Black Cohosh: The Plant That Herbalists Call On For Treating Period Cramps, Sleep Issues & More

mbg Contributor By Sara Weinreb
mbg Contributor
Sara Weinreb is the host of the Medium Well podcast and curator of the weekly email, Sara... lately.. She has a bachelor’s degree from Tulane University.
Black Cohosh: The Plant That Herbalists Call On For Treating Period Cramps, Sleep Issues & More

The deeper you dive into the world of herbalism, the more you come to realize that nature has already come up a cure for almost every ailment out there—from headaches to fatigue and beyond. One natural remedy that many herbalists have turned to for centuries is a medicinal plant known as black cohosh. While it hasn't quite gone mainstream in the wellness world, black cohosh has shown potential to help women during their cycle and through menopause and also offer some relief to those struggling with PCOS. Here's everything you need to know about adding it to your plant-powered health arsenal.

What is black cohosh?

Native to North America, black cohosh (actaea racemosa or cimicufuga racemosa) is also known as bugbane, rattleroot, and black snakeroot. The medicinal plant grows in the Eastern deciduous forest and is wild harvested in the Appalachian and the Ozarks, and its power is packed in its roots and underground stems.

Black cohosh has been used across the world as a natural remedy for centuries. Algonquins took the herb internally to remedy kidney programs, while the Iroquois used it topically for achy joints to ease pain. In the case of the Cherokees, it was used as a diuretic and treatment for tuberculous and fatigue.

Black cohosh gained mainstream popularity in the late 19th century, when herbalist Lydia E. Pinkham started selling an herbal tonic to support women's health (or, as she referred to it, "women's complaints") that included a variety of herbs including black cohosh. Though she was considered a little "off her rocker" at the time, her product is still sold and beloved by many.

Fast-forward to the current day, and black cohosh has been most readily prescribed in Europe for a range of symptoms related to women's health and hormonal balance—usually in place of more conventional hormone replacement therapies. It is, however, banned in Denmark due to its potential links to liver damage.


Why does black cohosh help ease the symptoms of menopause? (Looking at you, hot flashes.)

First and foremost, black cohosh is a phytoestrogen—a naturally occurring product that contains estrogen-like properties. "I typically suggest black cohosh to my patients going through menopause as well as other hormone problems such as PCOS for its ability to help rebalance hormones," shared Will Cole, D.C., IFMCP, a functional medicine practitioner. "Since black cohosh can also help improve sleep, it does double duty in hormone health since adequate sleep is essential for hormone production."

And while black cohosh is often associated with supporting hormonal issues in women, many studies on its efficacy are inconclusive. Most of the research done on black cohosh focuses on Remifemin, a supplement for menopausal women that contains a regulated dosage of the herb (40 mg). Remifemin has been used in Europe since the 1950s to treat symptoms of menopause and has been heavily researched since then with mixed results. While not all studies have found conclusive data, many have found enough evidence of potential efficacy to recommend additional studies. (One study concluded that taking black cohosh reduced hot flashes by showing it was more effective than a placebo, while another one found that it was no more effective than the placebo.)

As with many herbs, though, it's considered relatively safe, so it may be worth trying out to see if it works for you.

What else might it be able to help with?

It helps menopausal women get some sleep.

Many women in the early stages of menopause complain of insomnia. One study showed that menopausal women reported having a better night's sleep ("increased sleeping efficiency" and "decreased wake after sleep onset" were the terms they used) when taking black cohosh. The study did not find any negative effect of taking the herb.


It eases menstrual cramps.

Black cohosh has also been shown to be helpful for those who suffer from menstrual cramping. While there aren't many research studies to back this up, herbalists have been prescribing the herb to women during their time of the month for decades.

It relieves symptoms of PCOS.

Black Cohosh: The Plant That Herbalists Call On For Treating Period Cramps, Sleep Issues & More

Photo: @emer1940

There's some evidence that black cohosh may help reduce pain in patients with polycystic ovary syndrome (PCOS). One comprehensive review looked at 33 studies and concluded that there is evidence that black cohosh—along with vitex, tribulus, licorice, Paeonia lactiflora, and Chinese cinnamon—is an effective herbal medicine at easing symptoms such as irregular menstrual cycles, hirsutism, and acne. Another study even showed that women with PCOS who used the herb were more fertile than those who didn't, but again, more research is needed.


Are there any potential side effects to keep in mind?

First and foremost, you can avoid side effects by buying your black cohosh from a reputable source that you trust. As if often the case with herbal supplements, black cohosh is not regulated, and there's historically been problems with adulteration. If you want to try the herb out, ask an herbalist, naturopath, or your doctor first before giving it a go.

There also may be some connection between black cohosh and liver damage. A study showed that a handful of individuals have experienced liver damage while taking black cohosh, though there is no evidence of a causal relationship. It also appears that most of the individuals who had liver damage had been taking a tainted version of the herb. "Just like with anything, what works for one person doesn't always work for the next, so it's important to talk to your doctor before adding this herb to your wellness routine, especially if you already have liver problems," adds Dr. Cole.

Keep in mind that you should only take black cohosh for six months at a time (at the recommended dosage, of course) and you shouldn't take it at all if you're pregnant.

And remember that pairing black cohosh with other healthy lifestyle changes will always yield the best results. "Black cohosh can be really helpful for some menopausal symptoms, as well as protecting bones. I'd first suggest a very high-quality (nutrient-dense) plant-based diet for either state, and then consider including black cohosh additionally," shared Rachelle Robinett, holistic health practitioner and founder of Supernatural. Herbs are a powerful tool that can be a part of your overall health journey.

What are the best ways to consume it?

"Supplementation is the easiest way to add black cohosh to your wellness routine, but you can get it in tea as well," according to Dr. Cole. Supplementation recommendations range from 40 mg to 200 mg per day in divided dosages. Once again, consult with your doctor to see what's best for you.

The herb is also nice in tea form—simply simmer 2 teaspoons of chopped black cohosh root and rhizomes in 2 cups of water for 10 minutes. Or you can just buy the root in tea bags at your local health food store. Be warned, though, this is not the tastiest of teas!

Using herbal medicine can often involve a bit of trial and error. In partnership with your herbalist, doctor, or naturopath, you can explore whether black cohosh may be able to help you with your health needs.

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