Black cohosh for perimenopausal symptoms

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Black cohosh for perimenopausal symptoms

Black cohosh, also known as black snakeroot or bugbane, is a medicinal root. It is used to treat women's hormone-related symptoms, including premenstrual syndrome (PMS), menstrual cramps, and menopausal symptoms.

Black cohosh contains potent phytochemicals that have an effect on the endocrine system. How it works is not yet clear.¹

Black cohosh is widely used in the United States, Australia, and Germany. The German government has approved it as a prescription alternative to hormone therapy. In the U.S., black cohosh is available without a prescription. Be sure to talk to your doctor before taking it.

You can buy black cohosh as a standardized extract in pill form (Remifemin), which is taken twice per day. Root, extract, and tincture forms are also available in health food stores.

When black cohosh is used at regular doses, its only known side effect is occasional stomach discomfort.² However, black cohosh may have risks that are not yet known, including possible effects on liver function. More research needs to be done before experts can recommend it for long-term use.

Is it effective?

Most studies have shown that black cohosh reduces symptoms much like low-dose estrogen does, while a few studies show it does not. This may be because different preparations were used in the studies, or that, like many treatments, some women may benefit from it more than others.³ In most studies, black cohosh was shown to decrease hot flashes, profuse sweating, mood swings, irritability, depressive mood, heart palpitations, sleep problems, headache, and vertigo related to perimenopause.^{4, 5, 6}

Is it safe?

Large, long-term studies have not yet been done to confirm whether long-term use of black cohosh is safe. Because black cohosh has benefits somewhat like estrogen therapy, it may also have some estrogen-like risks.

If you plan to take black cohosh, talk to your health professional about how to take it safely.⁷ You may be able to take it short-term (no more than 6 months), or possibly longer, but with regular checkups to look for estrogen-related changes in the uterus and breasts.

Estrogen may increase the risk of cancer in women who have a history of uterine cancer or breast cancer or who are at high risk for breast cancer. Since black cohosh may work in ways similar to estrogen, these high-risk women should avoid using black cohosh until more is known about the long-term risks.

As with any medicine, be careful to avoid overdosing with black cohosh. Symptoms of overdose include vertigo, headache, nausea, vomiting, impaired vision, and impaired circulation. None of these symptoms have been reported with regular doses of black cohosh.⁶

What to avoid

Black cohosh should not be used during pregnancy or while you are breast-feeding. Do not take black cohosh if there is any chance that you might be pregnant.

Black cohosh should not be combined with birth control pills, hormone replacement therapy, or tamoxifen. It should not be used by women who are allergic to aspirin.

References

Citations

1. Kronenberg F, Fugh-Berman A (2002). Complementary and alternative medicine for menopausal symptoms: A review of randomized, controlled trials. Annals of Internal Medicine, 137(10): 805–813.

2. Geller SG, Studee L (2005). Botanical and dietary supplements for menopausal symptoms: What works, what does not. Journal of Women's Health: 14(7): 634–649.

3. Fitzpatrick LA (2003). Alternatives to estrogen. Medical Clinics of North America, 87(5): 1091–1113.

4. American College of Obstetricians and Gynecologists (2001). Use of botanicals for management of menopausal symptoms. ACOG Practice Bulletin No. 28. Obstetrics and Gynecology, 97(6, Suppl): 1–11.

5. Girman A, et al. (2003). An integrative medicine approach to premenstrual syndrome. American Journal of Obstetrics and Gynecology, 188(5, Suppl): S56–S65.

6. McKenna DJ, et al (2001). Black cohosh: Efficacy, safety, and use in clinical and preclinical applications. Alternative Therapies, 7(3): 93–100.

7. Dog TL, et al. (2001). An integrative approach to menopause. Alternative Therapies, 7(4): 45–55.

Credits

Last updated:	May 26, 2006
Author:	Kathe Gallagher, MSW
Reviewed By:	Joy Melnikow, MD, MPH - Family Medicine, Carla J. Herman, MD, MPH - Internal Medicine
Editors:	Kathleen M. Ariss, MS, Terrina Vail