Black cohosh is a herb that has been rising in popularity for supporting women’s hormonal health, enhancing female fertility, and managing menopause-related symptoms. Continue reading to learn about black cohosh benefits and how it may improve hormonal health for women.
What is black cohosh ?
Preparations of black cohosh are made using the roots and underground stems of the plant, which are called rhizomes. Black cohosh supplements can be found in powdered, liquid, and pill form. (5)
The technical (Latin) names for black cohosh are Actaea racemosa and Cimicifuga racemosa. Black cohosh is also known by a few other names, including:
Benefits of black cohosh
More recently, however, it has been studied for its effects on women’s health. Black cohosh is considered to be a phytoestrogen, a plant-based compound that has similar properties to the hormone estrogen. (16) It is believed that black cohosh may mimic the effects of estrogen in the body, and as a result, it may help to manage menopause symptoms, improve fertility, and hormonal health in females. (9)
Some studies have suggested that black cohosh supplementation may work similarly to ethinyl oestradiol in improving fertility and successful pregnancy rates when combined with clomiphene citrate. (11)(12)
Clomiphene citrate is a medication used to trigger ovulation in females who are not able to ovulate and thus cannot become pregnant. (13) Although clomiphene citrate can help induce ovulation, it is often not sufficient on its own to increase pregnancy rates. (10) For this reason, clomiphene citrate is often prescribed with ethinyl oestradiol, a bioidentical hormone, that thickens the lining of the uterus to improve pregnancy outcomes. (2)One randomized control trial including 134 patients examined the effectiveness of clomiphene citrate combined with black cohosh or ethinyl oestradiol for improving fertility. The study, found that the group taking black cohosh had faster maturation of eggs, a thicker uterine wall, and higher amounts of estrogen and progesterone, hormones that are essential for a successful pregnancy. (3)(10) Additionally, the study also found that taking black cohosh produced similar pregnancy rates as taking ethinyl oestradiol. (10)
2. Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is one of the most common causes of female infertility. The condition affects between 6 to 12% of females of reproductive age in the United States. Individuals with PCOS often have higher levels of androgens (e.g. testosterone). Androgens are sex hormones that are essential for both male and female reproductive health; however, females produce far less than males. Excess androgen production can prevent ovulation, the release of eggs from the ovaries, and therefore, interfere with fertility. (1)
A randomized controlled trial conducted in 2013 compared the effect of black cohosh and clomiphene citrate on ovulation in women with PCOS. The study included 100 women and was split evenly into two groups, with one group receiving black cohosh and one group taking clomiphene citrate. The study found that ovulation, uterine thickness, and pregnancy rates were higher in the group taking black cohosh. The authors, therefore, concluded that black cohosh may be used as an alternative to clomiphene citrate for inducing ovulation in females with PCOS. (6)
3. Menopausal symptoms
Menopause, a natural transition marked by the end of menstruation, is associated with various symptoms that can negatively impact quality of life. Symptoms associated with menopause may include hot flashes, night sweats, sleep disturbances, mood swings, hair loss, and weight gain. (14)
A 2016 trial compared the effect of black cohosh and menopausal hormone replacement medication on body weight, menopausal symptoms, and metabolic parameters in 174 menopausal women. The metabolic parameters measured included lipids (cholesterol), glucose (blood sugar), and insulin. Menopausal symptoms improved in the group taking both black cohosh and hormone replacement medication; however, there was no effect on metabolic parameters. (4)
A 2018 randomized control study compared the effectiveness of black cohosh or evening primrose oil supplementation for reducing menopause symptoms in 80 postmenopausal women. While both herbs improved hot flash severity, black cohosh also reduced the number of hot flashes the women experienced. (7)
Risks and adverse effects of black cohosh
Black cohosh is generally safe to use with the guidance of a healthcare practitioner. There are a few mild side effects associated with its use, including:
A few rare cases of liver damage have been reported from the use of commercial and unregulated black cohosh products. Ensure you purchase your supplements from a reputable source and speak with your health care practitioner before taking black cohosh products. (8)
The bottom line
Black cohosh is a herb native to North America that has been used for centuries for its medicinal properties. Black cohosh may be effective for improving female hormonal health and fertility due to its possible estrogen-mimicking effects in the human body. There are a few mild side effects associated with its use. Always speak with your healthcare practitioner before starting any new supplements.
- Centers for Disease Control and Prevention. (2020, March 24). PCOS (Polycystic Ovary Syndrome) and Diabetes. https://www.cdc.gov/diabetes/basics/pcos.html
- Check JH. The multiple uses of ethinyl estradiol for treating infertility. Clin Exp Obstet Gynecol. 2010;37(4):249-51.
- Durante, K. M., & Li, N. P. (2009). Oestradiol level and opportunistic mating in women. Biology Letters, 5(2), 179–182.
- Friederichsen, L., Nebel, S., Zahner, C., Bütikofer, L., & Stute, P. (2019). Effect of cimiicifuga racemosa on metabolic parameters in women with menopausal symptoms: a retrospective observational study (CIMBOLIC). Archives of Gynecology and Obstetrics, 301(2), 517–523.
- Furhad S, Bokhari AA. Herbal Supplements. 2021 Apr 20. In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Kamel, H. H. (2013). Role of phyto-oestrogens in ovulation induction in women with polycystic ovarian syndrome. European Journal of Obstetrics & Gynecology and Reproductive Biology, 168(1), 60–63.
- Mehrpooya M, Rabiee S, Larki-Harchegani A, Fallahian AM, Moradi A, Ataei S, Javad MT. A comparative study on the effect of “black cohosh” and “evening primrose oil” on menopausal hot flashes. J Educ Health Promot. 2018 Mar 1;7:36
- National Center for Complementary and Integrative Health. Black Cohosh. NIH. https://www.nccih.nih.gov/health/black-cohosh
- Office of Dietary Supplements. Office of Dietary Supplements – Black Cohosh. NIH. https://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/
- Shahin, A. Y., Ismail, A. M., & Shaaban, O. M. (2009). Supplementation of clomiphene citrate cycles with Cimicifuga racemosa or ethinyl oestradiol – a randomized trial. Reproductive BioMedicine Online, 19(4), 501–507.
- Shahin, A. Y., Ismail, A. M., Zahran, K. M., & Makhlouf, A. M. (2008). Adding phytoestrogens to clomiphene induction in unexplained infertility patients – a randomized trial. Reproductive BioMedicine Online, 16(4), 580–588.
- Shahin, A. Y., & Mohammed, S. A. (2014). Adding the phytoestrogen Cimicifugae Racemosae to clomiphene induction cycles with timed intercourse in polycystic ovary syndrome improves cycle outcomes and pregnancy rates – a randomized trial. Gynecological Endocrinology, 30(7), 505–510.
- U.S. National Library of Medicine. Clomiphene: MedlinePlus Drug Information. Medline Plus. Retrieved March 8, 2022, from https://medlineplus.gov/druginfo/meds/a682704.html
- U.S. National Library of Medicine. Menopause. MedlinePlus. Retrieved March 8, 2022, from https://medlineplus.gov/menopause.html
- Wobser RW, Takov V. Black Cohosh. . In: StatPearls . Treasure Island (FL): StatPearls Publishing; 2022 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK470187/
- Wuttke, W., Jarry, H., Haunschild, J., Stecher, G., Schuh, M., & Seidlova-Wuttke, D. (2014). The non-estrogenic alternative for the treatment of climacteric complaints: Black cohosh (Cimicifuga or Actaea racemosa). The Journal of Steroid Biochemistry and Molecular Biology, 139, 302–310.