If someone has told you that you don’t know what you are talking about when you tout black cohosh in the management of menopause, then we’re willing to wager that they don’t know, either. At the very least, they don’t know these seven things. Let’s start with a few basics.

Black cohosh is a herb, a flowering plant found in rich soil with lots of trees in the eastern portions of North America. Believe it or not, it is a member of the buttercup family. It has other names, too,: black snakeroot, bugbane, bugwort, and squawroot. For over two centuries, American Indians used the roots and the rhizomes (the underground stems) of the plant to make medicine that relieves the symptoms of menopause.

• What symptoms does black cohosh relieve? The herb alleviates symptoms such as night sweats, hot flashes, irritability, mood swings, and sleep disturbances. It may also help in alleviating the pain of PMS. In 2001, the American College of Obstetricians and Gynecologists recognized black cohosh to treat menopausal symptoms based on expert opinions and general agreement. The National Center for complementary and Alternative medicine at the National Institutes of Health is funding a rigorous scientific study to determine the effectiveness of black cohosh to treat hot flashes and other menopause symptoms.
• What is the active ingredient? Black cohosh contains glycosides (compounds made of sugar), isofurlic acids (anti-inflammatory in nature) and we think phytoestrogens which is a fancy word that means plant-based oestrogen. It also has other active ingredients.
• Does it come in pill form? You can buy black cohosh in pill form, capsules, tinctures, extracts and dried root that you have to mix with water to make a tea. The formulation for relief of menopause symptoms is 20-80 mg/day to a standard of 1 mg of 27-deoxyactein. That’s usually 2 tablets or capsules of pharmaceutical grade black cohosh. If you prefer the tincture, you would use 2-4 ml, 1-3 times a day in a tea or in water.
• How to make the tea. Using black cohosh in tea form is not considered as effective as other methods even though that is the traditional way to administer it. Put 20 grams of the dried herb root in 34 ounces of water. Bring the mixture to a rolling boil and then reduce the heat to simmer for 20-30 minutes. At this point, the amount of mixture is 1/3 less by volume. You have to strain the mixture, cover it, and store it in the refrigerator or a cool, dry place for up to 48 hours. After reduction by 1/3, the mixture should make about 3 cups. The usual dosage is 1-3 cups a day.
• Side Effects. Herbs are medicine, just like pharmaceuticals. As such, they can have side effects or interact with other herbs, supplements, and even drugs. People taking high doses of black cohosh have reported abdominal pain, shortness of breath, diarrhoea, nausea, slow heart rate, tremors, sight problems, and weight gain. You should stay away from black cohosh if you already take medicines that affect the liver (some blood pressure medicines, for example).
• Contra-indications. You should not use black cohosh if you are sensitive to hormone therapy, such as if you have breast, ovarian, or uterine cancer (or a family history of those diseases), endometriosis, or fibroid tumors. Due to the chances for liver toxicity, you should not use black cohosh if you already have liver damage or if you use alcohol excessively.
• Warnings. Do Not Confuse Black Cohosh with Blue Cohosh. Blue cohosh is also