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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:

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.

Wang, YP., Ma, D., Cheng, XT., Zhang, SJ., Xue, W., Deng, Y., Wang, YF., Sun, AJ., (2019) Comparison Of Cimicifuga foetida extract and different hormone therapies regarding in causing breast pain in early postmenopausal women.

This study aimed to compare the influence between Cimicifuga foetida extract and different hormone therapies on breast pain in early postmenopausal women. A prospective, randomized, controlled clinical trial was conducted among 96 early postmenopausal women. Participants were randomly assigned to three groups: group A received 1 mg/day estradiol valerate plus 4 mg/day medroxyprogesterone acetate on days 19-30; group B received 1 mg/day estradiol valerate plus 100 mg/day micronized progesterone on days 19-30; group C received C. foetida extract, 1talet (contains 33.3 mg extract), t.i.d. Breast pain diary and numerical rating scale was used to access the breast pain. For 6 months' treatment, the total incidence of breast pain in group A and B was significantly higher than that in group C (p < .05). The duration (day) of breast pain in each month decreased over time in group A and B while it was continuously low and without significant change in group C (p > .05). The intensity of breast pain was mild in most participants and did not differ among three groups (p > .05). During treatment of early postmenopausal women with C. foetida extract for 6 months, the incidence and duration of breast pain were lower than upon treatment with E2 plus cyclic MPA or m-P and did not change over time.