The Spartan Guide to Black Cohosh

The Claim A member of the buttercup family, black cohosh’s many monikers (mostly historical) tend to run dark: It’s been called snakeroot, rattleweed, black bugbane, and rheumatism weed. Native Americans relied on it for treating fever, cough, slow labor, and menstrual irregularities, and European settlers used it as a tonic to support women’s overall reproductive health. Today, it’s mostly used to treat menopausal symptoms.

The Evidence Healthcare practitioners tend to prescribe black cohosh for symptoms related to menopause, such as hot flashes, night sweats, heart palpitations, vaginal dryness, insomnia, and irritability. The herb seems effective anecdotally, but there's been no strong science to back its efficacy. In fact, a 2012 Cochrane review looked at 16 clinical trials covering 2,207 women and concluded there was “insufficient evidence ... to either support or oppose the use of black cohosh for menopausal symptoms.” But that could be because the experiments varied widely in dosage, duration, and preparation method. Similarly, a 2016 meta-analysis of four studies (covering 511 women total) found no clear link between black cohosh use and relief from menopausal symptoms. Still, both study reviews concluded that better, more consistent research really needs to be done.

“I tend to prescribe black cohosh for hot flashes, vaginal dryness, and sleep issues,” says Junella Chin, an osteopathic physician in New York City who specializes in functional medicine. “Black cohosh can have some mild estrogen-like side effects,” she adds, “such as upset stomach, cramping, headache, breast tenderness, and bloating.”

How to Use It Black cohosh doesn’t have any known interactions with medications, so it's safe to experiment with. For it to have any effect, try oral supplementation for at least 4 to 6 weeks, Chin says. Follow the directions on the packaging, and if the treatment proves to be beneficial for you, keep taking it.

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