Black Cohosh Safety

Although black cohosh is an herb, it may not be suitable for everyone. For instance, you may not be able to take black cohosh if you have cancer, a blood clotting disorder, or liver disease. Other precautions to be aware of concerning black cohosh safety include making sure the manufacturer of your product is reputable and being aware of the risks associated with taking black cohosh while pregnant or breastfeeding.

Is Black Cohosh Safe?

Black cohosh (Actaea racemosa, Cimicifuga racemosa) is a supplement often used for natural menopause relief, although it is sometimes used for other purposes. You may not be able to take black cohosh safely if you have:
 
  • Cancer (or a history of cancer)
  • Endometriosis
  • Uterine fibroids
  • Had a kidney transplant
  • Liver disease, including liver failure, hepatitis, or cirrhosis
  • A blood clotting disorder
  • Any allergies, including allergies to foods, dyes, or preservatives.
     
Also, let your healthcare provider know if you are:
 
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding.
     
Make sure to tell your healthcare provider about any other medicines you are taking, including prescription and non-prescription medicines, vitamins, and herbal supplements.
 

Specific Black Cohosh Warnings and Precautions

Some of the warnings and precautions to be aware of concerning the safety of black cohosh include the following:
 
  • Black cohosh should not be taken during pregnancy (except under the supervision of your healthcare provider) and only late in pregnancy. Black cohosh can stimulate labor, which can cause a miscarriage or premature delivery if taken too early (see Black Cohosh and Pregnancy for more information).
     
  • Black cohosh supplements may interact with some medications (see Black Cohosh Drug Interactions for more information).
     
  • It is not known if black cohosh is safe for breastfeeding women (see Black Cohosh and Breastfeeding).
     
  • Black cohosh may have estrogen-like properties and, theoretically, could stimulate some cancers (especially estrogen-sensitive cancers). There is conflicting evidence about black cohosh and cancer. Some studies have shown that black cohosh may reduce the growth of cancer cells, while other studies have shown that it may stimulate cancer cells. If you have cancer (or have ever had cancer) do not take black cohosh without checking with your healthcare provider.
     
  • Because black cohosh may have estrogen-like properties, there is some concern that it can worsen conditions that are sensitive to estrogen (such as endometriosis or uterine fibroids). However, early evidence suggests that this is not likely to be the case. Make sure to check with your healthcare provider before taking black cohosh if you have one of these conditions, as you may need to be monitored more closely.
     
  • There is one report of kidney transplant rejection in a person who took black cohosh (along with alfalfa). It is not known whether black cohosh caused the rejection. If you have a transplanted kidney, it may be a good idea to avoid black cohosh.
     
  • Liver damage, including hepatitis and liver failure, has been reported in people who took black cohosh. However, it is unclear if black cohosh caused these cases of liver damage. If you already have liver problems, you should probably not take black cohosh.
     
  • There is some concern that black cohosh can increase the risk of blood clots, particularly in people who already have a clotting disorder. If you have a clotting disorder (or have ever had a blood clot), check with your healthcare provider before taking black cohosh.
     
  • If you decide to use supplements, what you see on the label may not reflect what is in the bottle. For example, some herbal supplements have been found to be contaminated with heavy metals or prescription drugs, and some have been found to have much more or much less of the featured ingredients than their label states. Therefore, make sure the manufacturer of your black cohosh is a trusted and reputable manufacturer. It is a good sign if a manufacturer abides by the rules of Good Manufacturing Practices (GMP) for drugs. Your pharmacist is a good resource for information about which manufacturers are most reputable.
     
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