Black Cohosh

What is Black cohosh?

Black cohosh (known as both Actaea Racemosa and Cimicifuga Racemosa) is sold primarily as a dietary supplement and is widely used today for the treatment of hot flashes and other menopausal symptoms among women. Due to its supposed estrogenic properties it is generally not recommended for men.

Black Cohosh Root

It is a perennial plant native to North America and its roots have been used for centuries to treat a variety of ailments. Some other common names of black cohosh are: black snakeroot, bugwort, rattleroot, rattleweed and macrotys.

Black Cohosh Plant

Available Forms

Black cohosh is available in tablets, capsules, cream, oil, liquid tincture and extracts that can be mixed in water, while its dried roots are often consumed in the form of tea. A commercially standardized preparation of black cohosh is Remifemin which is widely recommended for use in menopause.


For Adults (over 18 years old)

The British Herbal Compendium recommends the usage of black cohosh as below:




40-200 milligrams

Dried root

In daily divided doses

0.4-2 milliliters (1:10)

60% ethanol tincture

Taken daily

Certain healthcare agencies like Commission E (Germany’s regulatory agency for herbs) recommend that the herb should not be taken for more than 6 months in a row. However, in certain studies and cases its use has been prescribed for almost a year.

With no standardized treatment plan available evidence from scientific research, publications, traditional use and expert opinion have been combined to suggest the use of the herb:

Medical Condition

Quantity to be Administered Orally

Duration of Treatment

Menopausal Symptoms

1)      6.5-160 milligrams of an alcoholic black cohosh extract (any formulation)2)      40 drops of a liquid extract3)      An adjusted dose starting at 64 milligrams gradually increased to 128 milligrams1)      Taken for up to one year.2)      Taken once or twice daily for up to 24 weeks.3)      Reduced dosage for the first two weeks with gradually doubling the dosage by fourth week.

For breast cancer treatment

(menopausal symptoms)

1)      1-4 tablets containing 2.5 milligrams of extract.2)      20 milligrams of extract1)      Taken for six months in addition to tamoxifen.2)      Taken daily for a year.

For heart disease in postmenopausal women

1)      40 milligrams of extract1)      Taken for 2 periods of 3 months each, with a 3 month interval between periods.

For bone density in postmenopausal women

1)      40 milligrams of black cohosh1)      Taken for upto 3 months.


1)      120 milligrams of black cohosh root1)      Taken daily for 12-13 days.

For mental performance in postmenopausal women

1)      128 milligrams of ground            black cohosh part1)      Taken once daily for a year.

For Children (under 18 years old)

Due to lack of proper information black cohosh is not recommended for children.


Consuming more than 900 milligrams of black cohosh a day constitutes as an overdose.

Symptoms of an overdose generally include:

  • Vision problems
  • Slow heartbeat
  • Increased sweating
  • Severe dizziness

In case of a suspected overdose contact a doctor immediately.

Black cohosh uses and benefits

Possibly beneficial for

Menopausal symptoms like:

  • Hot flashes
  • Irregular periods
  • Vaginal dryness
  • Night sweats
  • Insomnia

Earlier, Hormone therapy, which involves the use of estrogen or estrogen plus progesterone, had been very effective for reducing hot flashes, but concerns about its safety caused millions of women to abandon the treatment. These symptomatic women have now turned to black cohosh and other herbal supplements (like soy) after they stopped taking hormones. Studies have revealed that while black cohosh does relieve symptoms in some women it can be completely ineffective for others. Its beneficial effects are largely debated and much research is still needed.

Insufficient Evidence for


  • Induction of labor: Black cohosh supplements have been reportedly prescribed by nurses and midwives to help prepare the uterus for induction of labor. Popular belief is that in women who are approaching or have exceeded the due date, the herb can help regulate and strengthen contractions, while promoting the cause of cervical ripening. There is no scientific proof to suggest that it works. A case report has revealed development of neurological complications in a post term baby, after labor induction with a mixture of blue and black cohosh, during a home birth.
  • Abortion:  Traditionally black cohosh has been used in combination with other herbs (like dong quai) to carry out a natural abortion. Its effectiveness is yet to be established.

Osteoporosis (Weakened Bones)

Certain black cohosh products like Klimadynon or Menofem might help improve bone formation. Though it cannot be said for certain if it improves bone density or simply decreases the chances of developing weak bones, thereby, reducing the risk of fracture.


  • Anxiety
  • Cough
  • Fever
  • Acne
  • Wart/Mole removal
  • Premenstrual syndrome
  • Rheumatism
  • Bug bites
  • Snake bites

Black cohosh Safety: Side Effects and Dangers

Sustained use of black cohosh even for a relatively short period of time might cause the body to exhibit a bunch of adverse effects like

  • Headache
  • Stomach discomfort
  • Vomiting
  • Swelling
  • Blood clots
  • Hair Loss
  • Abnormal discharge
  • Rash and skin infection
  • Muscle and skeletal conditions
  • Weight gain
  • Vertigo (Dizziness)
  • Multi-organ damage to an infant when taken by the mother during childbirth

This is not an exhaustive list of possible side effects as people react differently and might be subject to varying conditions. In case any of the above mentioned side effects persists or worsens, contact your doctor promptly.

Though the herb is not known to cause fatal liver diseases, liver damage has been reported by a few individuals using black cohosh.

Symptoms of liver damage would include:

  • Persistent nausea
  • Loss of appetite
  • Unusual tiredness
  • Dark urine
  • Yellowing eyes/skin

As mentioned earlier, black cohosh is assumed to have benefits like estrogen therapy so it is wise to consider that it may also pose similar risks. It is possibly unsafe when used during pregnancy and since it exhibits the characteristics of a female hormone, an indiscriminate use of it might increase the chance of a miscarriage.

Long term use of black cohosh can have adverse effects on uterine and breast tissue as well. Thus, there are substantial risks of a user contracting a hormone sensitive cancer (e.g. breast, ovarian) along with problems of the uterus (e.g. endometriosis, fibroids) or estrogen related heart problems (e.g. heart attack, heart failure).

It is, therefore, advised that the herb be only used under proper medical supervision.


Black cohosh contains small amounts of salicylic acid (which is found in aspirin) and should be used cautiously by people who are allergic to aspirin and other salicylates.

Drug Interactions

People who are on birth control pills, hormone replacement therapy, sedatives and blood pressure medicine should avoid the use of Black cohosh. Also it is essential that while using Black cohosh supplements one does not stop or change its dosage or that of any other medication without the prior approval of a doctor.

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