Quick Navigation

Black Cohosh

Black Cohosh is the most popular supplement for menopause in North America, but the human studies are mixed. Pretty down the middle, and placebo effect seems to play a great deal in these studies. It holds some benefit for controlling hot flashes and night sweats, but does not appear very potent.

Our evidence-based analysis on black cohosh features 73 unique references to scientific papers.

Kamal Patel
Research analysis led by .
Reviewed by
Examine.com Team
Last Updated:
NEW: Our free Coronavirus guide to staying healthy (and sane) while stuck indoors

Summary of Black Cohosh

Primary information, health benefits, side effects, usage, and other important details

Black Cohosh is a herb native to North America that has traditionally been used for cognitive and inflammatory conditions, but has grown in popularity due to it's ability to treat vasomotor symptoms of menopause; primarily hot flashes and night sweats. It is one of the most popular and highest sold supplements in the Western world (10th place in 2008), according to some surveys.

Studies on the matter are highly mixed. The larger body of evidence favors the efficacy of Black Cohosh for treatment of vasomotor symptoms but consists largely of unblinded studies; as the placebo effect can reduce menopausal complaints, blinding is needed. Efficacy has been demonstrated with blinded studies on Black Cohosh as well, but many of them are confounded with consumption of other compounds. A few blinded studies on Black Cohosh without any other compounds have been conducted, and are basically split right down the middle on efficacy if not favoring 'no significant effects' a little bit more due to quality of data and sample size.

Beyond the questionable efficacy, Black Cohosh appears to be safe. It is non-estrogenic (despite being thought to influence estrogen in the past) and may act centrally (in the brain) via serotonin, dopamine or opioids. Stomach upset has been reported and seems to be attributable to Black Cohosh in some people, but reports of liver toxicity do not appear to be related to the Black Cohosh herb. These reports do exist, but they cannot be linked to Black Cohosh logically.

Make sure you only take supplements that work

Examine.com bases all of its recommendations on published scientific research. We’re a trusted resource because we don’t sell or even advertise supplements.

If you’re tired of wasting time and money on supplements that don’t work, our 17 Supplement Guides will help you figure out precisely what to take — and what to skip — based on your health goals and the latest scientific evidence. There’s a reason why over 50,000 customers rely on Examine.com’s independent and unbiased analysis.

Includes free lifetime updates so you always have the most accurate information.


I want unbiased recommendations to improve my health »

How to Take

Medical Disclaimer

Recommended dosage, active amounts, other details

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.

Get the latest information on 400+ supplements and their effects on 600+ health conditions & outcomes.

By becoming an Examine Plus member, you'll have access to all of the latest nutrition research. Quickly and easily look up scientific research on over 400 supplements across over 600 different health goals, outcomes, conditions, and more.

Human Effect Matrix

Unlocked for Examine Plus members

The Human Effect Matrix summarizes human studies to tell you what effects Black Cohosh has on your body, how much evidence there is, and how strong these effects are.

Full details are available to Examine Plus members.
Grade Level of Evidence
Robust research conducted with repeated double-blind clinical trials
Multiple studies where at least two are double-blind and placebo controlled
Single double-blind study or multiple cohort studies
Uncontrolled or observational studies only
Level of Evidence
? The amount of high quality evidence. The more evidence, the more we can trust the results.
Outcome Magnitude of effect
? The direction and size of the supplement's impact on each outcome. Some supplements can have an increasing effect, others have a decreasing effect, and others have no effect.
Consistency of research results
? Scientific research does not always agree. HIGH or VERY HIGH means that most of the scientific research agrees.
Notes
grade-a
Symptoms of Menopause
Minor Very High See all 13 studies
Although there appears to be some benefit over placebo, more recent studies note that the magnitude of benefit is much less than previously though (in the past, a false positive occurred when unblinded studies noted remarkable benefits with black cohosh; the placebo effect appears to be quite potent in regards to menopause)
grade-c
Anxiety
- - See study
The trial to measure anxiety related to menopausal symptoms failed to find a benefit associated with black cohosh
grade-c
Blood Glucose
- - See study
No significant influence on blood glucose levels
grade-c
C-Reactive Protein
- - See study
No significant alterations seen in C-RP with black cohosh
grade-c
Cognition
- - See study
No significant influences on cognition in menopausal women has been noted
grade-c
Estrogen
- - See study
No significant influences on circulating estrogen levels or biomarkers of estrogenicity (vaginal cytology)
grade-c
HDL-C
- - See study
No significant influence on HDL-C
grade-c
Insulin
- - See study
No significant influence on fasting insulin
grade-c
LDL-C
- - See study
No significant effects on LDL-C
grade-c
Memory
- - See study
No significant effect on memory function
grade-c
Triglycerides
- Very High See 2 studies
No significant effect on triglyceride concentrations in serum
grade-d
Coronary Heart Disease Risk
Minor - See study
A slightly increased chance of heart disease was said to occur in one study pairing black cohosh with exercise, and an increased risk was also determined in control but not in black cohosh in isolation.
grade-d
Subjective Well-Being
Minor - See study
May increase well being in those with menopause if a reduction of symptoms occurs.
grade-d
Blood Flow
- - See study
No significant influences on blood flow and vasodilation
grade-d
Blood Pressure
- - See study
No significant influence on blood pressure
grade-d
Bone Mineral Density
- - See study
No significant influence on bone mineral density
grade-d
Breast Density
- - See study
grade-d
Liver Enzymes
- - See study
No significant influence on liver enzymes
grade-d
Weight
- - See study
No significant influences on body weight

