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black cohosh

© 2018 Steven Foster

A black cohosh monograph for the home

Latin Name: Actaea racemosa, Cimicifuga racemosa

Common Names: black cohosh, black snakeroot, macrotys, bugbane, bugwort, rattleroot, rattleweed

This black cohosh monograph provides basic information about black cohosh—common names, usefulness and safety, and resources for more information.


Black Cohosh Basics

  • Black cohosh, a member of the buttercup family, is a plant native to North America. Native American and Chinese herbalists have traditionally used black cohosh for a variety of ailments and as an insect repellent.
  • Currently, people use black cohosh as a dietary supplement for hot flashes and other menopausal symptoms. It’s also been used as a dietary supplement for other conditions, including menstrual cramps and premenstrual syndrome, and to induce labor.
  • The part of the black cohosh plant used in herbal preparations is the root or rhizome (underground stem). Black cohosh is sold as the dried root, in tablets and capsules, and as an extract.

Black Cohosh Health Research

  • Black cohosh has been studied for menopause symptoms in people, but most of the studies were not of the highest quality. Therefore, knowledge of the effects of black cohosh is limited.

Black Cohosh Research Summary

  • Studies that tested black cohosh for menopause symptoms have had inconsistent results. The overall evidence is insufficient to support using black cohosh for this purpose.
  • There are not enough reliable data to show whether black cohosh is effective for other uses.
  • The National Center for Complementary and Integrative Health (NCCIH) is funding research to identify active components in black cohosh and understand their effects in the body.

Black Cohosh Safety

  • In clinical trials, people have taken black cohosh for as long as 12 months with no serious harmful effects. The only reported side effects were minor problems such as upset stomach or rashes.
  • Some commercial black cohosh products have been found to contain the wrong herb or to contain mixtures of black cohosh and other herbs that are not listed on the label.
  • Cases of liver damage—some of them very serious—have been reported in people taking commercial black cohosh products. These problems are rare, and it is uncertain whether black cohosh was responsible for them. Nevertheless, people with liver disorders should consult a health care provider before taking black cohosh products, and anyone who develops symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice, while taking black cohosh should stop using it and consult a health care provider.
  • The risk of interactions between black cohosh and medicines appears to be small. NCCIH is funding research to learn more about possible interactions involving black cohosh.
  • It’s not clear if black cohosh is safe for women who have had hormone-sensitive conditions such as breast cancer or for pregnant women or nursing mothers.
  • Black cohosh should not be confused with blue cohosh (Caulophyllum thalictroides), which has different effects and may not be safe. Black cohosh has sometimes been used with blue cohosh to stimulate labor, but this use was linked to severe adverse effects in at least one newborn.

Black Cohosh References


PubMed Articles About Actaea racemosa

Source: National Center for Biotechnology Information (NCBI)[Internet]. Bethesda (MD): National Library of Medicine (US), National Center for Biotechnology Information; [1988] – [cited 2018 Apr 5]. Available from:

Castelo-Branco, C., Gambacciani, M., Cano, A., Minkin, MJ., Rachoń, D., Ruan, X., Beer, AM., Schnitker, J., Henneicke-von Zepelin, HH., Pickartz, S., (2021) Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidence.

A systematic literature search revealed 35 clinical studies and one meta-analysis comprising 43,759 women, of which 13,096 were treated with isopropanolic extract (iCR). Compared to placebo, iCR was significantly superior for treating neurovegetative and psychological menopausal symptoms, with a standardized mean difference of -0.694 in favor of iCR ( < 0.0001). Effect sizes were larger when higher dosages of iCR as monotherapy or in combination with St. John's wort ( [HP]) were given (-1.020 and -0.999, respectively), suggesting a dose-dependency. For psychological symptoms, the iCR+HP combination was superior to iCR monotherapy. Efficacy of iCR was comparable to low-dose transdermal estradiol or tibolone. Yet, due to its better tolerability, iCR had a significantly better benefit-risk profile than tibolone. Treatment with iCR/iCR+HP was well tolerated with few minor adverse events, with a frequency comparable to placebo. The clinical data did not reveal any evidence of hepatotoxicity. Hormone levels remained unchanged and estrogen-sensitive tissues (e.g. breast, endometrium) were unaffected by iCR treatment. As benefits clearly outweigh risks, iCR/iCR+HP should be recommended as an evidence-based treatment option for natural climacteric symptoms. With its good safety profile in general and at estrogen-sensitive organs, iCR as a non-hormonal herbal therapy can also be used in patients with hormone-dependent diseases who suffer from iatrogenic climacteric symptoms.

