Black Cohosh

Last Updated: October 5, 2023

Black Cohosh is the most popular supplement for menopause in North America, but the results of human studies are mixed. It holds some benefits for controlling hot flashes and night sweats.

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Black Cohosh is most often used for

What is black cohosh?

Black cohosh (Cimicifuga racemosa), a perennial plant native to North America, is known for its roots and rhizomes that are used in supplements. The plant contains various active compounds, including triterpene glycosides and flavonoids, and its rhizomes are typically harvested in early autumn.

What is the etymology of black cohosh?

How was black cohosh used by indigenous North Americans?

What are black cohosh’s main benefits?

Black cohosh is primarily researched for its benefits in alleviating neurovegetative and psychological symptoms associated with perimenopause and postmenopause, and it has shown effectiveness in reducing hot flashes, night sweats, and depression. However, its effects in women who are undergoing medically induced menopause are inconsistent, and further studies with objective measurements are needed to validate these findings.

Does black cohosh improve bone density?

Can black cohosh be taken with St. John’s wort?

Can black cohosh be used instead of HRT for symptoms of menopause?

What are black cohosh’s main drawbacks?

Black cohosh is generally considered safe and has few significant side effects, though some menopausal women may experience gastrointestinal discomfort. However, animal studies suggest potential risks, including genetic alterations and anemia, which indicates the need for further clinical research to assess its effects on humans.

How does black cohosh work?

Black cohosh does not activate estrogen receptors as previously thought; instead, it binds to central nervous system receptors that regulate functions like thermoregulation and mood. Additionally, it exhibits antiestrogenic properties and may influence the immune system by promoting nitric oxide production.

Does black cohosh have estrogenic properties?

What are other names for Black Cohosh?
Note that Black Cohosh is also known as:
  • Cimicifuga racemosa
  • Bugbane
  • Bugroot
  • Snakeroot
  • Rattleroot
  • Blackroot
  • Black Snake Root
Black Cohosh should not be confused with:
  • Blue Cohosh (completely different herb)
Dosage information

If using an isopropanolic extract (usually sold under the brand name of Remifemin), 20-40mg daily is used in doses of 20mg; taking 20mg results in a once daily dosing, whereas taking 40mg is twice daily dosing of the 20mg. This dosage (20-40mg) confers 1-2mg of triterpenoid glycosides.

If using an aqueous:ethanolic extract of black cohosh root (ie. not Remifemin) then doses range from 64-128mg daily which are usually taken in two divided doses. This contributed about the same amount of triterpenoid glycosides.

It is not known whether or not black cohosh needs to be taken with food, although it is sometimes recommended to do so out of prudency.

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Examine Database: Black Cohosh
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Update History
2023-10-05 00:30:03

New meta-analyses added

minor

We added a few meta-analyses to our database and update the clinical effects accordingly.

