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Black Cohosh Benefits the Menstrual Cycle, Pain and Uterine Health

Black Cohosh Benefits the Menstrual Cycle, Pain and Uterine Health

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 hepatotoxicity (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 Retrieved from:
  • 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

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

    Thanks for your information regarding the possible side effects and the fact that it should not be used as a long term and not for more than 6 months.

    One of our products contains this herb and will be letting customers know about this important information.

  2. Avatar

    There are so many herbs for uterine health ,i am confused.
    Which is the best to use for uterine polyps?

  3. Avatar

    Hi, I am just wondering if you would be able to advise me, I am suffering from side effects from taking oral Black Cohosh supplements, how long after stopping, will it take for the herb to be clear from my body?

    Many thanks

    • Hi Ruth,

      Herbs are cleared from the body rather quickly, so give it a couple days to a week. Also, I am not sure how much you were taking, so not sure that my answer will be very accurate for you.

  4. Avatar

    I have PCOS and my doctors keep batting me back and forth between their selves. They both want to put me on Metaformin but neither one want to give the prescription for it. If I take Black Conosh will it bring on periods for me and help me get pregnant??

    • Hi Leslie Cross,

      To be honest, there is really no way for me to say if Black Cohosh is the the right herb for you, or the only herb your body may need to help bring it back to balance. If you are interested in natural options to treat your PCOS and help you achieve pregnancy naturally, I would urge you to find a natural practitioner to work with. We offer excellent personalized fertility consultations, or you may want to look for someone in your area to work with.

      In regard to your doctors… I am not sure why you are working with two different doctors, but maybe working with just one would be better? Stand up for yourself and if they aren’t willing to work with you, maybe it is time to find someone who will.

      In the mean time, I think you will find this article helpful: Resources for Treating PCOS Naturally

      Please let us know if you have more questions!

  5. Avatar

    I use a diva cup for my period so I can count how much fluid I am loosing and on average I am bleeding 2-3 cups of blood. So I started taking Red Raspberry leaf tea and RR capsules as well as Black Cohosh. I started spotting for my period this a.m. should I stop taking the black cohosh during my cycle or continue taking it through my cycle?

    • Dear Sarah,

      Known for it’s ability to help with menstrual pain/cramps, in general Black Cohosh is best used a few days prior to the start of menstruation, and can be used through menstruation if necessary. It would be best to reach follow the guidance of the makers of the Black Cohosh supplement being taken.

  6. Avatar

    I use black cohosh combined with evening primrose for perimenopause symptoms. They are helping. I suspect it’s mostly due to the black cohosh, as I was seeing good results before adding evening primrose to my routine. What is a good alternative after 6 months of use?

    • Dear Melissa,

      How great that you’ve found a combination that’s working for you!

      It is suggested to either wean off of Black Cohosh to see how the body manages on its own, or to work with a naturopath or herbalist to determine how it is best to continue it.

      The article Achieving Pregnancy During Perimenopause offers additional consideration and tips that may be helpful!

      I am glad you are feeling well!

  7. Avatar

    I am in menopause and had not had a period since April of 2014 but continued to have night sweats so I began taking black cohosh the end of May beginning of June and in July I had a full blown period. Is this a side effect to black cohosh

    • Hello Leslie!

      I can not be certain of course, but Black Cohosh is known to aid in uterine tone and healthy, regular function, as well as in the shedding of the uterine lining. It is a bit hard for me to answer your question directly without knowing more about you.

  8. Avatar

    What are the risks if taken long term? The article doesn’t say.

    • Elizabeth Willett, MA, CH

      Dear Marie,

      The German Commission E Monograph states that Black Cohosh should not be used for longer than six months duration because FDA and WHO adverse events monitoring systems have recorded a small number of adverse events from long-term use (as well as with higher doses than recommended) such as gastrointestinal upset, headaches, elevated blood pressure, and toxicity to the liver.

  9. Update 2014 – We are back! We have been away for a while and we sure have missed all of your wonderful questions and thoughts on our articles. Moving forward, one of our staff herbalists will be here to respond to comments! We look forward to connecting with our readers once again!

  10. Hi..I used black cohosh (tincture form) to induce labor with both my boys. With the first, I mixed with blue cohosh. My 2nd just black (both tincture form). It worked for both within 24-48 hrs! With my 2nd, I think I took too much. During labor I had alot of bleeding! The doctor was going to do a c-section/and/or clamp me due to this excessive bleeding, but he came too fast! I read somewhere that this may have caused me to have a pituitary adenoma(tumor) and cause my amennorrhea and current infertility. Its been 5 yrs. since diagnosis and I had my first period 1 wk. ago. Also, recent hormone tests show Im balancing out and recent mri shows tumor now gone. We r trying to conceive. I am afraid to take this again after what happened, but I know it is powerful and works, so Im hesitent yet tempted. What do u suggest to get my body back in balance? If black cohosh caused the inbalance, will it reverse it? Women be aware..this is a very strong and powerful herb…use with caution! Best to all. Any comments/response will be gr8ly appreciated. God Bless. Robin