Black Cohosh

Last Updated: September 28 2022

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.

Black Cohosh is most often used for


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.

What else is Black Cohosh known as?
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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2.^Jiang B, Ma C, Motley T, Kronenberg F, Kennelly EJPhytochemical fingerprinting to thwart black cohosh adulteration: a 15 Actaea species analysisPhytochem Anal.(2011 Jul-Aug)
3.^Mahady GB, Doyle B, Locklear T, Cotler SJ, Guzman-Hartman G, Krishnaraj RBlack cohosh (Actaea racemosa) for the mitigation of menopausal symptoms: recent developments in clinical safety and efficacyWomens Health (Lond Engl).(2006 Sep)
5.^Chen SN, Li W, Fabricant DS, Santarsiero BD, Mesecar A, Fitzloff JF, Fong HH, Farnsworth NRIsolation, structure elucidation, and absolute configuration of 26-deoxyactein from Cimicifuga racemosa and clarification of nomenclature associated with 27-deoxyacteinJ Nat Prod.(2002 Apr)
8.^Shao Y, Harris A, Wang M, Zhang H, Cordell GA, Bowman M, Lemmo ETriterpene glycosides from Cimicifuga racemosaJ Nat Prod.(2000 Jul)
9.^Watanabe K, Mimaki Y, Sakagami H, Sashida YCycloartane glycosides from the rhizomes of Cimicifuga racemosa and their cytotoxic activitiesChem Pharm Bull (Tokyo).(2002 Jan)
11.^Gödecke T, Lankin DC, Nikolic D, Chen SN, van Breemen RB, Farnsworth NR, Pauli GFGuanidine alkaloids and Pictet-Spengler adducts from black cohosh (Cimicifuga racemosa)J Nat Prod.(2009 Mar 27)
12.^Powell SL, Gödecke T, Nikolic D, Chen SN, Ahn S, Dietz B, Farnsworth NR, van Breemen RB, Lankin DC, Pauli GF, Bolton JLIn vitro serotonergic activity of black cohosh and identification of N(omega)-methylserotonin as a potential active constituentJ Agric Food Chem.(2008 Dec 24)
13.^Gurley BJ, Barone GW, Williams DK, Carrier J, Breen P, Yates CR, Song PF, Hubbard MA, Tong Y, Cheboyina SEffect of milk thistle (Silybum marianum) and black cohosh (Cimicifuga racemosa) supplementation on digoxin pharmacokinetics in humansDrug Metab Dispos.(2006 Jan)
14.^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 phenotypesClin Pharmacol Ther.(2005 May)
15.^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 EchinaceaMol Nutr Food Res.(2008 Jul)
16.^Zierau O, Bodinet C, Kolba S, Wulf M, Vollmer GAntiestrogenic activities of Cimicifuga racemosa extractsJ Steroid Biochem Mol Biol.(2002 Jan)
17.^Pineda B, García-Pérez MA, Vázquez F, Juliá MD, Tarín JJ, Hermenegildo C, Cano ANo effect of Cimicifuga racemosa extract on serum interleukin-6 levels and prostacyclin production by human endothelial cellsEur J Obstet Gynecol Reprod Biol.(2009 May)
19.^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-17betaEur J Endocrinol.(2003 Oct)
20.^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)
21.^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 neuroimagingMenopause.(2008 Sep-Oct)
26.^Seidlová-Wuttke D, Thelen P, Wuttke WInhibitory effects of a black cohosh (Cimicifuga racemosa) extract on prostate cancerPlanta Med.(2006 May)
27.^Frei-Kleiner S, Schaffner W, Rahlfs VW, Bodmer Ch, Birkhäuser MCimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trialMaturitas.(2005 Aug 16)
