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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 and reviewed by the Examine team.
Last Updated:

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.

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How to Take

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.

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Human Effect Matrix

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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.

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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
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 (CRP)
- - 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
High-density lipoprotein (HDL)
- - See study
No significant influence on HDL-C
grade-c
Insulin
- - See study
No significant influence on fasting insulin
grade-c
Low-density lipoprotein (LDL)
- - 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 artery disease (CAD)
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]

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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

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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.

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