Written By

Giulia Guerrini

Reviewed By

Nick Milazzo
References
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  2. ^Wobser RW, Takov VBlack CohoshStatPearls.(2023-01)
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  4. ^Jiang K, Jin Y, Huang L, Feng S, Hou X, Du B, Zheng J, Li LBlack cohosh improves objective sleep in postmenopausal women with sleep disturbance.Climacteric.(2015)
  5. ^Jacobson JS, Troxel AB, Evans J, Klaus L, Vahdat L, Kinne D, Lo KM, Moore A, Rosenman PJ, Kaufman EL, Neugut AI, Grann VRRandomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancerJ Clin Oncol.(2001 May 15)
  6. ^Sievert LLSubjective and objective measures of hot flashes.Am J Hum Biol.(2013)
  7. ^Wen-pei Bai, Shu-yu Wang, Jian-li Liu, Li Geng, Li-na Hu, Zhong-lan Zhang, Shu-ling Chen, Shu-rong ZhengEfficacy and safety of remifemin compared to tibolone for controlling of perimenopausal symptomsZhonghua Fu Chan Ke Za Zhi.(2009 Aug)
  8. ^Shams T, Setia MS, Hemmings R, McCusker J, Sewitch M, Ciampi AEfficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysisAltern Ther Health Med.(2010 Jan-Feb)
  9. ^Smith-Roe SL, Swartz CD, Shepard KG, Bryce SM, Dertinger SD, Waidyanatha S, Kissling GE, Auerbach SS, Witt KLBlack cohosh extracts and powders induce micronuclei, a biomarker of genetic damage, in human cells.Environ Mol Mutagen.(2018-Jun)
  10. ^Reame NE, Lukacs JL, Padmanabhan V, Eyvazzadeh AD, Smith YR, Zubieta JKBlack cohosh has central opioid activity in postmenopausal women: evidence from naloxone blockade and positron emission tomography neuroimaging.Menopause.(2008)
  11. ^Ruhlen RL, Sun GY, Sauter ERBlack Cohosh: Insights into its Mechanism(s) of Action.Integr Med Insights.(2008)
  12. ^Bodinet C, Freudenstein JInfluence of Cimicifuga racemosa on the proliferation of estrogen receptor-positive human breast cancer cells.Breast Cancer Res Treat.(2002-Nov)
  13. ^Seidlova-Wuttke D, Hesse O, Jarry H, Christoffel V, Spengler B, Becker T, Wuttke WEvidence for selective estrogen receptor modulator activity in a black cohosh (Cimicifuga racemosa) extract: comparison with estradiol-17beta.Eur J Endocrinol.(2003-Oct)
  14. ^Michael Bebenek, Wolfgang Kemmler, Simon von Stengel, Klaus Engelke, Willi A KalenderEffect of exercise and Cimicifuga racemosa (CR BNO 1055) on bone mineral density, 10-year coronary heart disease risk, and menopausal complaints: the randomized controlled Training and Cimicifuga racemosa Erlangen (TRACE) studyMenopause.(2010 Jul)
  15. ^Foster,SBlack Cohosh: A Literature ReviewHerbalGram: The Journal of the American Botanical Council.(1999)
  16. ^Nappi RE, Malavasi B, Brundu B, Facchinetti FEfficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol.Gynecol Endocrinol.(2005-Jan)
  17. ^Borrelli F, Ernst EBlack cohosh (Cimicifuga racemosa): a systematic review of adverse events.Am J Obstet Gynecol.(2008 Nov)
  18. ^Lontos S, Jones RM, Angus PW, Gow PJAcute liver failure associated with the use of herbal preparations containing black cohosh.Med J Aust.(2003 Oct 6)
  19. ^Cohen SM, O'Connor AM, Hart J, Merel NH, Te HSAutoimmune hepatitis associated with the use of black cohosh: a case study.Menopause.(2004 Sep-Oct)
  20. ^Levitsky J, Alli TA, Wisecarver J, Sorrell MFFulminant liver failure associated with the use of black cohosh.Dig Dis Sci.(2005 Mar)
  21. ^Lynch CR, Folkers ME, Hutson WRFulminant hepatic failure associated with the use of black cohosh: a case report.Liver Transpl.(2006 Jun)
  22. ^Dunbar K, Solga SFBlack cohosh, safety, and public awareness.Liver Int.(2007 Sep)
  23. ^Zimmermann R, Witte A, Voll RE, Strobel J, Frieser MCoagulation activation and fluid retention associated with the use of black cohosh: a case study.Climacteric.(2010 Apr)
  24. ^Mahady GB, Low Dog T, Barrett ML, Chavez ML, Gardiner P, Ko R, Marles RJ, Pellicore LS, Giancaspro GI, Sarma DNUnited States Pharmacopeia review of the black cohosh case reports of hepatotoxicity.Menopause.(2008 Jul-Aug)
  25. ^Brar HS, Marathi RCase of cholestatic drug-induced liver injury (DILI) associated with black cohosh.BMJ Case Rep.(2021 May 7)
