Black Cohosh: The Safe Herb For Hot Flashes And Other Menopausal Symptoms

During the past 50 years, millions of American women have taken synthetic hormones to alleviate menopausal symptoms and to avert diseases like osteoporosis, heart disease (and more recently for Alzheimer’s), which usually have their onset after menopause. But in July 2002, the Journal of the American Medical Association reported that a large-scale study of HRT-known as the Women’s Health Initiative (WHI)-was halted when it was found that the increased risk of breast and uterine cancers, heart attack, and blood clots associated with HRT far outweighed any benefits the therapy might provide.

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Additionally, in May of 2003, the WHI Memory Study reported that women older than 65 who used “estrogen” plus progestin doubled their risk of developing dementia. It’s important to note that the WHI study used synthetic hormone-like drugs. The medical establishment calls them “hormones,” but the molecules used are not identical to those normally found in a woman’s body. Because of this, it did not surprise us in the least that there turned out to be serious side effects.

In contrast, the use of natural hormones, or bio-identical hormones like natural progesterone, still appears to be safe.

The good news is recent studies have shown that black cohosh provides relief equal to synthetic-HRT for menopausal symptoms … without any side effects.

Scientists have assumed that black cohosh worked as a phytoestrogen, or natural plant-based estrogen. Just very recently, however, several studies were published indicating that black cohosh is not a phytoestrogen—meaning it does not produce estrogenic effects—and is therefore considered VERY safe for all women who want to reduce menopausal symptoms safely without worrying about the potentially bad effects of estrogen.

Menopause is a natural phase of life

Most American women reach menopause between the ages of 45 to 55, but menopause-like symptoms can begin at least ten years earlier. “Menopause is often heralded by the onset of a change in menstrual flow or skipped menstrual periods, “says Christiane Northrup, M.D., bestselling author of Women’s Bodies, Women’s Wisdom (Bantam Books, July 1994), and The Wisdom of Menopause (Bantam Books, July 2001), and a past president of the American Holistic Medical Association. “Some women simply stop having periods and have no symptoms whatsoever. Others experience hot flashes, vaginal dryness, decreased libido, and fuzzy thinking,” she adds.

It is these annoying problems that have given menopause its bad reputation. Furthermore, studies have shown that the onset of menopause can contribute to a higher risk of heart disease and a decline in bone density. So, what’s a woman to do?

Black cohosh has been used as a female tonic for hundreds of years

Black cohosh (Cimicifuga racemosa) was used by Europeans and numerous Native American tribes for “female problems” long before the New World was settled. Native Americans also used it for arthritis, diarrhea and snake bites, as well as coughs and other pulmonary conditions.1

Black cohosh was first listed in the U.S. Pharmacopoeia in 1830 under the name black snakeroot, and was introduced to the medical community in 1844 when Dr. John King prescribed it for rheumatism and nervous disorders. It was a prominent herb in midwifery practice, and the Eclectic Physicians used it in the mid-nineteenth century for a number of Ob/Gyn problems including endometriosis, menstrual irregularities, sterility, uterine prolapse, after-birth pains, and to allay miscarriage and increase breast milk production.

And, during the past 40 years, black cohosh has been used in Europe as an herbal pharmaceutical by more than 1.5 million women, and scientific research has recently demonstrated that black cohosh is a promising therapy for menopausal symptoms.2

What are menopausal hot flashes?

Hot flashes affect 70 to 85 percent of all perimenopausal women. 3 What exactly happens in your body to make you throw the covers off in the middle of a winter night, only to find that you’re freezing and wanting to bundle up a few minutes later? And why do some women have an intense heat spread over their face, scalp, and chest accompanied by redness and perspiration?

According to Dr. Northrup, hot flashes are triggered by falling estrogen and rising follicle stimulating hormone (FSH). Most women have them just before or during the menstrual periods during perimenopause. They become more frequent during menopause—when your period ceases—and this can last for several years.

Some women suffer from sleep deprivation because they experience a continuum of hot flashes during the night. Consequently, rapid eye movement (REM) sleep—during which dreaming occurs—is interrupted, which can lead to depression.

Besides hormonal factors, external factors can impact the intensity and duration of a woman’s hot flashes. Stress, anxiety, a poor diet loaded with carbohydrates, caffeine, sugar, and alcohol, and lack of exercise can all exacerbate menopausal symptoms.


How does black cohosh work?

There have been many theories about how black cohosh works, but exactly how and what it is that makes it work are still being determined. Up until now, the theory has been that it contains phytoestrogens that bind to estrogen receptor sites, thus inducing an estrogen-like effect.

We now know from recent studies that black cohosh is technically a “Selective Estrogen-Receptor Modulator” (SERM). This means it selectively mimics estrogen in the brain and bone, but not in the uterus—or estrogen-dependant cancers. In one study it compared favorably with raloxifene (a SERM sold by prescription for osteoporosis), though with less potency.4

It’s likely something in black cohosh is interacting with some part of the estrogen signaling pathway, but not the estrogen receptors. This gives the benefit of some of estrogen’s good effects, without the negative effects.

