How Black Cohosh Benefits Menopause, PMS, Cramps, and Women’s Health

Published on February 21, 2024

By Kristen Boye BS, Natural Health

Kristen Boye

Kristen Boye is a natural health expert, writer, copywriter, and editor. Kristen was raised on an organic farm in British Columbia which inspired her life’s work. She holds a Bachelor’s Degree in Natural Health, is a Certified Natural Foods Chef, co-owner of a medicinal herb farm, and is a natural foods and children’s health advocate. Kristen lives with her husband and two children on their medicinal herb farm in Western North Carolina.

Few herbs have gained such widespread acceptance for women’s health than Black Cohosh.

This legendary herb has a rich history of traditional use in the East and West for supporting women during their childbearing years and menopause, in addition to other uses.

It’s also one of the top-selling herbal supplements in the United States, which has caused some issues with ethical sourcing and endangerment.REF#3556

In this article, we pay homage to one of the true Queens of the herbal world by digging deep into the history, benefits, and side effects of Black Cohosh for supporting women’s health and how to find an ethically sourced supplement.

Historical and Traditional Uses of Black Cohosh

Black Cohosh (Actaea racemosa) is a flowering plant in the buttercup family native to eastern North America. 

It goes by many names, including Snakeroot, Bugbane, Baneberry, Bug Root, Fairy Candles, or Rattletop, and has been used in Native American medicine and herbal folklore for centuries.

Native American tribes have used Black Cohosh rhizome (root) extracts to support:REF#3557

  • Normal inflammatory response
  • Bronchial function 
  • Energy levels 
  • Kidney function
  • The female reproductive system
  • Menopausal and postmenopausal symptoms
  • Breastmilk production

It was also used as an antidote for rattlesnake bites, although no evidence supports this use.

Word got out about Black Cohosh to the non-native population around 1850, where its use is documented for supporting joint health, helping relieve pain during childbirth, headaches, and menstrual cramps, and supporting normal inflammatory response.REF#3558

Black Cohosh is also used in the traditional herbal and wellness practices of Mexico, Brazil, Guatemala, China, Spain, and other parts of Europe for menopausal complaints and other aspects of women’s health.

Black Cohosh’s rich and colorful history has made it the subject of various studies aimed to investigate if and how it may support women’s health.

How Black Cohosh May Benefit Women’s Health

Scientific analysis has identified several active plant compounds in Black Cohosh, including plant estrogens, known as phytoestrogens, believed to be responsible for its potential benefits.

According to recent studies, the most important plant chemicals known in Black Cohosh rhizome are:REF#3559

  • Phenolic compounds, particularly isoflavones like formononetin, which acts as a phytoestrogen
  • Chromones
  • Triterpenoids, such as —these are of particular abundance in Black Cohosh
  • And Nitrogen-containing constituents

These plant compounds act in different ways, with many showing a potentially beneficial and protective estrogenic effect on the body.

Here, we explore five benefits of Black Cohosh and how it may work to support reproductive function and more.

5 Benefits of Black Cohosh

Black Cohosh is approved in many countries for the relief of menopausal symptoms, PMS, menstrual cramps, and perimenopausal symptoms. 

It’s used for these same purposes in Traditional Chinese Medicine, alone or with complementary herbs.

However, the benefits of Black Cohosh appear to extend beyond the female reproductive system. Here, we explore five benefits of Black Cohosh, from menopause to menstrual cramps.*

1: Black Cohosh May Help Ease Symptoms of Menopause

As mentioned above, Black Cohosh’s claim to fame is its potentially beneficial effects on various aspects of perimenopause, menopause, and post-menopause.

Its use is extensively documented in historical texts and traditional herbalism books worldwide and has been validated by modern research.

Unlike other traditional herbs lacking research to explain their traditional uses, research on Black Cohosh’s efficacy in relieving menopausal symptoms has been published for over 50 years.REF#3560

So, how does it work?

The exact mechanism still needs to be fully understood. However, studies suggest active plant compounds, such as the isoflavone mentioned above, formononetin—a phytoestrogen—may support normal estrogen receptor regulation in women, and Cimicifuga and triterpene glycosides may play a role in supporting serotonin pathways.REF#3561

Other studies suggest plant compounds in Black Cohosh may act as antioxidants to promote normal inflammatory response.REF#3562

These mechanisms of action could explain its purported effects on various menopausal symptoms such as mood swings, aches and pains, aging, vaginal dryness,REF#3563 and mild vasomotor symptoms (hot flashes, night sweats, and temperature changes) related to menopause.

Although more research is needed to understand the exact way Black Cohosh works, substantial evidence suggests a benefit for symptoms of perimenopause, menopause, and post-menopause.

2: Black Cohosh May Help with PMS

PMS, also known as premenstrual syndrome, is extremely common, affecting nearly half of all menstruating women and people.REF#3564

Symptoms of PMS vary widely and may include: 

  • Abdominal pain
  • Anger
  • Anxiety
  • Back pain
  • Breast swelling and/or tenderness
  • Changes in appetite
  • Constipation
  • Fatigue
  • Irritability
  • Mood swings and crying
  • Restlessness or sleeplessness
  • Weight gain

The lack of modern solutions available for PMS have led many women to seek answers from traditional herbal wisdom.

Although many people associate Black Cohosh with menopause, research suggests its active plant compounds, such as triterpenes, may help relieve PMS. This is why you may find Black Cohosh in herbal formulas targeting various PMS symptoms.REF#3565

However, more research is needed to understand how Black Cohosh may affect various PMS symptoms.

