As hot flashes are one of the most disruptive and common symptoms during perimenopause, many women scour the internet looking for answers. Black cohosh is one of the most studied herbs for menopausal symptoms so it’s likely a solution you’ve come across.
But is it that effective for hot flashes? And is it safe to use?
Black cohosh (Actaea racemosa or Cimicifuga racemosa) is found in North America and has been also known as Black bugbane or Black snakeroot. The root of the plant is what contains medicinal properties and it has been traditionally used for female issues.
Overall, it appears that black cohosh does have positive effects on reducing the frequency and severity of hot flashes. Some research also suggests black cohosh may also help with mood changes like depression and anxiety and improve sleep. However, the vast majority of research relates to hot flashes so more research needs to be done to further understand its impact on mood and sleep.
That being said, almost all of the research I’ve come across focused on postmenopausal women, women that have not had a period for a year or longer but are still dealing with hot flashes. While it seems reasonable to assume that a hot flash in postmenopause would be the same as a hot flash in perimenopause, we can not definitively say that an herb widely studies for postmenopausal women has the same impact in perimenopausal women.
What’s also interesting is that we don’t know how black cohosh works. It was originally thought that black cohosh must impact estrogen directly and could qualify as a phytoestrogen. However, more recent research suggests that black cohosh does not promote estrogen formation but rather, may negate the impact of estrogen, possibly putting to rest concerns around women with estrogen positive breast cancer using black cohosh.
In addition, back cohosh appears to impact serotonin, dopamine, GABA and even opioid receptors in the brain, which supports the idea that black cohosh does so much more than just reduce hot flashes.
Another common question that comes up around black cohosh is safety. If you start looking on Google, odds are you’ll see information linking black cohosh to hepatitis and liver failure. The majority of these cases purported to be due to black cohosh were not in fact considered linked.
While any reports of safety concerns should always be taken seriously and investigated, decades of data suggest that black cohosh is a generally safe herb. However, black cohosh is not advised in women that are pregnant or breast feeding.
Dosages vary depending on the study but they range from 40mg up to 3 grams a day of the dried root or 2mL a day of the tincture. As always, consult your medical provider for guidance.
With years of research behind it and being a relatively safe herb, you may be surprised to discover that I actually don’t recommend black cohosh a lot in my practice.
As a naturopathic doctor, my focus is always on treating the underlying root cause. While black cohosh can help alleviate the symptoms of hot flashes, they tend to recur once someone discontinues the herb.
I’ve seen a lot of women get symptomatic relief from simple nutritional and lifestyle changes, especially focusing on stress management, which we’ll discuss more in depth in the future. Though it’s not my first choice, I find black cohosh can be a good option if someone needs faster symptomatic relief.