The bottom line seems to be that black cohosh does not stimulate estrogen receptors, which can promote cancer. This makes it a very safe alternative for osteoporosis and hot flashes.

May reduce risk of osteoporosis

There’s more good news. A preliminary recent German study indicates that black cohosh may prevent bone loss in menopausal women. The study examined the effects of black cohosh extract on bone density in rats that had their ovaries removed. Typically, bone loss is accelerated after menopause, or in this case, after the removal of the rats’ ovaries, their main source of estrogen.

The rats were divided into three groups: one received a normal diet, the second group received a normal diet plus raloxifene (a SERM sold by prescription for osteoporosis) and the third group was fed a normal diet with black cohosh extract.

The rats given black cohosh had significantly lower markers for bone loss in their urine. They also showed a reversal of the effects of ovariectomy on bone loss. These results were similar to the group given the prescription SERM, raloxifene, which is currently used to prevent osteoporosis. These exciting results led the researchers to conclude that a longer-term clinical trial of black cohosh for the treatment of osteoporosis is warranted.5

Who should use black cohosh?

Although the herb has been used traditionally for hundreds of years, the recent scientific research validates its effectiveness and proves its safety. Many women never have hot flashes, and for those who do, the annoyance lasts only a few years. BUT, because black cohosh exerts positive effects on the brain and bone—which have nothing to do with hot flashes—every menopausal woman can benefit from using it long-term to help prevent osteoporosis and mental changes. Additionally, perimenopausal women can use it safely long-term to prevent symptoms of PMS and future bone health and menopausal symptoms.

Is black cohosh safe for everyone?

So far, we know that black cohosh is not recommended for pregnant women. The question of whether the herb is safe for women with breast cancer has been questionable, although a recent study at the University of Illinois in which it was found to be non-estrogenic indicates that it is.6

These researchers at the Evanston Northwestern Healthcare Research Institute, Northwestern Medical School, also found that black cohosh does not promote the growth of breast cancer cells.5

For general use, and even among women who have had breast cancer as we saw in the previous cited studies, black cohosh appears to be extremely safe. According to Dr. B Kligler, a researcher at the Albert Einstein College of Medicine in New York, “Adverse effects are extremely uncommon, and there are no known significant adverse drug interactions.”7

How will black cohosh make me feel?

  • Less irritable
  • Clearer mind
  • Calmer emotions
  • Fewer mood swings
  • More peaceful sleeping patterns
  • Relief of hot flashes, night sweats

Taking black cohosh is a gentle way to naturally treat menopausal symptoms and deal with some of the physical and emotional stresses unique to perimenopausal and menopausal women. In addition to getting relief for hot flashes, night sweats, and other menopausal symptoms, women typically report they feel less irritable, have a clearer mind, calmer emotions, fewer mood swings and better sleep.

The importance of taking standardized European pharmaceutical-grade black cohosh

Unfortunately, as black cohosh has become popular as a natural menopause treatment, a large number of products have been marketed that do not meet the exacting pharmaceutical standards of quality required of black cohosh products marketed in Europe as pharmaceuticals. It seems safe to say that if you want to get the amazing benefits of black cohosh you must use a high-quality extract like has been used in all the scientific research. Only black cohosh extracts that meet European Pharmaceutical Standards satisfy this quality criteria.

The keys to reaping the benefits of black cohosh are patience and consistency, since it may take three to four weeks for its effects to be fully realized. Consistently using a recommended daily dose of standardized European pharmaceutical-grade black cohosh is one of the safest and most effective ways to naturally deal with the physical and emotional stresses unique to perimenopausal and menopausal women. With the recent flurry of scientific research on black cohosh, it seems clear that it is the best choice for anyone looking for a natural and safe alternative to synthetic estrogen therapy.

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  1. Foster S. Black cohosh: for ease in menopause. The Herb Companion, 1998, Aug-Sep:63-65.
  2. Cimicifuga racemosa – Monograph. Altern Med Rev. 2003 May;8(2):186-189. [No authors listed]
  3. Guthrie, J., et al. Hot flushes, menstrual status, and hormone levels in a population-based sample of midlife women. Obstetrics & Gynecology 1996; 88, 437-442.
  4. Seidlova-Wuttke D, Hesse O, Jarry H, Christoffel V, Spengler B, Becker T, Wuttke W. Evidence for selective estrogen receptor modulator activity in a black cohosh (Cimicifuga racemosa) extract: comparison with estradiol-17beta. Eur J Endocrinol. 2003 Oct;149(4):351-62.
  5. Nisslein T, Freudenstein J. Effects of an isopropanolic extract of Cimicifuga racemosa on urinary crosslinks and other parameters of bone quality in an ovariectomized rat model of osteoporosis. J Bone Miner Metab. 2003;21(6):370-6.
  6. Burdette JE, Liu J, Chen SN, Fabricant DS, Piersen CE, Barker EL, Pezzuto JM, Mesecar A, Van Breemen RB, Farnsworth NR, Bolton JL. Black cohosh acts as a mixed competitive ligand and partial agonist of the serotonin receptor. J Agric Food Chem. 2003 Sep 10;51(19):5661-70.
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