Black cohosh Dosage and Side Effecst for Menopausal Symptoms

Black cohosh (Cimicifuga racemosa, Actaea racemosa) is an herb that was first used for medicinal purposes by Native American Indians, who introduced it to European colonists. It is an herb that exerts its effects on the endocrine regulatory (hormonal) mechanism in your body. It’s a phytoestrogen, but by definition that means it’s weaker than the estrogens your body creates. In the mid-1950s in Europe, Black cohosh became a popular treatment for women’s health issues, Generations of American women have relied on the gnarled root of black cohosh(Cimicifuga racemosa) to relieve various “female problems, exspecialy has commonly been used to treat symptoms of menopause, premenstrual syndrome (PMS), painful menstruation, acne, weakened bones (osteoporosis), and for starting labor in pregnant women. But black cohosh hasn’t only been helpful for women going through natural menopause. It also helped women who had undergone hysterectomy with partial removal of their ovaries.

Black Cohosh Benefits

black cohosh plantBlack cohosh root contains several chemicals that might have effects in the body. Some of these chemicals work on the immune system and might affect the body’s defenses against diseases and help to reduce inflammation. Black cohosh root also seems to have some effects similar to the female hormone, estrogen. In some parts of the body, black cohosh might increase the effects of estrogen. In other parts of the body, black cohosh might decrease the effects of estrogen. Estrogen itself has various effects in different parts of the body. Estrogen also has different effects in people at different stages of life. Black cohosh should not be thought of as an “herbal estrogen” or a substitute for estrogen. It is more accurate to think of it as an herb that acts similar to estrogen in some people. Structurally, black cohosh more closely resembles estradiol, which researchers believe offers protection against cancer of the endometrium, ovaries and breast. That’s a real conclusion from research done on menopause treatment alternatives. You can take black cohosh for menopausal symptoms and get protection against cancer at the same time. Black cohosh may be a herb you may want to consider taking if you have hot flashes, vaginal pain or itching, depression, or bone loss due to natural or surgically-induced menopause. And don’t forget, it also may protect against breast, ovarian and endometrial cancer.

Black Cohosh Side Effect

The research shows that for the majority of menopausal women taking black cohosh, it is safe and effective. Black cohosh is generally safe in recommended doses and when used up to one year in healthy, non pregnant, non breastfeeding women. Researchers at Northwestern Medical School found that black cohosh extracts do not demonstrate any estrogenic activity (associated with breast cancer) so in that respect black cohosh is safe. Although so far, no overdose amount has been found for black cohosh in humans. But long-term safety data are lacking. An important consideration for long-term use of black cohosh, or any substance, is its potential toxicity and cancer-causing attributes. Large doses of black cohosh have been reported to cause nausea, dizziness, seizures, visual disturbances,reduced pulse rate, and increased sweating. Stomach upset has been reported as a common side effect with the use of therapeutic doses of black cohosh. This is not a complete list of side effects and others may occur. Tell your doctor, pharmacist, herbalist, or other healthcare provider about any unusual or bothersome side effect.


  1. Caution is advised in people taking drugs or herbs and supplements that lower blood pressure
  2. In nature, black cohosh contains small amounts of salicylic acid (which is found in aspirin), but it is not clear how much (if any) is present in commercially available products. Black cohosh should be used cautiously in people allergic to aspirin or to other salicylates.
  3. Use cautiously in people with a history of hormone-sensitive conditions, such as breast cancer, uterine cancer, or endometriosis (growth of endometrial tissue outside the uterus). Use cautiously in people with known seizure disorders, liver disease, or a history of stroke or disease involving blood clots. Use cautiously as a labor-inducing agent simultaneously with blue cohosh (Caulophyllum thalictroides).
  4. Avoid in patients with known allergy to black cohosh, its parts, aspirin, other salicylates, or members of the Ranunculaceae (buttercup or crowfoot) family.
  5. Do not take black cohosh without medical advice if you are using any of the following medications:
    • acetaminophen (Tylenol); cisplatin; donepezil; erythromycin; isoniazid; methotrexate; ondansetron; an antidepressant or antipsychotic medicine–amitriptyline, clozapine,
    • desipramine, fluoxetine, olanzapine, trazodone; antifungal medicine–fluconazole, itraconazole; cholesterol medication–atorvastatin (Lipitor),
    • simvastatin (Zocor, Vytorin), and others; heart or blood pressure medicine–amiodarone, flecainide, methyldopa, metoprolol; narcotic medicine–codeine,
    • fentanyl, meperidine, methadone, tramadol; or seizure medicine–carbamazepine, phenytoin.
  6. This list is not complete. Other drugs may interact with black cohosh, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this product guide.
  7. Avoid using black cohosh together with other herbal/health supplements that can harm your liver. This includes androstenedione, chaparral, comfrey, DHEA, germander, kava, niacin (vitamin B3), pennyroyal oil, or red yeast.
  8. Do not take black cohosh without first talking to your doctor if you have ever been diagnosed with breast cancer. It is unknown whether black cohosh can stimulate breast cancer cell growth.
  9. Black cohosh pregnancy – Avoid in pregnant or breastfeeding women. Do not take black cohosh without first talking to your doctor or health care provider if you are pregnant or could become pregnant. It is not known whether black cohosh will harm an unborn baby. In large doses, Black cohosh has been reported to cause uterine stimulation, and may induce miscarriage or premature birth.

Black Cohosh Dosage

black cohosh dosage

black cohosh root

  • For menopausal symptoms, the dose of black cohosh used in studies has been 20-40 milligram tablets of a standardized extract taken twice a day. for three months, stopped for three months, then taken for three months again. More than 900 milligrams a day of black cohosh is considered an overdose. Directions for taking black cohosh in other forms will vary.
  • For Adults (over 18 years old) There is no proven effective dose for black cohosh. The British Herbal Compendium recommends 40-200 milligrams of dried black cohosh root daily in divided doses. As a tincture or liquid, the British Herbal Compendium recommends 0.4-2 milliliters of a (1:10) 60% ethanol tincture daily. Powdered black cohosh root or tea (1-2 grams three times daily) also has been used.
  • For breast cancer treatment (menopausal symptoms), 1-4 tablets containing 2.5 milligrams of black cohosh extract have been taken by mouth for six months in addition to tamoxifen. In another study, 20 milligrams of black cohosh was taken by mouth daily for a year. A dose of 20 milligrams of black cohosh has also been given twice daily for 1-6 months.
  • For heart disease in postmenopausal women, 40 milligrams of black cohosh has been taken by mouth daily
  • For infertility, 120 milligrams of black cohosh root has been taken by mouth daily for 12-13 days.
  • For menopausal symptoms, 6.5-160 milligrams of an alcoholic black cohosh extract, a black cohosh root extract, or other black cohosh formulations has been taken by mouth daily for up to one year in various studies. In some studies, 40 drops of a liquid extract have been taken by mouth once or twice daily for up to 24 weeks. An adjusted dose of black cohosh, starting at 64 milligrams for two weeks increased to 128 milligrams by the fourth week, has been studied.
  • For mental performance in postmenopausal women, 128 milligrams of ground black cohosh parts has been taken once daily by mouth for one year.

If you choose to use black cohosh, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. Do not use more of this product than is recommended on the label. Do not use different forms (tablets, liquid, tincture, teas, etc) of black cohosh at the same time without medical advice. Using different formulations together increases the risk of an overdose. Black cohosh is often sold as an herbal supplement. Not all uses for black cohosh have been approved by the FDA. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination. Use black cohosh as directed on the label, or as your healthcare provider has prescribed. Do not use this product in larger amounts or for longer than recommended.

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