  26. ^Wuttke W, Gorkow C, Seidlová-Wuttke DEffects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study.Menopause.(2006 Mar-Apr)
  27. ^Huntley AThe safety of black cohosh (Actaea racemosa, Cimicifuga racemosa).Expert Opin Drug Saf.(2004 Nov)
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  30. ^Huntley A, Ernst EA systematic review of the safety of black cohosh.Menopause.(2003 Jan-Feb)
  31. ^Kanadys WM, Leszczyńska-Gorzelak B, Oleszczuk JEfficacy and safety of Black cohosh (Actaea/Cimicifuga racemosa) in the treatment of vasomotor symptoms--review of clinical trials.Ginekol Pol.(2008 Apr)
  32. ^Patel, NM et alPossible Increase in Liver Enzymes Secondary to Atorvastatin and Black Cohosh AdministrationJournal of Pharmacy Practice.(2007)
  33. ^Li J, Gödecke T, Chen SN, Imai A, Lankin DC, Farnsworth NR, Pauli GF, van Breemen RB, Nikolić DIn vitro metabolic interactions between black cohosh (Cimicifuga racemosa) and tamoxifen via inhibition of cytochromes P450 2D6 and 3A4.Xenobiotica.(2011 Aug 9)
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  35. ^Gurley BJ, Gardner SF, Hubbard MA, Williams DK, Gentry WB, Khan IA, Shah AIn vivo effects of goldenseal, kava kava, black cohosh, and valerian on human cytochrome P450 1A2, 2D6, 2E1, and 3A4/5 phenotypes.Clin Pharmacol Ther.(2005-May)
  36. ^Gurley BJ, Swain A, Hubbard MA, Williams DK, Barone G, Hartsfield F, Tong Y, Carrier DJ, Cheboyina S, Battu SKClinical assessment of CYP2D6-mediated herb-drug interactions in humans: effects of milk thistle, black cohosh, goldenseal, kava kava, St. John's wort, and Echinacea.Mol Nutr Food Res.(2008 Jul)
  37. ^Huang Y, Jiang B, Nuntanakorn P, Kennelly EJ, Shord S, Lawal TO, Mahady GBFukinolic acid derivatives and triterpene glycosides from black cohosh inhibit CYP isozymes, but are not cytotoxic to Hep-G2 cells in vitro.Curr Drug Saf.(2010 Apr)
  38. ^Yalçın M, Oğuz A, Beştepe EE, Sağlam NGU, Ergelen MBlack cohosh associated mania in a patient with unipolar depression.Int J Psychiatry Med.(2021 Mar)
  39. ^Burdette JE, Liu J, Chen SN, Fabricant DS, Piersen CE, Barker EL, Pezzuto JM, Mesecar A, Van Breemen RB, Farnsworth NR, Bolton JLBlack cohosh acts as a mixed competitive ligand and partial agonist of the serotonin receptor.J Agric Food Chem.(2003 Sep 10)
  40. ^Dernbach MR, Carpenter JE, Shah N, Carter GBBlack Cohosh Interactions with Prescription Medications Associated with Serotonin Toxicity and Rhabdomyolysis: A Case Report.J Emerg Med.(2024 May)
  41. ^Gail B MahadyBlack cohosh (Actaea/Cimicifuga racemosa): review of the clinical data for safety and efficacy in menopausal symptomsTreat Endocrinol.(2005)
  42. ^Dugoua JJ, Seely D, Perri D, Koren G, Mills ESafety and efficacy of black cohosh (Cimicifuga racemosa) during pregnancy and lactation.Can J Clin Pharmacol.(2006 Fall)
  43. ^Black Cohosh.Drugs and Lactation Database (LactMed®).(2006)
  44. ^Lupu R, Mehmi I, Atlas E, Tsai MS, Pisha E, Oketch-Rabah HA, Nuntanakorn P, Kennelly EJ, Kronenberg FBlack cohosh, a menopausal remedy, does not have estrogenic activity and does not promote breast cancer cell growth.Int J Oncol.(2003 Nov)
  45. ^Fritz H, Seely D, McGowan J, Skidmore B, Fernandes R, Kennedy DA, Cooley K, Wong R, Sagar S, Balneaves LG, Fergusson DBlack cohosh and breast cancer: a systematic review.Integr Cancer Ther.(2014 Jan)
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Examine Database References
  1. Menopausal Symptoms - Castelo-Branco C, Gambacciani M, Cano A, Minkin MJ, Rachoń D, Ruan X, Beer AM, Schnitker J, Henneicke-von Zepelin HH, Pickartz SReview & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidence.Climacteric.(2021-Apr)
  2. Menopausal Symptoms - Wen-pei Bai, Shu-yu Wang, Jian-li Liu, Li Geng, Li-na Hu, Zhong-lan Zhang, Shu-ling Chen, Shu-rong Zheng[Efficacy and safety of remifemin compared to tibolone for controlling of perimenopausal symptoms]Zhonghua Fu Chan Ke Za Zhi.(2009 Aug)
  3. Menopausal Symptoms - Geller SE, Shulman LP, van Breemen RB, Banuvar S, Zhou Y, Epstein G, Hedayat S, Nikolic D, Krause EC, Piersen CE, Bolton JL, Pauli GF, Farnsworth NRSafety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trialMenopause.(2009 Nov-Dec)
