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Black Cohosh Side Effects & Safety

Evidence:Strong
·

This content is for informational purposes only and does not constitute medical advice. Statements about dietary supplements have not been evaluated by the FDA and are not intended to diagnose, treat, cure, or prevent any disease. Individual results may vary — consult your healthcare provider before starting any supplement. Full disclaimer

Safety Profile

Overall safety rating: Safe with Caution

Potential Side Effects

  • GI upset — stomach discomfort, nausea, or diarrhea (most common)
  • Headache and dizziness (occasional)
  • Musculoskeletal complaints — joint or muscle pain reported in some trials
  • Rare hepatotoxicity — isolated case reports of liver injury, though causality is debated; monitor liver function if using long-term

Drug & Supplement Interactions

  • Hepatotoxic medications — potential additive liver stress; avoid combining with known hepatotoxic drugs
  • Hormone replacement therapy — effects may overlap; consult physician before combining
  • Tamoxifen and aromatase inhibitors — while black cohosh appears non-estrogenic, discuss with oncologist before use in breast cancer patients
  • Statins — both may affect liver function; monitor liver enzymes

Maximum Dose

Do not exceed: 40mg standardized extract daily; do not exceed 6 months of continuous use without medical review

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References

  1. ReviewLeach MJ, Moore V (2012). Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database of Systematic Reviews. DOI PubMed
  2. RCTOsmers R, Friede M, Liske E, et al. (2005). Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstetrics & Gynecology. DOI PubMed
  3. Meta-analysisSadahiro R, Matsuoka LN, Zeng BS, Chen KH, et al. (2023). Black cohosh extracts in women with menopausal symptoms: an updated pairwise meta-analysis.. Menopause (New York, N.Y.). DOI PubMed
  4. Castelo-Branco C, Gambacciani M, Cano A, Minkin MJ, et al. (2021). Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidence.. Climacteric : the journal of the International Menopause Society. DOI PubMed
  5. Meta-analysisNaser B, Schnitker J, Minkin MJ, de Arriba SG, et al. (2011). Suspected black cohosh hepatotoxicity: no evidence by meta-analysis of randomized controlled clinical trials for isopropanolic black cohosh extract.. Menopause (New York, N.Y.). DOI PubMed
  6. Meta-analysisShams T, Setia MS, Hemmings R, McCusker J, et al. (2010). Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis.. Alternative therapies in health and medicine. PubMed
  7. Fan CW, Cieri-Hutcherson NE, Hutcherson TC (2022). Systematic Review of Black Cohosh (Cimicifuga racemosa) for Management of Polycystic Ovary Syndrome-Related Infertility.. Journal of pharmacy practice. DOI PubMed
Show 5 more references
  1. Naser B, Castelo-Branco C, Meden H, Minkin MJ, et al. (2022). Weight gain in menopause: systematic review of adverse events in women treated with black cohosh.. Climacteric : the journal of the International Menopause Society. DOI PubMed
  2. Peng J, Xu W, Li X, Wu Q (2020). [Efficacy of black cohosh extracts for improving low estrogen status induced by postoperative GnRHa treatment in patients with endometriosis: a systematic review].. Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences. DOI PubMed
  3. Ruan X, Mueck AO, Beer AM, Naser B, et al. (2019). Benefit-risk profile of black cohosh (isopropanolic Cimicifuga racemosa extract) with and without St John's wort in breast cancer patients.. Climacteric : the journal of the International Menopause Society. DOI PubMed
  4. Fritz H, Seely D, McGowan J, Skidmore B, et al. (2014). Black cohosh and breast cancer: a systematic review.. Integrative cancer therapies. DOI PubMed
  5. Palacio C, Masri G, Mooradian AD (2009). Black cohosh for the management of menopausal symptoms : a systematic review of clinical trials.. Drugs & aging. DOI PubMed