Black cohosh (formerly known as Cimicifuga racemosa, now Actaea racemosa) is the most popular herb for perimenopausal complaints. Black cohosh also has lesser-known, yet wonderful benefits as an herb for women in their childbearing years. It has been widely used for hundreds of years for pain related to the menstrual cycle.

Traditional Use of Black Cohosh
Black cohosh is indigenous to North America, specifically the east coast US, from the very southern part of Ontario, Canada, to Georgia and as far west as Missouri down to Arkansas. This herb was widely used by eastern Native American tribes including the Cherokee, Iroquois, Penobscot and Micmac. These tribes #1 use of Black cohosh was for the relief of pain. In 1749 von Linne describes it as an herb for female debility and pain relief, as well as a cardiac (heart) tonic and uterine tonic. It appears in botanical literature as early as 1680. Black cohosh was used extensively by the Eclectics for women’s muscular pains, uterine pain, tender uterus, irregular pains, and dysmenorrhea. This herb was also widely used as a mild sedative.

Black cohosh is quite a lovely plant. This plant has long, white delicate flowering tops, with strong roots. I have successfully grown Black cohosh in Portland, OR. Though it is indigenous to the eastern states, it is not an invasive plant and may be cultivated elsewhere. I was always so excited when it flowered, it has created beautiful contrast in the garden. Its long white flowering tops stand out. It goes by other common names, such as, Black bugband, Black snakeroot, and fairy candle.

Medicinal Benefits of Black Cohosh

Black cohosh is not a nutritive herb to be used long-term. This plant has specific medicinal action. Many herbalists find that taking it long-term is not advised. Because of its popularity for menopausal complaints, many women feel that it is fine to consume long-term, this is not the case. Black cohosh should only be used for up to 6 months. This suggested length of time of use would be the same for women who are choosing to use it for any sort of fertility related ailment. It is best to only choose this herb after careful evaluation and consideration. It would probably be a good idea to seek the advice of a skilled herbalist before choosing to use this plant.

Uses for Fertility

Amenorhea (absent period): Black cohosh has been used for hundreds of years to help bring on a menstrual period. Aids in tone, regular function, and shedding of the uterine lining.

Dysmenorrhea (painful menstruation): This plant is very anti-inflammatory and wonderful at reducing spasm in both the smooth muscles, but also the skeletal muscles associated with menstrual cramping pain that radiates to the lower back and down the thighs. It is best used a few days prior to the onset of menstruation and through menstruation, if necessary. It combines well with other herbs for pain like, Crampbark or Blackhaw.

Relief of uterine contractions associated with threatened miscarriage: While this herb is not recommended for regular use in pregnancy, it has been used successfully in some cases to prevent pre-term uterine contractions in a threatened miscarriage. It is always used in combination with other herbs to help prevent miscarriage and should never be self-prescribed for miscarriage. The success of using Black Cohosh is dosage dependent; only a skilled midwife or herbalist would be able to determine the best amount to use and what combination with other herbs is necessary.

Uterine irritability: For women with a uterus that feels inflamed or irritated throughout the month, Black cohosh may be an effective option in relaxing the uterus, reducing inflammation of the uterus.

Uterine and ovarian neuralgia (nerve pain): Excellent for relieving pain, shooting, pinched or inflammatory conditions causing nerve pain.

Congested pelvic conditions: Because it is an excellent anti-inflammatory herb and heart tonic, it promotes healthy blood flow to the pelvic area. Aids in healing of uterine fibroids, ovarian cysts, and endometriosis.

Premenstrual migraine headache: Has been shown to greatly reduce migraine headache, best used at least 3 days prior to menstruation to help prevent migraine, but may also be used acutely to treat migraine.

Ovarian pain: Whether it be ovarian cyst pain or mittelschmerz (ovulation pain), this plant has proven to be effective at reducing ovarian pains.

Weak pelvic floor muscles, uterine prolapse: According to Susun S. Weed in her book Down There Sexual and Reproductive Health, Black cohosh tincture taken at 1 dropperful a day for 3 months will aid in toning pelvic floor muscles. This helps to reverse organ prolapse, in addition to Kegels or other pelvic floor therapies.

Estrogenic Action Debate: There have been several studies performed using Black cohosh to determine if it will increase estrogen and could therefore be a threat to estrogen fueled cancer. Initial studies suggest an estrogenic action. More recent studies have shown it has no effect on estrogen, LH, FSH, prolactin, SHGB or endometrial proliferation (increase in endometrial cells within the uterus).

