Black Cohosh

Reviewed on 6/11/2021
Other Name(s):

Actaea macrotys, Actaea racemosa, Actée à Grappes, Actée à Grappes Noires, Actée Noire, Aristolochiaceae Noire, Baie d'actée, Black Cohosh, Baneberry, Black Aristolochiaceae, Black Snakeroot, Bugbane, Bugwort, Cimicaire à Grappes, Cimicifuga, Cimicifuga Racemosa, Cimicifuge, Cohosh Negro, Cohosh Noir, Cytise, Herbe aux Punaises, Macrotys, Phytoestrogen, Phytoestrogène, Racine de Serpent, Racine de Squaw, Racine Noire de Serpents, Rattle Root, Rattle Top, Rattlesnake Root, Rattleweed, Rhizoma Cimicifugae, Sheng Ma, Snakeroot, Squaw Root.


Black cohosh is an herb. The root of this herb is used for medicinal purposes. Black cohosh was first used for medicinal purposes by Native American Indians, who introduced it to European colonists. Black cohosh became a popular treatment for women's health issues in Europe in the mid-1950s.

Since that time, black cohosh has commonly been used to treat symptoms of menopause, premenstrual syndrome (PMS), painful menstruation, weakened bones (osteoporosis), and for starting labor in pregnant women. It is also used to promote sleep, for breast cancer, heart disease, to improve mental function, for infertility, arthritis, and indigestion.

Black cohosh has also been tried for a lot of additional uses, such as anxiety, fever, sore throat, and cough, but it is not often used for these purposes these days.

Some people also apply black cohosh directly on the skin. This is because there was some thought that black cohosh would improve the skin's appearance. Similarly, people used black cohosh for other skin conditions such as acne, wart removal, and even the removal of moles, but this is seldom done anymore.

Black cohosh also goes by the name "bugbane" because it was once used as an insect repellent. It is no longer used for this purpose. Frontiersmen had said that black cohosh was useful for rattlesnake bites, but no modern researchers have tested this.

Do not confuse black cohosh with blue cohosh or white cohosh. These are unrelated plants. The blue and white cohosh plants do not have the same effects as black cohosh, and may not be safe.

How does it work?

The root of black cohosh is used for medicinal purposes. Black cohosh root contains several chemicals that might have effects in the body. Some of these chemicals work on the immune system and might affect the body's defenses against diseases. Some might help the body to reduce inflammation. Other chemicals in black cohosh root might work in nerves and in the brain. These chemicals might work similar to another chemical in the brain called serotonin. Scientists call this type of chemical a neurotransmitter because it helps the brain send messages to other parts of the body.

Black cohosh root also seems to have some effects similar to the female hormone, estrogen. In some parts of the body, black cohosh might increase the effects of estrogen. In other parts of the body, black cohosh might decrease the effects of estrogen. Estrogen itself has various effects in different parts of the body. Estrogen also has different effects in people at different stages of life. Black cohosh should not be thought of as an "herbal estrogen" or a substitute for estrogen. It is more accurate to think of it as an herb that acts similar to estrogen in some people.


If menopause occurs in a woman younger than ___ years, it is considered to be premature. See Answer

Uses & Effectiveness

Possibly Effective for...

  • Menopausal symptoms. Research shows that some black cohosh extracts can reduce some symptoms of menopause when taken by mouth. Most of this research is for a specific commercial black cohosh product, Remifemin. Research shows that the effects of Remifemin on menopausal symptoms are comparable to hormone therapy. The benefits may not occur with all products that contain black cohosh.

    Research using black cohosh products other than Remifemin has not always shown benefits for menopausal symptoms. Some studies show that other black cohosh products do not reduce hot flashes or menopausal symptoms any better than a sugar pill ("placebo").

    In some studies, products containing black cohosh and other ingredients have been investigated. Products containing black cohosh plus St. John's wort seem to reduce menopausal symptoms. Similar results have been observed for products containing black cohosh, Panax ginseng, soy, and green tea extract or black cohosh, kava, hops, and valerian extract. However, a homeopathic product containing black cohosh doesn't seem to be effective at reducing overall menopausal symptoms, although it may reduce hot flashes.