3: Black Cohosh May Indirectly Ease Menstrual Cramps

Although research is lacking regarding Black Cohosh’s effects on menstrual cramps, many women swear by its benefits. It is also used for this purpose in traditional herbalism.

Black Cohosh may help by supporting normal inflammatory response, estrogen receptors, and/or supporting normal function of uterine muscles.

Research has also shown Black Cohosh may bind to opioid receptors, giving it a mild pain-killing effect in menopausal women.REF#3566 Again, this doesn’t prove it works on menstrual cramps but may explain anecdotal accounts and its traditional use.

So, should you try Black Cohosh for menstrual cramps? There isn’t any direct evidence it works, but historical and anecdotal accounts suggest a benefit. 

If you’re looking for natural solutions for menstrual cramps, check out: 18+ Natural Solutions & Herbs for Menstrual Cramps, PMS, Cravings, & More for more evidence-based options.

4: Black Cohosh May Help With Sleep in During and Post-Menopause

For many, sleep disturbance is one of the primary (and most frustrating) symptoms of menopause and postmenopause.

For many, sleep disturbance is one of the primary (and most frustrating) symptoms of menopause and postmenopause.

Research has shown Black Cohosh may help in several ways.

Firstly, since studies suggest Black Cohosh may help alleviate pesky menopausal symptoms like anxiousness, hot flashes, and night sweats, this may indirectly help you get a better night's sleep.

Secondly, a small 2015 study found that postmenopausal women who took Black Cohosh daily improved their sleep.REF#3567

Although Black Cohosh’s effects on various menopausal symptoms are well-documented, more research is needed to know how well it may help with sleep.

If you’re already taking or planning on taking Black Cohosh, this emerging research suggests improved sleep may be a welcomed side effect.

5. Black Cohosh May Promote Bone Health in Menopausal Women

Nearly all types of doctors and healthcare practitioners recommend taking steps to maintain bone health and function during and after menopause.

The reason is that our bones not only age as we age, but natural dips in hormones, like estrogen during menopause, can have a negative effect on bone function.

Herbalists have long recommended specific herbs for bone support, such as Black Cohosh, Ashwagandha, Bamboo, Boneset, and Horsetail.REF#3568 REF#3569

Regarding Black Cohosh, emerging research suggests its estrogenic properties may have a protective effect on bone function, but more research is needed.REF#3570

Side Effects & Possible Contraindications of Black Cohosh

Black Cohosh has been used for centuries and is generally considered safe with no significant side effects reported in clinical studies.

One meta analysis reported gastrointestinal discomfort occurred in 0.5-15% of participants taking Black Cohosh.REF#3571 High doses of Black Cohosh have also been associated with gastrointestinal symptoms such as stomach upset and nausea.

There have been some reports of liver damage in people taking Black Cohosh, but no causal relationship has been proven.REF#3572

Check with your doctor or healthcare practitioner before taking Black Cohosh if you have any liver issues.

Is Black Cohosh Endangered?

Black Cohosh’s growing popularity has led to overharvesting in some areas of the country.

According to United Plant Savers, an organization dedicated to preserving plant life, the annual harvest of Black Cohosh is as much as 500,000 pounds in dry weight per year, and about 97% is wild-harvested.REF#3573

Development and logging have also wiped out large crops of Black Cohosh in its woodland habitats.

Black Cohosh is endangered in Illinois and Massachusetts but is still abundant in the Appalachian mountains and other regions of the East Coast.

The other issue with Black Cohosh is it is easily mistaken for similar endangered or rare herbs.

Herbal identity testing of raw materials using High Performance Thin-Layer Chromatography testing is the best way for supplement companies to prevent issues with identity and adulteration.

Fortunately, Black Cohosh is easy to cultivate, and eco-conscious suppliers, manufacturers, and supplement companies will source cultivated Black Cohosh or Black Cohosh harvested from areas where it is not endangered.

This is one example of why it is so important to source bulk herbs and herbal supplements from companies who are transparent and ethical about sourcing and traceability.

Black Cohosh is available in various forms, including tinctures, teas, tablets, powder, and liquid or powder-based capsules.

Its naturally bitter flavor makes capsule and tablet versions more palatable, although some enjoy that bitter bite.

The best way to take Black Cohosh is a matter of preference and how to get the best quality product for the best price.

For example, if you aim to get a certain amount of Black Cohosh per serving, a capsule, tincture, or tablet supplement that lists how much is in every serving would be preferable to a bulk tea.

If you enjoy Black Cohosh's flavor, it can make a tasty tea, especially if sweetened with honey or paired with complementary herbs.

How to Make Black Cohosh Tea

Black Cohosh tea is easy to make and can be customized with other herbs or aromatics to suit your taste.

Here’s a basic recipe for a perfect cup of Black Cohosh Tea:

  • 1/2 to 1 teaspoon organic Black Cohosh Root powder
  • 1 cup water
  • 1 teaspoon raw honey or natural sweetener of choice and/or a squeeze of lemon

Simmer the Black Cohosh in water for 5-10 minutes. Strain and sweeten to taste.

Looking for More Information on Herbs for Women’s Health?

Black Cohosh is often a gateway herb for women to experience the power of traditional herbs and natural wellness.

However, it isn’t the only herb that can help with menopause and women’s health.

For more on the best herbs to support every season of womanhood, check out the following articles:


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