32.^Osmers R, Friede M, Liske E, Schnitker J, Freudenstein J, Henneicke-von Zepelin HHEfficacy and safety of isopropanolic black cohosh extract for climacteric symptomsObstet Gynecol.(2005 May)
33.^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)
34.^Borrelli F, Ernst ECimicifuga racemosa: a systematic review of its clinical efficacyEur J Clin Pharmacol.(2002 Jul)
36.^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)
37.^MacLennan A, Lester S, Moore VOral oestrogen replacement therapy versus placebo for hot flushesCochrane Database Syst Rev.(2001)
38.^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)
39.^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)
40.^Uebelhack R, Blohmer JU, Graubaum HJ, Busch R, Gruenwald J, Wernecke KDBlack cohosh and St. John's wort for climacteric complaints: a randomized trialObstet Gynecol.(2006 Feb)
41.^Chung DJ, Kim HY, Park KH, Jeong KA, Lee SK, Lee YI, Hur SE, Cho MS, Lee BS, Bai SW, Kim CM, Cho SH, Hwang JY, Park JHBlack cohosh and St. John's wort (GYNO-Plus) for climacteric symptomsYonsei Med J.(2007 Apr 30)
43.^Verhoeven MO, van der Mooren MJ, van de Weijer PH, Verdegem PJ, van der Burgt LM, Kenemans P; CuraTrial Research GroupEffect of a combination of isoflavones and Actaea racemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind studyMenopause.(2005 Jul-Aug)
45.^Ma X, Zhang H, Wang K, Yang L, Qin L, Bai W, Guan Y, Jia J, Kang J, Zhou CEffects of an isopropanolic-aqueous black cohosh extract on central body temperature of ovariectomized ratsJ Ethnopharmacol.(2011 Oct 31)
47.^García-Pérez MA, Pineda B, Hermenegildo C, Tarín JJ, Cano AIsopropanolic Cimicifuga racemosa is favorable on bone markers but neutral on an osteoblastic cell lineFertil Steril.(2009 Apr)
50.^Kapur P, Wuttke W, Seidlova-Wuttke DThe Cimicifuga racemosa special extract BNO 1055 prevents hot flashes in ovariectomized ratsPhytomedicine.(2010 Sep)
51.^Rhyu MR, Lu J, Webster DE, Fabricant DS, Farnsworth NR, Wang ZJBlack cohosh (Actaea racemosa, Cimicifuga racemosa) behaves as a mixed competitive ligand and partial agonist at the human mu opiate receptorJ Agric Food Chem.(2006 Dec 27)
52.^Hirschberg AL, Edlund M, Svane G, Azavedo E, Skoog L, von Schoultz BAn isopropanolic extract of black cohosh does not increase mammographic breast density or breast cell proliferation in postmenopausal womenMenopause.(2007 Jan-Feb)
54.^Al-Akoum M, Maunsell E, Verreault R, Provencher L, Otis H, Dodin SEffects of Hypericum perforatum (St. John's wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trialMenopause.(2009 Mar-Apr)
56.^Bai WP, Wang SY, Liu JL, Geng L, Hu LN, Zhang ZL, Chen SL, Zheng SREfficacy and safety of remifemin compared to tibolone for controlling of perimenopausal symptomsZhonghua Fu Chan Ke Za Zhi.(2009 Aug)
59.^Whiting PW, Clouston A, Kerlin PBlack cohosh and other herbal remedies associated with acute hepatitisMed J Aust.(2002 Oct 21)
60.^Lontos S, Jones RM, Angus PW, Gow PJAcute liver failure associated with the use of herbal preparations containing black cohoshMed J Aust.(2003 Oct 6)
61.^Cohen SM, O'Connor AM, Hart J, Merel NH, Te HSAutoimmune hepatitis associated with the use of black cohosh: a case studyMenopause.(2004 Sep-Oct)
65.^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)
66.^Borrelli F, Ernst EBlack cohosh (Cimicifuga racemosa): a systematic review of adverse eventsAm J Obstet Gynecol.(2008 Nov)