The Benefits of Black Cohosh for Women

Dr. Jolene BrightenPublished: Last Reviewed: Balancing Your Hormones Leave a Comment

Black cohosh, a white flowering plant native to eastern North America, was first used in Native American medicine to support women's health and reproduction, body pain, coughs, colds, fatigue, and weakness.

Today black cohosh is one of the most popular women's health supplements. As research into its efficacy began to grow, scientists began to sort out what it may help with (hint: menopause) and what benefits need more research. 

In this blog post, we will discuss how black cohosh works, how it could benefit your health, and potential side effects so you can decide if it's a good fit for you.

What is Black Cohosh?

Black cohosh (Actaea racemose or Cimicifuga racemosa) is an herb used in traditional medicine for many years. While it's said to have many health benefits because of its anti-inflammatory and calming effects on the nervous system, it's most well-known for supporting women's health, especially during menopause.

Black cohosh supplements contain the dried root or rhizome of the plant. You may also see it listed as:

  • Snakeroot
  • Bugbane
  • Fairy Candles
  • Rattletop

The magic of why certain herbs or botanicals work can't always be explained, and researchers still don't completely understand the mechanisms behind black cohosh. While some suggest that the herb is helpful for women because it acts as a phytoestrogen in the body, most studies have concluded that it doesn't have estrogenic activity.

Instead, it could influence how estrogen behaves in the body independent of estrogen receptors. It may help alleviate symptoms by acting like some of the neurotransmitters in your body that affect mood and pain response (like dopamine, serotonin, and GABA). Some studies show that black cohosh supports pain relief by binding to receptors that help regulate pain in the body.

Extracts of black cohosh root also contain several chemical compounds that could explain the health benefits, including those that support the immune system, inflammation reduction, and the nervous system.

Black Cohosh Benefits

While herbs usually aren't always well-researched (pharmaceutical companies have a lot more money to spend on clinical studies), black cohosh happens to have a lot of interesting studies examining its use. 

Here is what the science says about the benefits of black cohosh.


Supporting the symptoms of menopause tops the list of why women reach for black cohosh. As mentioned earlier, it was first believed that black cohosh acted like estrogen in the body and therefore helped women normalize their hormones. But more recent research has concluded that it does not have estrogenic activity

A chemical found in black cohosh called fukinolic acid may have weak estrogenic effects in the body, but experts don't believe it's enough to fully explain why it supports healthy hormone balance.

Regardless of exactly how it works, black cohosh could help with symptoms of menopause, including hot flashes, anxiety, and insomnia.

Multiple studies suggest that menopausal women who take black cohosh daily report significantly fewer night sweats, hot flashes, and reduced severity. 

One meta-analysis found that across nine studies, black cohosh improved symptoms of menopause by more than 25 percent. While a Cochrane Review found no significant differences between black cohosh and placebo, a more recent review of placebo-controlled studies with black cohosh found that black cohosh did appear to significantly improve symptoms.

A study comparing black cohosh to a hormone therapy drug found both the drug and the supplement improved symptoms of menopause without significant differences. This could be especially appealing to women seeking alternatives to hormone therapy.

Another condition associated with menopause is bone health. As estrogen drops, it impacts the activity of bone-building cells. Based on several studies, black cohosh may help support healthy bones in menopausal women, but more research is needed.

While results are mixed, based on all the positive evidence, black cohosh appears to be a reasonable option to support menopause symptoms, especially hot flashes and night sweats.

Hormone Balance

Given the potential impact black cohosh has on menopause, it may also help with other areas of women's health also connected to hormone balance. After all, this is what it was used for in traditional medicine. 

While not as well-researched as menopause, here's what the science says about other women's health conditions and black cohosh:

  • PMS and PMDD. Herbalists have used black cohosh for years to support symptoms of PMS or PMDD like cramps, headaches, breast tenderness, and mood changes. There aren't many studies to support it, but it may help because of the impacts on neurotransmitters and pain regulation mentioned above. One study found that when black cohosh was combined with dong quai and soy (two other hormone supporting botanicals), it could help reduce migraine frequency.
  • Polycystic ovarian syndrome (PCOS). Black cohosh may help with ovulation and, as a result, help support fertility associated with PCOS. A small study on women with PCOS found that black cohosh could positively impact hormone levels (LH and progesterone) and ratios and increase endometrial thickness to support ovulation even better than a fertility-supporting medication. It may also help women with PCOS get pregnant when combined with fertility medication.
  • Fertility. In addition to the studies explicitly looking at black cohosh and fertility for women with PCOS, a few studies also found that adding black cohosh to Clomid improved the chance of getting pregnant for women with unexplained fertility. More research is needed before making more extensive claims about black cohosh and fertility.
  • Fibroids. The root cause of fibroids isn't attributable to one thing, but hormone imbalance is a likely root cause for many women. Since black cohosh may support estrogen levels in your body, it could also help with fibroids. While more research is needed, one study found that black cohosh helped shrink uterine fibroids by 30%. In contrast, fibroids grew larger in the group of women taking hormone therapy in this study.