Uses for Pregnancy

Using Black cohosh during pregnancy should only be done under the skilled care of your midwife or herbalist. Never self-prescribe Black cohosh during pregnancy. I wanted to share with you the benefits, so you know its uses during pregnancy as well. It is important to know a plant well prior to using it. Only a skilled midwife or herbalist can suggest the correct dosage for your particular situation.

Dysfunctional contractions during labor: Sometimes contractions in labor are inefficient, slow down or are irregular. Black cohosh may be given to help promote regular contractions.

Partus preparator (preparation for labor in last 2 weeks of pregnancy): Many midwives suggest to pregnant women in their care to take liquid extract of this herb for the last 2 weeks of pregnancy to help prepare the uterus for labor. It may also help to stimulate labor, speed it up or help to make contractions more efficient.

Helps to maintain contractions after birth:This is very important to prevent hemorrhage. For some women, they may find their uterus is tired and not contracting efficiently after the birth of her baby. Black cohosh may help to sustain contractions. The uterus needs to contract back to down pre-pregnancy size, or thereabout. This is hard work for the uterus.

Additional ways it has been used for pregnancy:

• Reduces reflux, aiding in morning sickness
• Its relaxing effects help the birth canal and perineum to relax, thus reducing the chance of tearing at birth
• Used for pregnant mothers with insomnia
• Used for hysteria

Other Virtues (uses) of This Plant
Black Cohosh has been used for these other ailments. As the herbalist Jim McDonald pointed out…plants have more than one virtue.

• Menopausal symptoms (hot flashes, night sweat, heart palpitation, headache, sweating, nervousness, insomnia, irritability, depression)
• Chronic fatigue syndrome
• Whooping Cough
• Lowered muscle function
• Dull-achy inflammatory pain of any sort
• Rheumatoid arthritis
• Heart tonic
• Sciatica
• General coughs from cold’s, etc.
• Osteoporosis

Traditional Suggested Usage

A lower dosage is considered quite efficient in most cases.

Tincture of fresh root is best, although, tincture of dried root is okay as well. Use small dosage 5-15 drops, a day at most.
If using dried root in a capsule: 40 to 200mg a day.

Do NOT use past 6 months, unless directed by your naturopath or herbalist.

The liquid tincture is very strong-tasting, I find it to be pretty nasty. I like to mix it in a bit of juice and swallow all at one time (take a shot). Black cohosh combines well with many other herbs!

Be aware that this herb may have a strong effect on mood and disposition. For melancholic type women, it seems to help make them happier and content. For women with a happy and content disposition, it may make them brooding and withdrawn. Taking too high of a dosage may cause a dull achy headache. There are no known drug-interactions with Black cohosh. Those with liver disease may want to avoid this herb, as it has had a couple of reports of hepatoxicity (toxic to the liver), though they were isolated incidence with other factors involved, it is best to be safe.

• Romm, Aviva. (2010). Botanical Medicine for Women’s Health. St. Louis, Missouri: Churchill Livingstone.
• (Video) Plant Walk with Jim McDonald at herbcraft.org
• Weed, Susun S. (2011). Down There Sexual and Reproductive Health. Woodstock, New York. Ash Tree Publishing.
• Hudson, Tori. N.D. (2008). Women’s Encyclopedia of Natural Medicine. McGraw Hill

Dalene Barton-Schuster - Certified Herbalist, Birth Doula

Practicing natural health and herbalism for over 18 years, Dalene received her training and herbal certification under the guidance of Lynn Albers at Yarmony Mt. Herbal College in Colorado in 2000. She went on to become a Certified Birth Doula at Birthingway College of Midwifery in Portland, Oregon in 2007. As a Birth Doula, Dalene has helped to bring many new lives in to this world. Dalene has written 280+ fertility articles and with her vast array of herbal and holistic healing knowledge has helped 1000’s of women on their journey to Motherhood.

Dr. Christine Traxler M.D., OB/GYN

Dr. Traxler is a University-trained obstetrician/gynecologist, working with patients in Minnesota for over 20 years. She is a professional medical writer; having authored multiple books on pregnancy and childbirth; textbooks and coursework for medical students and other healthcare providers; and has written over 1000 articles on medical, health, and wellness topics.  Dr. Traxler attended the University of Minnesota College of Biological Sciences and University of Minnesota Medical School,  earning a degree in biochemistry with summa cum laude honors in 1981,  and receiving her Medical Doctorate degree (MD) in 1986.

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