From the Guidelines
Black cohosh should be used with extreme caution for menopause symptoms due to its potential liver toxicity and lack of established efficacy, as evidenced by a recent study published in the Annals of Oncology 1. When considering black cohosh for menopause symptoms, it is essential to weigh the potential risks and benefits. The study published in the Annals of Oncology 1 highlights the lack of efficacy of black cohosh in reducing menopausal symptoms and raises concerns about its safety, particularly regarding liver failure. Key precautions to consider include:
- Avoiding black cohosh entirely if you have liver disorders, as it has been associated with rare cases of liver damage
- Not using black cohosh if you have hormone-sensitive conditions like breast cancer, uterine cancer, or endometriosis, due to its potential estrogenic effects
- Avoiding black cohosh during pregnancy and breastfeeding
- Being cautious about potential interactions with medications metabolized by the liver
- Monitoring for common side effects like headache, gastrointestinal discomfort, dizziness, and weight gain
- Not exceeding six months of treatment without medical supervision, and being aware that the typical dosage ranges from 20-80 mg of standardized extract daily
- Discontinuing use immediately and seeking medical attention if symptoms like jaundice, dark urine, or abdominal pain occur. Given the mixed scientific evidence for its effectiveness and potential risks, it is crucial to consult a healthcare provider before starting black cohosh for menopause symptoms.
From the FDA Drug Label
Directions: Adults: Take two (2) tablets three (3) times a day, with meals. For the best results, take regularly throughout the month. The FDA drug label does not answer the question.
From the Research
Precautions for Taking Black Cohosh
When considering black cohosh (Cimicifuga racemosa) for menopause symptoms, several precautions should be taken into account:
- Potential Side Effects: Adverse reactions such as nausea, vomiting, headaches, dizziness, mastalgia, and weight gain have been observed in clinical trials 2.
- Estrogenic Effects: The estrogenic effects of black cohosh are controversial, with some data indicating anti-estrogenic activity, which may be a concern for certain individuals 2.
- Pregnancy and Lactation: Black cohosh should not be administered to children or during pregnancy and lactation due to potential effects on sex hormones 2.
- Muscle Damage: There have been reports of muscle damage induced by black cohosh, characterized by severe asthenia and high blood levels of creatine phosphokinase and lactate dehydrogenase 3.
- Liver Injury: Severe hepatitis and liver injury have been associated with the use of black cohosh, with features mimicking autoimmune hepatitis 4, 5.
- Interactions and Contraindications: While no drug interactions are reported in the medical literature, caution should still be exercised when taking black cohosh with other medications or in individuals with certain medical conditions.
- Dosage and Treatment Duration: The recommended dose of black cohosh is 40-80 mg per day, and at least 4-12 weeks of treatment may be required before therapeutic benefits are apparent 2.