Can you tell me what are the risks of taking black cohosh?

Black cohosh (Actaea racemosa, formerly known as Cimicifuga racemosa) is a plant native to North America that has been traditionally used by Native Americans for a variety of health issues, including menstrual cramps and menopause symptoms. In more recent times, black cohosh has been popularly used for managing symptoms of menopause such as hot flashes, night sweats, mood disturbances, and vaginal dryness.

However, like all supplements and medications, black cohosh is not without risks. Here are some of the potential risks and side effects associated with its use:

Liver Damage: Some reports suggest that black cohosh may cause liver problems. Symptoms can include yellowing of the skin or eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting, and abdominal pain. Anyone taking black cohosh should consult with a healthcare provider if they experience these symptoms.
Digestive Upset: Some people may experience stomach upset, cramping, or diarrhea when taking black cohosh.
Weight Gain: Some users have reported weight gain when using black cohosh.
Rash: In some cases, people might develop a rash or other allergic reactions.
Headache: Some users report headaches as a side effect.
Interactions with Medications: Black cohosh might interfere with or intensify the effects of certain medications, including those used to treat blood pressure, liver disease, or cancer.
Possible Hormonal Effects: Although black cohosh is often used for menopause symptoms, the exact way it works is not fully understood. There's some debate about whether it might have estrogen-like effects, which could be relevant for individuals with hormone-sensitive conditions, such as certain types of cancer.
Effects on Pregnancy: Black cohosh may stimulate the uterus and potentially lead to miscarriage. It should not be used during pregnancy.
Blood Pressure Changes: There are some reports of changes in blood pressure in those taking black cohosh.
Limitations in Safety Data: While black cohosh has been used for a long time, comprehensive long-term safety data are limited.

It's important to note that the quality and composition of black cohosh products can vary, as dietary supplements aren't as tightly regulated as prescription drugs. This can lead to variations in potency, purity, and safety among different products.