Black Cohosh
Actaea racemosa
A root used traditionally by Native Americans and recognized in Europe for menopausal hot flushes. Rare liver problems have been reported.
Black Cohosh may interact with some medicines. If you take any medicine, read Interactions with medicines below and talk to your doctor or pharmacist before using it.
What is Black Cohosh?
- Plant family
- Ranunculaceae, the buttercup family
- Parts used
- The root and rhizome (underground stem)
- Genus
- Actaea
- Species
- racemosa
Also called
Black Snakeroot, Bugbane, Rattleweed, Macrotys
Older scientific names
Cimicifuga racemosa
Traditionally used for
- Menopause
- Hot flashes
Traditionally described as
- May ease hot flashes
Health topics
Where Black Cohosh appears in symptom search, and why. Being listed doesn't mean it's a proven treatment.
- Liver Safety Warnings
Cases of liver damage have been reported, though it's not certain black cohosh caused them. Stop and see a doctor if you notice dark urine or yellow skin or eyes.
- Menopause Symptoms
Recognized in Europe for hot flushes and sweating, but a Cochrane review found too little evidence. Watch for liver warning signs.
- Menstrual Discomfort
Traditionally used by Native Americans for menstrual cramps.
Traditions that use it
Native American Ethnobotany
Used by Native Americans for kidney problems, malaria, sore throat and menstrual cramps.
European Folk Medicine
Used as a medicine in Germany since the late 1800s. The European Medicines Agency recognizes it for menopausal hot flushes and heavy sweating.
Safety
Interactions with medicines
Black cohosh may interact with some medicines. Check with your health care provider before using it.[1]
Who should avoid it
Its safety is uncertain for people with hormone-sensitive cancers, such as some breast cancers, and during pregnancy or breastfeeding.[1]
Side effects
Other side effects include allergic skin reactions (rash, itching), swelling of the face, hands or feet, indigestion and diarrhea.[2]
Toxicity testing
Cases of liver damage have been reported in people taking black cohosh, though it's not certain black cohosh caused them. Watch for signs such as dark urine and tiredness.[1]
Stop taking black cohosh and see a doctor straight away if you get signs of liver problems: tiredness, loss of appetite, yellow skin or eyes, severe upper stomach pain with nausea and vomiting, or dark urine.[2]
How much to use
Black cohosh medicines are for adult women. Don't take them for more than 6 months without talking to a doctor.[2]
Contamination
Some black cohosh products have contained the wrong herb or ingredients not listed on the label. Blue cohosh is a different herb that may cause serious side effects.[1]
What does the research say?
Traditional use
These are traditional uses, not proven treatments.
Native Americans used black cohosh for kidney problems, malaria, sore throat and menstrual cramps. It has been used as a medicine in Germany since the late 19th century.[1]
Research in people
Based on around 20 clinical studies with more than 6,000 patients, the European Medicines Agency concluded that black cohosh extracts can treat menopausal complaints such as hot flushes and heavy sweating.[2]
Technical detail: "well-established use" for dry extracts.
A 2023 review found black cohosh products may help overall menopause symptoms, improving hot flashes but not anxiety or depression. It's unclear whether it helps hot flashes caused by breast cancer treatment, and there isn't enough data for other uses.[1]
A 2012 Cochrane review of 16 trials with 2,027 women found black cohosh didn't reduce hot flashes or menopause symptom scores more than placebo, and hormone therapy worked better. Because the quality of the trials was unclear, the reviewers concluded there isn't enough evidence to support black cohosh for menopause symptoms, though more research is justified.[3]
Technical detail: median dose 40 mg/day for a mean of 23 weeks; hot flushes MD 0.07 per day (95% CI −0.43 to 0.56), 3 trials, 393 women; symptom scores SMD −0.10 (95% CI −0.32 to 0.11), 4 trials.
In short
Stop and see a doctor if you notice dark urine, yellow skin or eyes, or unusual tiredness.
Sources
- [1] Black Cohosh: Usefulness and Safety — National Center for Complementary and Integrative Health (NIH)Government health agency
- [2] Black cohosh (Cimicifuga racemosa (L.) Nutt., rhizoma): summary of the HMPC conclusions (EMA/265439/2018) — European Medicines Agency, Committee on Herbal Medicinal Products (HMPC)Government health agency
- [3] Black cohosh (Cimicifuga spp.) for menopausal symptoms — Cochrane Database of Systematic Reviews · DOI: 10.1002/14651858.CD007244.pub2Review or clinical trial
This information is educational and traditional in nature, and is not a substitute for professional medical advice.