Table of ContentsView AllTable of ContentsUsesSide EffectsWho Should Avoid Black Cohosh?DosageInteractionsStorageSimilar SupplementsSources
Table of ContentsView All
View All
Table of Contents
Uses
Side Effects
Who Should Avoid Black Cohosh?
Dosage
Interactions
Storage
Similar Supplements
Sources
Blackcohoshis an herbal remedy used for hot flashes, night sweats, and other menopausal symptoms. Some also turn to it to treattinnitus(ear ringing) andheart palpitations, among other conditions.There’s limited research evidence, and more study is needed to understand whether and how black cohosh increases estrogen levels and treatsmenopause symptoms.
In the United States, the Food and Drug Administration (FDA) does not regulate supplements the way it regulates prescription drugs. That means some supplement products may not contain what the label says. Whenchoosing a supplement, look for independently tested products and consult a healthcare provider, registered dietitian nutritionist (RD or RDN), or pharmacist.
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What Is Black Cohosh Used For?
Black cohosh is probably best known as a potential treatment for symptoms ofmenopauseand other ailments that affect the female reproductive system.Although results are mixed and not definitive, some research studies suggest black cohosh may be used to treat certain health conditions.
Below is a look at scientific evidence surrounding various potential uses of black cohosh, including what’s known on the benefits of phytoestrogens. Keep in mind that supplement use should be discussed with a registereddietitian(RD), pharmacist, or other healthcare provider. No supplement is intended to treat, cure, or prevent disease.
Black Cohosh Supplement FactsBlack cohosh facts include:Active ingredient(s):Triterpene glycosides, resins, aromatic acid derivativesAlternate name(s):Actaea racemosa,Cimicifuga racemosa, snakeroot, macrotys, black bugbane, bugwort, rattleroot, rattleweedLegal status:Legal and available over the counter in the United StatesSuggested dose: No standardized dosing recommendations
Black Cohosh Supplement Facts
Black cohosh facts include:Active ingredient(s):Triterpene glycosides, resins, aromatic acid derivativesAlternate name(s):Actaea racemosa,Cimicifuga racemosa, snakeroot, macrotys, black bugbane, bugwort, rattleroot, rattleweedLegal status:Legal and available over the counter in the United StatesSuggested dose: No standardized dosing recommendations
Black cohosh facts include:
Menopausal Symptoms
It’s not exactly known why or how black cohosh may alleviatemenopausalsymptoms. While some studies have shown positive effects of the herb, others have found black cohosh to have little to no use in treating symptoms of menopause.
In one study, researchers compared black cohosh withevening primrose oilto see if either was able to relievehot flashes, a common vasomotor side effect of menopause. At the end of eight weeks, both herbs showed beneficial effects. However, black cohosh was said to improve both hot flashes and quality of life better than evening primrose oil.
However, other research has found no association between black cohosh use and the relief of symptoms such as hot flashes.Black cohosh showed no benefit in studies of its effect on cognitive function in menopausal people.
Research does not consistently support the claim that black cohosh can help to ease hot flashes, vaginal dryness, or night sweats associated with menopause. The North American Menopause Society advises against unproven remedies and urges caution when using black cohosh.
Polycystic Ovary Syndrome
Polycysticovary syndrome (PCOS) is a common hormonal imbalance that affects many women and can cause acne, infertility, mood swings, and other issues.
Some studies have evaluated the potential use of black cohosh in PCOS, specifically when it comes to infertility, although research is lacking in this area.
One systematic review looked at whether black cohosh could be used to induce ovulation and improve pregnancy rates in people assigned female at birth with PCOS. The researchers determined there was not enough high-quality data to support black cohosh’s use for this purpose.
More thorough and better-designed research is needed to understand the relationship between black cohosh and PCOS.
Can Supplements Help Balance Your Hormones?
Other Uses
The herb is also commonly used for:
Although people may use black cohosh for these and other health issues, there is not enough supportive research. Higher-quality studies are needed before determining whether black cohosh is an effective treatment for these conditions.
What Are the Side Effects of Black Cohosh?
Although rare, you may experience side effects when using black cohosh. These side effects may be mild or severe.
Common Side Effects
Generally, black cohosh is thought to be safe. But mild side effects are possible.
Common side effects of black cohosh may include:
Typically, side effects go away once you stop taking the substance. However, if side effects persist or are concerning, you should speak with a healthcare provider.