    Some women take black cohosh for hot flashes related to breast cancer treatment. Women with breast cancer should not use black cohosh without talking to their cancer specialist or other health provider. Some early research suggested that black cohosh might reduce hot flashes in breast cancer patients, but more recent and higher quality research shows that black cohosh does not reduce hot flashes in women with breast cancer. There is some question as to whether black cohosh is safe for women with breast cancer. It is important for a woman with breast cancer to discuss any use of black cohosh with her health provider before using it.

Insufficient Evidence to Rate Effectiveness for...

  • Breast cancer. One study suggests that taking black cohosh supplements is linked to a deceased risk of breast cancer. However, other research has found no link. Results from one study shows that taking black cohosh might increase survival in women already diagnosed with breast cancer.
  • Heart disease. Early research shows that taking 40 mg per day of a specific black cohosh extract (CR BNO 1055) does not reduce the risk of heart disease in postmenopausal women.
  • Mental function. Early research suggests that taking 128 mg of black cohosh daily for 12 months does not improve memory or attention in postmenopausal women.
  • Infertility. Early research suggests that taking 120 mg per day of black cohosh extract plus 150 mg of clomiphene citrate can increase pregnancy rates in infertile women compared to clomiphene citrate alone. Other research shows that taking 120 mg of black cohosh with 150 mg of clomiphene citrate results in pregnancy rates that are similar to those found when clomiphene citrate is taken with another fertility drug.
  • Induction of labor. Some people report that black cohosh can help start labor. As many as 45% of nurse-midwives use black cohosh to start labor in pregnant women at term. Despite its common use, there is no reliable scientific evidence that black cohosh works for this purpose.
  • Migraine headache. Early research shows that taking 25 mg of black cohosh extract plus 75 mg of soy extract and 50 mg of dong quai two times per day for 24 weeks reduces the occurrence of menstrual migraines.
  • Osteoarthritis. Early research suggests that taking a specific product containing black cohosh and other ingredients (Reumalex) daily for 2 months improves pain, but not joint function, in people with osteoarthritis.
  • Weak bones (Osteoporosis). Evidence regarding the benefit of black cohosh for treating or preventing osteoporosis is conflicting. One study shows that taking a product containing 40 mg of black cohosh (Remifemin, Schaper & Brümmer) for 3 months improves bone formation and reduces the breakdown of bone. Another study shows that taking a different product containing 40 mg of black cohosh extract (CR BNO 1055, Klimadynon/Menofem, Bionorica AG) for 3 months increases markers of bone formation in postmenopausal women. However, other research shows that taking this black cohosh product does not improve bone mineral density. It is not known if black cohosh reduces the risk of bone fractures.
  • Rheumatoid arthritis. Early research suggests that taking a specific product containing black cohosh (Reumalex, Gerard House Ltd.) twice daily for 2 months improves pain, but not joint function, in people with rheumatoid arthritis.
  • Acne.
  • Anxiety.
  • Bug bites.
  • Cough.
  • Fever.
  • Mole removal.
  • Painful menstruation.
  • Premenstrual syndrome (PMS).
  • Rheumatism.
  • Snake bite.
  • Sore throat.
  • Wart removal.
More evidence is needed to rate black cohosh for these uses.

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).

Side Effects

Black cohosh is POSSIBLY SAFE when taken by mouth appropriately by adults for up to one year.

Black cohosh can cause some mild side effects such as stomach upset, cramping, headache, rash, a feeling of heaviness, vaginal spotting or bleeding, and weight gain.

There is also some concern that black cohosh may be associated with liver damage. It is not known for sure if black cohosh actually causes liver damage. Researchers are studying this. Until more is known, people who take black cohosh should watch for symptoms of liver damage. Some symptoms that may suggest liver damage are yellowing of the skin and eyes (jaundice), unusual fatigue, or dark urine. If these symptoms develop, black cohosh should be stopped and a health provider should be contacted. People who take black cohosh should talk with their health provider about getting tests to make sure their liver is working well.


What Is Osteoporosis? Treatment, Symptoms, Medication See Slideshow

Special Precautions & Warnings

Pregnancy or breast-feeding: Black cohosh is POSSIBLY UNSAFE when used during pregnancy or breast-feeding. Since black cohosh acts somewhat like a female hormone it might increase the risk of miscarriage.

