We encourage you to talk to your healthcare providers doctor, registered dietitian, pharmacist, etc. Any mention in this publication of a specific product or service, or recommendation from an organization or professional society, does not represent an endorsement by ODS of that product, service, or expert advice.
However, some homeopathic practitioners recommend the use of black cohosh to induce labor in pregnant women who are at or past term. Even then, pregnant women should never use black cohosh unless under the strict supervision of a knowledgeable physician.
There are no known scientific reports of interactions between black cohosh and conventional medications. There is some concern about taking black cohosh along with medications that are toxic to the liver.
Since so many medications affect the liver, it is possible that combining black cohosh with prescription medications could potentially be harmful to the liver. It is also possible that taking black cohosh could alter the effects of drugs that are metabolized by the liver. Speak with your physician and see the Precautions section.
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 chemotherapy drugs. Randomized, double-blind, placebo-controlled trial of Cimicifuga racemosa black cohosh in women with anxiety disorder due to menopause.
J Clin Psychopharmacol. Borrelli F, Ernst E. Black cohosh Cimicifuga racemosa for menopausal symptoms: a systematic review of its efficacy. Pharmacology Res. Black cohosh and St. Yonsei Med J. Growth inhibitory activity of extracts and purified components of black cohosh on human breast cancer cells. Breast Cancer Research and Treatment. Ernst E, Chrubasik S. Phyto -- anti-inflammatories. A systematic review of randomized, placebo-controlled, double-blind trials. Rheum Dis Clin North Am. Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial.
Black cohosh and breast cancer: a systematic review. Integr Cancer Ther. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Effects of herbal preparations on symptom clusters during the menopausal transition. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer.
J Clin Oncol. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Leach MJ, Moore V. Black Cohosh Cimicifuga supp. Cochrane Database Syst Rev. Black cohosh: efficacy, safety, and use in clinical and preclinical applications.
Altern Ther Health Med. United Sates Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Mahady GB. Treat Endocrinol.
Annals of Internal Medicine. Niederhuber: Abeloff's Clinical Oncology. Philadelphia, PA: Elsevier Saunders;
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