Severe Side Effects
In extremely rare cases, black cohosh use has been reported to causeliver damage(includinghepatitis).However, there is some thought that black cohosh itself may not be to blame, as some other products or contaminants in supplements may be the cause of the liver damage.
Signs of liver damage may include:
Stop using black cohosh and seek medical attention if you notice these and other signs of liver damage.
Some people may need to take extra precautions when using black cohosh.
There is not enough information available to know if black cohosh is safe for people who are pregnant or nursing. If you are pregnant or nursing, talk with your healthcare provider before using black cohosh.
You should also avoid black cohosh if you have:
It should also be noted that long-term studies on black cohosh are lacking. Not enough is known about the safety of taking black cohosh for longer than six months.
Talk with your healthcare provider before using black cohosh if you have these or other health conditions. It’s always best to take precautions and be safe when using supplements.
Dosage: How Much Black Cohosh Should I Take?
Black cohoshdosagehas not been standardized. This means that there are varying doses of black cohosh, and how much you take may depend on the reason you’re using it or the brand you use.
Black cohosh studies have used a wide range of doses, anywhere from 8 milligrams (mg) to 160 mg or more per day.
Because dosing has varied so much in research, it’s difficult to determine a recommended dosage for everyone. Carefully read the black cohosh supplement label.
Always speak with a healthcare provider before taking a supplement to ensure that the supplement and dosage are appropriate for your individual needs.
What Happens if I Take Too Much Black Cohosh?Too much black cohosh may increase your chances of side effects.Hepatotoxicity(liver damage) has been reported in rare instances of black cohosh usage. It’s not clear why this occurs, and there’s no recommended dosage for cohosh. To prevent potential side effects or liver damage, only take black cohosh exactly as directed.
What Happens if I Take Too Much Black Cohosh?
Too much black cohosh may increase your chances of side effects.Hepatotoxicity(liver damage) has been reported in rare instances of black cohosh usage. It’s not clear why this occurs, and there’s no recommended dosage for cohosh. To prevent potential side effects or liver damage, only take black cohosh exactly as directed.
Black cohosh may interact with certain medications, supplements, or foods. However, extensive research needs to be done in this area, as not enough is known regarding potential interactions with black cohosh.
There is some preliminary evidence to suggest that black cohosh may interact with the following medications:
If you’re taking these medications, check with your healthcare provider before using black cohosh.
Otherwise, black cohosh is thought to have a low likelihood of interacting with other medications, supplements, or foods. Still, more research is needed.
How to Store Black Cohosh
Store black cohosh supplements in a cool, dry place. They should also be kept out of direct sunlight. Proper storage will help ensure shelf-life. Take precautions to keep black cohosh out of reach of small children and pets.
Discard black cohosh supplements that have passed their expiration date.
There are supplements and herbs on the market that have been researched for uses similar to black cohosh:
There may be additional supplements that work in ways similar to black cohosh. However, you should typically only take one supplement at a time for a given reason. Talk with your healthcare provider about which supplements are best for you.
Is Black Cohosh the Same as Blue Cohosh?Black cohosh should not be confused with blue cohosh (Caulophyllum thalictroides). The blue cohosh herb has different effects than black cohosh. In addition, some believe blue cohosh to be unsafe as it may cause severeadverse effects.
Is Black Cohosh the Same as Blue Cohosh?
Black cohosh should not be confused with blue cohosh (Caulophyllum thalictroides). The blue cohosh herb has different effects than black cohosh. In addition, some believe blue cohosh to be unsafe as it may cause severeadverse effects.
Sources of Black Cohosh and What to Look For
The best way to get all the nutrients your body needs is through a well-balanced diet. However, sometimes supplements and herbs may be recommended to you for various reasons. There are a few things to remember when searching for black cohosh supplements.
Food Sources of Black Cohosh
Black cohosh is not found in any foods. However, some people use dried black cohosh to maketea. Typically, though, certain parts of the black cohosh plant are used to make herbal remedies. You can find these remedies in many forms.
Black Cohosh Supplements
Black cohosh is sold as capsules, tablets, gummies, and tinctures. You can also find dried black cohosh roots.
