Does black cohosh help with heart palpitations during perimenopause?

The most important thing to say about heart palpitations and black cohosh is this: palpitations during perimenopause need to be medically evaluated before you try any supplement. Skipped beats, a racing heart, or fluttering sensations can be a normal part of the hormonal transition, but they can also signal a cardiac arrhythmia that requires diagnosis and treatment. Please see your doctor to rule out a cardiac cause before treating palpitations with supplements of any kind.

With that critical point established, the evidence for black cohosh specifically helping heart palpitations is very limited. There are no dedicated randomized controlled trials testing black cohosh for palpitations as a primary outcome. In some larger menopausal symptom trials using standardized questionnaires, palpitations were listed alongside other vasomotor complaints, and women in the black cohosh group sometimes reported overall symptom score improvement. But it is not possible to draw firm conclusions about palpitations specifically from composite data like that. Some researchers have suggested that black cohosh may exert mild effects on the autonomic nervous system, which regulates heart rate, through its serotonergic activity at 5-HT1A and 5-HT7 receptors. This is biologically plausible but remains speculative with no dedicated trial evidence. The honest summary is that there is very little evidence to support using black cohosh specifically for palpitations.

Hormone fluctuations during perimenopause affect the autonomic nervous system in ways that can directly trigger palpitations. Estrogen has receptors in cardiac tissue and plays a role in regulating heart rhythm and vascular tone. As estrogen levels become unpredictable, the autonomic balance between the sympathetic and parasympathetic nervous systems can shift, leading to a higher resting heart rate and increased sensitivity to rhythm irregularities. Hot flashes themselves trigger a brief surge in heart rate and skin blood flow, which many women perceive as palpitations immediately following the flush. So in some cases, treating vasomotor symptoms more broadly may reduce palpitation frequency as a downstream effect. This is the most plausible mechanism by which black cohosh could help, if it helps at all, and it only applies to the subgroup of palpitations that are genuinely vasomotor in origin.

If your doctor has evaluated your palpitations and confirmed they are benign and linked to perimenopause, and you want to try black cohosh, the doses used in research for menopausal vasomotor symptoms are typically 20 to 40 mg of standardized extract twice daily, standardized to 2.5% triterpene glycosides. Remifemin at 20 mg twice daily is the most clinically studied formulation. Trials have generally run for 8 to 24 weeks before assessing outcomes. Talk to your healthcare provider about the right dose for your situation and do not start black cohosh without first getting your palpitations properly assessed by a clinician.

Check with your provider before using black cohosh if you take any heart medications, antiarrhythmics, beta blockers, or blood pressure medications. The interaction data for black cohosh with cardiac drugs is incomplete, and caution is warranted. Also check in if you take antidepressants, since black cohosh may have serotonergic effects that could overlap. Avoid black cohosh if you have liver disease. Use brands that are independently tested and standardized to 2.5% triterpene glycosides.

If black cohosh is going to help your broader vasomotor symptoms, most women notice some change within 4 to 8 weeks of consistent daily use. Whether that translates to fewer palpitations is individual and depends heavily on whether your palpitations are vasomotor in origin. Do not use black cohosh as a substitute for a cardiac evaluation or for monitoring if you have known heart disease. Be especially cautious if your palpitations are worsening, more frequent, or accompanied by any other symptoms.

If you have or have had a hormone-sensitive condition such as breast cancer, endometriosis, or uterine fibroids, discuss black cohosh with your healthcare provider before using it. There is also a rare but documented signal of liver toxicity associated with black cohosh. Use reputable brands standardized to 2.5% triterpene glycosides, and stop use and seek medical attention if you develop jaundice, upper right abdominal pain, or unusual fatigue.

See a doctor promptly for palpitations that are frequent, prolonged, or accompanied by chest pain, shortness of breath, dizziness, fainting, or swelling in your legs. These symptoms need cardiac evaluation and cannot be managed with supplements. Also seek care if palpitations started suddenly and feel different from anything you have experienced before. Do not self-treat palpitations with any supplement until a cardiac cause has been ruled out by a healthcare provider.

Once your palpitations have been assessed and confirmed as perimenopausal and benign, tracking them alongside your hot flash frequency, sleep quality, stress level, and cycle patterns can help you and your provider understand what is driving them. Patterns often become visible after a few weeks of consistent logging. PeriPlan makes it easy to log all of these symptoms in one place so you can bring clear data to your appointments. Download PeriPlan at https://apps.apple.com/app/periplan/id6740066498.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.