Studies Excluded from Consideration

  • Confounded with other herbs and phytoestrogens[1][2][3]

Become an Examine Plus member to access the latest nutrition research on over 400 supplements across over 600 different health goals, outcomes, conditions, and more.

Becoming an Examine Plus member not only unlocks the Human Effect Matrix for supplements, but also all health topics on Examine.com. We neatly summarize all the latest research so you can make the best decisions for your health based on what's accurate and not out-dated information.

Things to Note

Primary Function:

Also Known As

Cimicifuga racemosa, Bugbane, Bugroot, Snakeroot, Rattleroot, Blackroot, Black Snake Root

Do Not Confuse With

Blue Cohosh (completely different herb)

Goes Well With

  • St.John's Wort (not synergistic, but both together have shown added efficacy in treating vasomotor symptoms of menopause)

  • Black Cohosh has been reported to be associated with liver disease (general hepatotoxicity or auto-immune liver disease), but trials and reviews into the matter have come back inconclusive. Black Cohosh does not appear to be related to these case studies, and tampering of supplements with other herbs in the same genus cannot be ruled out

  • Might be good to take with a meal, as upset stomachs have been reported at a low rate but consistently in blinded studies

  • Anecdotes, and some studies, suggest the benefits may be delayed and take a few weeks to kick in

Tired of misinformation? Get unbiased info on supplements.

At Examine.com, our incentives line up with yours — getting unbiased information. It’s why we don’t sell any advertising or supplements.

Join over 250,000 people who’ve learned about effective versus overrated supplements, supplement buying tips, and how to combine supplements for safety and efficacy.

Research Breakdown on Black Cohosh

1Sources and Composition

1.1Sources

1.2Composition

1.3Structure and Properties

2Pharmacology

2.1Enzymatic Interactions

3Interactions with Hormones

3.1Estrogen

3.2Testosterone

3.3Luteinizing Hormone

3.4Follicle-Stimulating Hormone

4Effects on Menopause

4.1Intervention Studies

4.2Mechanisms of Menopausal Symptoms

4.3Effects on Bone Health

4.4During Breast Cancer Treatment

5Interactions with Body Fat and Obesity

5.1Food intake

6Interactions with Neurology

6.1Opioids

6.2Serotonin

7Notable Forms of Black Cohosh

7.1Remifemin

7.2BNO 1055

8Nutrient-Nutrient Interactions

8.1St.John's Wort

9Safety and Toxicity

9.1Side-effects related to Menopause

9.2Hepatotoxicity (Liver)

9.3Other Notables
Click here to see all 73 references.

This page is regularly updated, to include the most recently available clinical trial evidence.

Each member of our research team is required to have no conflicts of interest, including with supplement manufacturers, food companies, and industry funders. The team includes nutrition researchers, registered dietitians, physicians, and pharmacists. We have a strict editorial process.

This page features 73 references. All factual claims are followed by specifically-applicable references. Click here to see the full set of research information and references for Black Cohosh.

Examine.com is intended to be used for educational and information purposes only. Examine.com and its Editors do not advocate nutritional supplementation over proper medical advice or treatment and this sentiment will never be expressed through pages hosted under Examine.com. If using any pharmaceuticals or drugs given to you by a doctor or received with a prescription, you must consult with the doctor in question or an equally qualified Health Care Professional prior to using any nutritional supplementation. If undergoing medical therapies, then consult with your respective Therapist or Health Care Professional about possible interactions between your Treatment, any Pharmaceuticals or Drugs being given, and possible nutritional supplements or practices hosted on Examine.com.

Examine.com does not assume liability for any actions undertaken after visiting these pages, and does not assume liability if one misuses supplements. Examine.com and its Editors do not ensure that unforeseen side effects will not occur even at the proper dosages, and thereby does not assume liability for any side effects from supplements or practices hosted under the domain of Examine.com.

Supplements

Articles

Health Topics

NERD

This website is certified by Health On the Net Foundation. Click to verify.

About

Never miss an update!

Your e-mail is safe with us. We don’t share personal data.