Breast cancer: There is some concern that black cohosh may worsen existing breast cancer. Women who have breast cancer or who have had breast cancer in the past, and women at high-risk for breast cancer, should avoid black cohosh.

Hormone-sensitive conditions, including endometriosis, fibroids, ovarian cancer, uterine cancer, and others: Black cohosh acts somewhat like the female hormone, estrogen, in the body. There is some concern that it could worsen conditions that are sensitive to female hormones. Do not take black cohosh if you have a condition that could be affected by female hormones. These conditions include ovarian cancer, uterine cancer, endometriosis, fibroids, and other conditions.

Kidney transplant: Taking a product containing black cohosh plus alfalfa has been linked to a report of kidney transplant rejection. It is not known if black cohosh is the cause of this rejection. Until more is known, people who have received a transplant should avoid black cohosh.

Liver disease: Some reports suggest that black cohosh might cause liver damage. It is not known for sure if black cohosh is the cause of liver damage in these cases. Until more is known, people with liver disease should avoid taking black cohosh.

Protein S deficiency: People with a condition called protein S deficiency have an increased risk of blood clots. Due to the hormone-like effects of black cohosh, there is some concern that black cohosh might also increase the risk of blood clots. There is a report linking blood clots in someone with protein S deficiency after taking black cohosh along with several other herbal products. Until more is known, people with protein S deficiency should avoid black cohosh.


Atorvastatin (Lipitor)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

There is concern that black cohosh might harm the liver. Taking black cohosh with atorvastatin (Lipitor) might increase the chance of liver damage. However, there is not enough scientific information to know if this is an important concern. Before taking black cohosh talk to your healthcare provider if you take atorvastatin (Lipitor).

Cisplatin (Platinol-AQ)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

Cisplatin (Platinol-AQ) is used to treat cancer. There is some concern that black cohosh might decrease how well cisplatin (Platinol-AQ) works for cancer. Do not take black cohosh if you are taking cisplatin (Platinol-AQ).

Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

Some medications are changed and broken down by the liver. Black cohosh might decrease how quickly the liver breaks down some medications. Taking black cohosh along with some medications that are change by the liver may increase the effects and side effects of your medication. Before taking black cohosh talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications that are changed by the liver include amitriptyline (Elavil), clozapine (Clozaril), codeine, desipramine (Norpramin), donepezil (Aricept), fentanyl (Duragesic), flecainide (Tambocor), fluoxetine (Prozac), meperidine (Demerol), methadone (Dolophine), metoprolol (Lopressor, Toprol XL), olanzapine (Zyprexa), ondansetron (Zofran), tramadol (Ultram), trazodone (Desyrel), and others.

Medications that can harm the liver (Hepatotoxic drugs)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

There is concern that black cohosh might harm the liver. Taking black cohosh along with medication that might also harm the liver can increase the risk of liver damage. Do not take black cohosh if you are taking a medication that can harm the liver.
Some medications that can harm the liver include acetaminophen (Tylenol and others), amiodarone (Cordarone), carbamazepine (Tegretol), isoniazid (INH), methotrexate (Rheumatrex), methyldopa (Aldomet), fluconazole (Diflucan), itraconazole (Sporanox), erythromycin (Erythrocin, Ilosone, others), phenytoin (Dilantin), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), and many others.

Medications moved by transporters in cells (Organic anion-transporting polypeptide (OATP) substrates)Interaction Rating: Minor Be cautious with this combination.Talk with your health provider.

Some medications are moved by transporters in cells. Black cohosh can make these transporters less active and decrease how much of some medications get absorbed by the body. This might decrease the effectiveness of some medications.

Some medications that are moved by these transporters include aliskiren (Tekturna), amiodarone (Cordarone), atorvastatin (Lipitor), fexofenadine (Allegra), fluvastatin (Lescol), glyburide (Diabeta, Micronase), and rosuvastatin (Crestor).


The following doses have been studied in scientific research:


  • Menopausal symptoms: 20-80 mg of black cohosh extract once or twice daily for up to 6 months. Also black cohosh extract equivalent to 40-127 mg of black cohosh rootstock has been taken in one or two divided doses per day for 12 weeks. Specific products used in research include CR BNO 1055 (Bionorica), Remifemin (Schaper & Brümmer GmbH & Co.), and Remixin (Mikro-Gen).

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