While black cohosh may be a part of your hormone-balancing plan, you can bring your hormones back into balance starting now with our free hormone starter kit. We make it easy with a seven-day meal plan, recipes, and all the info you need to start your journey.


Black cohosh may help women experiencing hot flashes as a side effect from treatment for breast cancer, though the results are mixed. 

While there was some concern that black cohosh could increase the risk of breast cancer because of its supposed estrogenic activity, several studies concluded this is not true. One study also found that black cohosh could positively impact survival time for women with breast cancer. It may even have a small protective effect against breast cancer while helping women during menopause.

In several animal or test-tube studies, black cohosh inhibited the expression of specific cells related to liver, colon, and prostate cancer cells. Still, much more research is needed before expanding the results to people.

Mental Health 

Many of the studies on black cohosh and mental health improvements once again center around the menopause transition. According to some research, black cohosh may activate a serotonin receptor (a feel-good neurotransmitter) and therefore positively impact feelings of depression or anxiety. 

A review examined the effects of herbal medicine on anxiety and depression, specifically for peri-and postmenopausal women, and concluded that black cohosh had an overall significant effect on psychological symptoms, but not on anxiety.

However, herbalists have used black cohosh for anxiety for many years, especially for women with menopause. One study that looked at black cohosh and St. John's wort, a botanical used to support mood, found that both black cohosh and St. John's wort effectively helped mood, but improvements were even more significant when the two herbs were combined.


Black cohosh could support sleep by supporting how well you sleep while reducing sleep interruptions. It could also decrease the amount of time you stay awake after waking up in the middle of the night.

The main benefits of black cohosh for better rest aren't necessarily directly related to sleep quality. Instead, it can help reduce symptoms that interrupt sleep, such as hot flashes and night sweats. 

Weight Loss

Since weight gain is a concern during menopause, scientists are also interested if black cohosh could help women slow or stop weight gain associated with fluctuating hormones. Black cohosh is not traditionally used as a weight loss herb, and there is little research supporting its use. 

However, a few small studies suggest that it could help regulate appetite and support estrogen-related weight gain. Still, again more research is needed, and these uses are not likely a primary reason to use black cohosh.

Other Reported Benefits of Black Cohosh 

You may see some of the following listed as benefits of black cohosh, and some are considered traditional uses, but the research is lacking:

  • Heart disease
  • Cognitive health
  • Labor support
  • Respiratory health
  • Arthritis

Black Cohosh Side Effects

Black cohosh is considered safe when taken as recommended and from a reputable source. The most common concern associated with black cohosh is liver toxicity. 

While there were several reports related to black cohosh supplements and liver concerns, a follow-up review concluded that black cohosh was not necessarily the cause of the cases of liver toxicity. This was echoed by another meta-analysis that found no evidence of liver toxicity associated with black cohosh.

However, it was suggested that the liver issues may have resulted from “spiked” black cohosh products with unlisted ingredients.

As with all supplements, choosing a high-quality brand with third-party testing for safety and purity is critical. Unfortunately, oversight for many supplements is lacking, so you want to select a product manufactured by a company that decides to verify their supplements. 

Other side effects have been reported, although these are primarily associated with taking much more than the recommended dose:

  • Upset stomach
  • Dizzy
  • Rash

Black Cohosh Dosage

The dosage of black cohosh depends on the reason you are taking it. The best way to use the correct dose is to work with a healthcare practitioner familiar with black cohosh and your individual needs.

Clinical trials for menopause have different dosage recommendations depending on the formula. Dosages can range from 40 mg to 400 mg in capsule form to 40 drops in liquid extracts. Therefore it's best to follow your practitioner's advice or the dosage on the product's label. 

Balance is a comprehensive women's formula that includes black cohosh to support hormone balance. In combination with other herbs, B vitamins, and antioxidants, black cohosh helps eliminate excess estrogen and support healthy detoxification.

Black Cohosh and Your Health

Black cohosh has been used as a natural remedy for centuries to support women's health, especially during menopause. 

More research is needed on some of the other potential benefits, but it does appear to support healthy hormone balance and may be especially helpful for symptoms such as hot flashes and night sweats. Just make sure you choose a product from a company you trust.

If you've tried black cohosh before or are considering using this herb, let me know what your experience was like below!



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About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten, NMD, is a women’s hormone expert and prominent leader in women’s medicine. As a licensed naturopathic physician who is board certified in naturopathic endocrinology, she takes an integrative approach in her clinical practice. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones. She is the best selling author of Beyond the Pill and Healing Your Body Naturally After Childbirth. Dr. Brighten is an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health. She is a member of the MindBodyGreen Collective and a faculty member for the American Academy of Anti Aging Medicine. Her work has been featured in the New York Post, Forbes, Cosmopolitan, Huffington Post, Bustle, The Guardian, Sports Illustrated, Elle, and ABC News. Read more about me here.