Why Black Cohosh Is Harmful for PCOS but Helpful for Menopause: A Hormonal Perspective

Black Cohosh (Cimicifuga racemosa) is often celebrated for its benefits in easing menopause symptoms, but its use in women with polycystic ovary syndrome (PCOS) can be not only inappropriate but potentially harmful. While menopause and PCOS both affect female hormone health, they represent two very different hormonal landscapes. One involves declining oestrogen levels, while the other is frequently marked by excessive oestrogen and androgen dominance.

Understanding the difference is crucial when selecting herbal supplements. In this article, we explore the science behind Black Cohosh, its proven benefits for menopause, and why it may worsen the hormonal imbalance in PCOS.

Black Cohosh: A Natural Ally for Menopause

Black Cohosh is a herbal remedy native to North America and traditionally used to treat hot flushes, night sweats, mood swings, and other symptoms associated with menopause. These symptoms are typically caused by falling oestrogen levels during the perimenopausal and postmenopausal years.

Several studies support the use of Black Cohosh for menopausal women:

• A Cochrane Review analysing 16 randomised trials concluded that Black Cohosh may have some effect on hot flushes and mood-related symptoms, though results remain mixed (Leach and Moore, 2012).

• Another review published by the National Institutes of Health discusses the potential of Black Cohosh to bind to oestrogen receptors, possibly mimicking mild oestrogenic effects in women with low oestrogen levels (NIH Office of Dietary Supplements).

This makes it potentially effective in hormone replacement therapy alternatives for menopause—but this same mechanism may pose risks to women with PCOS.

PCOS and Oestrogen Dominance: A Critical Contrast

Polycystic ovary syndrome is one of the most common endocrine disorders in women of reproductive age. It is characterised by irregular menstrual cycles, high levels of androgens (male hormones), insulin resistance, and frequently, elevated oestrogen levels.

Unlike menopause, where oestrogen is deficient, women with PCOS often face:

• Oestrogen dominance, which means oestrogen levels are too high relative to progesterone

• Anovulation, where no egg is released, disrupting the natural progesterone production

• Endometrial hyperplasia risk, due to unopposed oestrogen exposure

• Weight gain, fatigue, and mood issues, all worsened by hormonal imbalance

Adding a supplement like Black Cohosh, which can mimic or stimulate oestrogenic activity, may aggravate these hormonal imbalances rather than alleviate them.

Scientific Evidence: The Mismatch Between Black Cohosh and PCOS

While Black Cohosh has been studied for its use in menopausal women, its research base for PCOS is both limited and inconclusive. A 2021 systematic review of Black Cohosh for PCOS-related infertility reported insufficient evidence to support its effectiveness and noted concerns around hormonal interference (Fan, C.W. et al., 2021).

Key concerns:

• Possible oestrogenic effect: May raise already elevated oestrogen levels in PCOS

• Disruption of LH and FSH ratios: PCOS often includes abnormal luteinising hormone (LH) levels; Black Cohosh may worsen this

• Liver strain: Some studies have raised concerns over Black Cohosh and liver toxicity, which is especially relevant given the liver’s key role in detoxifying excess hormones in PCOS

PCOS and Menopause: Two Very Different Hormonal Conditions

To truly understand why Black Cohosh is unsuitable for PCOS, it helps to compare the two conditions:

Condition	Oestrogen Levels	Primary Issue	Treatment Goal
Menopause	Low	Declining oestrogen production	Restore or mimic oestrogen to relieve symptoms
PCOS	Often elevated	Hormonal imbalance, insulin resistance	Reduce oestrogen dominance, support progesterone, balance insulin and androgens

What Women with PCOS Should Use Instead

For women with PCOS, the goal is to clear excess oestrogen, support healthy ovulation, and reduce inflammation. Helpful natural ingredients include:

• Calcium D-Glucarate: Supports liver detoxification of excess oestrogen

• Chaste Tree (Vitex Agnus-Castus): Promotes ovulation by balancing LH and FSH

• Gynostemma Pentaphyllum: Supports AMPK activation and metabolic healing without raising testosterone

• Curcumin: Potent anti-inflammatory

• D-Chiro and Myo-Inositol: Improve insulin sensitivity and egg quality

None of these botanicals mimic oestrogen. Instead, they support the body's own regulatory systems—critical for sustainable healing in PCOS.

Final Thoughts: Know Your Hormones Before You Supplement

While Black Cohosh remains a respected herbal remedy for menopausal women, it is not a safe or effective solution for women with PCOS. Using oestrogen-like compounds in an oestrogen-dominant condition can increase the risk of worsening symptoms, from bloating and brain fog to more serious concerns like endometrial thickening.

When selecting natural remedies for PCOS, always work with a practitioner who understands your unique hormone profile. Choose supplements that detoxify excess oestrogen, support ovulation naturally, and reduce systemic inflammation rather than artificially raise hormone levels.

References

1. Leach, M.J. & Moore, V. (2012). Black cohosh (Cimicifuga spp.) for menopausal symptoms. The Cochrane Database of Systematic Reviews, Issue 9. Art. No.: CD007244. DOI: 10.1002/14651858.CD007244.pub2

2. National Institutes of Health. (2022). Black Cohosh - Health Professional Fact Sheet. Office of Dietary Supplements. Available at: https://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/

3. Fan, C. W., Cieri-Hutcherson, N. E., & Hutcherson, T. C. (2021). Systematic review of black cohosh (Cimicifuga racemosa) for management of polycystic ovary syndrome-related infertility. Journal of Pharmacy Practice. Available at: https://pubmed.ncbi.nlm.nih.gov/33926292/