  4. Menopausal Symptoms - Karel Raus, Cosima Brucker, Christoph Gorkow, Wolfgang WuttkeFirst-time proof of endometrial safety of the special black cohosh extract (Actaea or Cimicifuga racemosa extract) CR BNO 1055Menopause.(Jul-Aug 2006)
  5. Menopausal Symptoms - Shams T, Setia MS, Hemmings R, McCusker J, Sewitch M, Ciampi AEfficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysisAltern Ther Health Med.(2010 Jan-Feb)
  6. Menopausal Symptoms - Briese V, Stammwitz U, Friede M, Henneicke-von Zepelin HHBlack cohosh with or without St. John's wort for symptom-specific climacteric treatment--results of a large-scale, controlled, observational studyMaturitas.(2007 Aug 20)
  7. Menopausal Symptoms - Ross SMMenopause: a standardized isopropanolic black cohosh extract (remifemin) is found to be safe and effective for menopausal symptomsHolist Nurs Pract.(2012 Jan-Feb)
  8. Menopausal Symptoms - Newton KM, Reed SD, LaCroix AZ, Grothaus LC, Ehrlich K, Guiltinan JTreatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trialAnn Intern Med.(2006 Dec 19)
  9. Menopausal Symptoms - Pockaj BA, Gallagher JG, Loprinzi CL, Stella PJ, Barton DL, Sloan JA, Lavasseur BI, Rao RM, Fitch TR, Rowland KM, Novotny PJ, Flynn PJ, Richelson E, Fauq AHPhase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1J Clin Oncol.(2006 Jun 20)
  10. Estrogen - Liske E, Hänggi W, Henneicke-von Zepelin HH, Boblitz N, Wüstenberg P, Rahlfs VWPhysiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effectJ Womens Health Gend Based Med.(2002 Mar)
  11. Anxiety Symptoms - Amsterdam JD, Yao Y, Mao JJ, Soeller I, Rockwell K, Shults JRandomized, double-blind, placebo-controlled trial of Cimicifuga racemosa (black cohosh) in women with anxiety disorder due to menopauseJ Clin Psychopharmacol.(2009 Oct)
  12. Subjective Well-Being - Maria Dolores Juliá Mollá, Yolanda García-Sánchez, Alberto Romeu Sarri, Faustino R Pérez-lópezCimicifuga racemosa treatment and health related quality of life in post-menopausal Spanish womenGynecol Endocrinol.(2009 Jan)
  13. Menopausal Symptoms - Ahmed Nasr, Hanan NafehInfluence of black cohosh (Cimicifuga racemosa) use by postmenopausal women on total hepatic perfusion and liver functionsFertil Steril.(2009 Nov)
  14. Menopausal Symptoms - Jacobson JS, Troxel AB, Evans J, Klaus L, Vahdat L, Kinne D, Lo KM, Moore A, Rosenman PJ, Kaufman EL, Neugut AI, Grann VRRandomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancerJ Clin Oncol.(2001 May 15)
  15. Menopausal Symptoms - Matthias Rostock, Julia Fischer, Andreas Mumm, Ute Stammwitz, Reinhard Saller, Hans Helge BartschBlack cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints - a prospective observational studyGynecol Endocrinol.(2011 Oct)
  16. Breast Density - E Lundström, A L Hirschberg, G SöderqvistDigitized assessment of mammographic breast density--effects of continuous combined hormone therapy, tibolone and black cohosh compared to placeboMaturitas.(2011 Dec)
  17. Bone Mineral Density - Michael Bebenek, Wolfgang Kemmler, Simon von Stengel, Klaus Engelke, Willi A KalenderEffect of exercise and Cimicifuga racemosa (CR BNO 1055) on bone mineral density, 10-year coronary heart disease risk, and menopausal complaints: the randomized controlled Training and Cimicifuga racemosa Erlangen (TRACE) studyMenopause.(2010 Jul)
  18. Blood glucose - Spangler L, Newton KM, Grothaus LC, Reed SD, Ehrlich K, LaCroix AZThe effects of black cohosh therapies on lipids, fibrinogen, glucose and insulinMaturitas.(2007 Jun 20)
  19. C-Reactive Protein (CRP) - Verhoeven MO, Teerlink T, Kenemans P, Zuijdgeest-van Leeuwen SD, van der Mooren MJEffects of a supplement containing isoflavones and Actaea racemosa L. on asymmetric dimethylarginine, lipids, and C-reactive protein in menopausal womenFertil Steril.(2007 Apr)
  20. Cognition - Maki PM, Rubin LH, Fornelli D, Drogos L, Banuvar S, Shulman LP, Geller SEEffects of botanicals and combined hormone therapy on cognition in postmenopausal womenMenopause.(2009 Nov-Dec)