Wang, C., Huang, Q., Liang, CL., Zhang, YW., Deng, DH., Yu, Y., Chen, DB., Yang, HJ., Yu, XF., (2020) Effect of cimicifuga racemosa on menopausal syndrome caused by LHRH-a in breast cancer.

Cimicifuga racemose is previously proved effective on nature menopausal syndrome (MPS). However, its clinical value in treating with MPS induced by luteinizing-hormone releasing hormone analogue (LHRH-a) therapy of pre-/peri-menopausal breast cancer patients is still unknown.

Fernandes, ES., Celani, MFS., Fistarol, M., Geber, S., (2021) Effectiveness of the short-term use of in the endothelial function of postmenopausal women: a double-blind, randomized, controlled trial.

This study aimed to assess the effects of daily use of on endothelial function through flow-mediated dilation of the brachial artery, when used for 28 days by healthy postmenopausal women. The double-blind, randomized, placebo-controlled study included two groups of postmenopausal women ( = 31 each). The subjects were clinically assessed and flow-mediated dilation of the brachial artery was measured before and after 28 days of treatment. Patients received dry extract corresponding to 160 mg (extract with 4 mg of triterpene glycosides) or placebo. Mean age, time since menopause, and body mass index in the two groups were similar. The measurements of flow-mediated dilation of the brachial artery, pre and post treatment, respectively, showed a significant increase in patients who used ( = 0.006), unlike patients who used placebo, who did not present changes in the outcome of flow-mediated dilation of the brachial artery after 28 days of use ( ≥ 0.05). When comparing the number of women in both groups who showed an increase in flow-mediated dilation, a significant difference was found in the measurements of the treated group after the use of the medication ( = 0.018). Daily use of 160 mg extract by postmenopausal women for 28 days beneficially influences endothelial function by promoting elasticity of the brachial artery.

Gao, L., Zheng, T., Xue, W., Wang, Y., Deng, Y., Zuo, H., Sun, A., (2019) Efficacy and safety evaluation of Cimicifuga foetida extract in menopausal women.

The aim of this study was to evaluate the efficacy and safety of long-term treatment with Cimicifuga foetida extract in menopausal women.

Ruan, X., Mueck, AO., Beer, AM., Naser, B., Pickartz, S., (2020) Benefit-risk profile of black cohosh (isopropanolic extract) with and without St John's wort in breast cancer patients.

Endocrine therapy in breast cancer survivors can cause severe 'climacteric' symptoms, which may compromise therapy adherence. To determine whether such symptoms can be treated with herbal medication containing black cohosh in the form of isopropanolic extract (iCR) alone or in fixed combination with St John's wort ( [HP]) (iCR + HP), a systematic literature search was conducted. Results were viewed in relation to experimental data and metabolism of endocrine therapies. Most breast cancer survivors receiving endocrine therapy experienced reductions in climacteric symptoms under iCR/iCR + HP. Tamoxifen's interference potential may be countered by using higher iCR doses or iCR + HP. No estrogen-like effects at the breast or on hormones were seen. After breast cancer, even if receiving tamoxifen, patients using iCR/iCR + HP had significantly increased recurrence-free survival rates compared to non-users. These results are substantiated by experimental data demonstrating antiproliferative and anti-invasive effects of iCR in breast cancer cells and enhancement of the antineoplastic effects of tamoxifen. There are no known clinical interactions for iCR and HP with endocrine therapies. The HP extract used in iCR + HP did not exhibit any clinically relevant interaction potential. In conclusion, with its positive benefit-risk profile, iCR/iCR + HP may offer a safe non-hormonal therapeutic option for breast cancer survivors receiving endocrine therapy.