It is recommended that you look for supplements that contain black cohosh roots or rhizomes as these are thought to be the medicinal parts of the plant.Most black cohosh supplements are naturally vegan and gluten-free but check the product label regarding these and other diet restrictions you may have.
Summary
Black cohosh is an herb that may be used to treat various health conditions, most of which affect people assigned female at birth.
Despite its long use in traditional medicine, scientific evidence is conflicting regarding its use in relieving menopause symptoms like hot flashes, vaginal dryness, and night sweats.
Side effects are rare but possible when taking black cohosh, and certain people should take extra precautions. Talk with your healthcare provider before trying black cohosh to ensure it is right for you.
17 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institutes of Health’s Office of Dietary Supplements.Black cohosh.Kargozar R, Azizi H, Salari R.A review of effective herbal medicines in controlling menopausal symptoms.Electron Physician. 2017 Nov 25;9(11):5826-5833. doi:10.19082/5826.National Institutes of Health’s Office of Dietary Supplements.Black cohosh.Kenda M, Glavač NK, Nagy M, Sollner Dolenc M, On Behalf Of The Oemonom.Herbal Products Used in Menopause and for Gynecological Disorders.Molecules. 2021 Dec 8;26(24):7421. doi:10.3390/molecules26247421.Mehrpooya M, Rabiee S, Larki-Harchegani A, et al.A comparative study on the effect of “black cohosh” and “evening primrose oil” on menopausal hot flashes.J Educ Health Promot. 2018;7:36. doi:10.4103/jehp.jehp_81_17Franco OH, Chowdhury R, Troup J, et al.Use of plant-based therapies and menopausal symptoms: a aystematic review and meta-analysis.JAMA. 2016;315(23):2554-2563. doi:10.1001/jama.2016.8012Roozbeh N, Kashef R, Ghazanfarpour M, Kargarfard L, Darvish L, Khadivzadeh T,et al.Overview of the Effect of Herbal Medicines and Isoflavones on the Treatment of Cognitive Function.J Menopausal Med. 2018 Aug;24(2):113-118. doi: 10.6118/jmm.2018.24.2.113.North American Menopause Society.Natural Remedies for Hot Flashes.Fan CW, Cieri-Hutcherson NE, Hutcherson TC.Systematic review of black cohosh (Cimicifuga racemosa) for management of polycystic ovary syndrome-related infertility.J Pharm Pract. 2022;35(6):991-999. doi:10.1177/08971900211012244.National Center for Complementary and Integrative Health.Black cohosh.Naser B, Castelo-Branco C, Meden H, et al.Weight gain in menopause: systematic review of adverse events in women treated with black cohosh.Climacteric. October 5, 2021:1-8. doi:10.1080/13697137.2021.1973993Yu Y, Tan J, Nie J, Lv C, Lu J.Fibrous Roots of Cimicifuga Are at Risk of Hepatotoxicity.Molecules. 2022 Jan 29;27(3):938. doi:10.3390/molecules27030938.Asher GN, Corbett AH, Hawke RL.Common herbal dietary supplement–drug interactions.AFP. 2017;96(2):101-107.Kanadys W, Barańska A, Błaszczuk A, Polz-Dacewicz M, Drop B, Kanecki K,et al.Evaluation of clinical meaningfulness of red clover (Trifolium pratenseL.) extract to relieve hot flushes and menopausal symptoms in peri- and post-menopausal women: a systematic review and meta-analysis of randomized controlled trials.Nutrients. 2021;13(4):1258. doi:10.3390/nu13041258.Facchinetti F, Appetecchia M, Aragona C, Bevilacqua A, Bezerra Espinola MS, Bizzarri M.Experts’ opinion on inositols in treating polycystic ovary syndrome and non-insulin dependent diabetes mellitus: a further help for human reproduction and beyond.Expert Opin Drug Metab Toxicol. 2020;16(3):255-274. doi:10.1080/17425255.2020.1737675Larmo PS, Yang B, Hyssälä J, Kallio HP, Erkkola R.Effects of sea buckthorn oil intake on vaginal atrophy in postmenopausal women: a randomized, double-blind, placebo-controlled study.Maturitas. 2014;79(3):316-321. doi:10.1016/j.maturitas.2014.07.010.Naseri R, Farnia V, Yazdchi K, Alikhani M, Basanj B, Salemi S.Comparison of Vitex agnus-castus extracts with placebo in reducing menopausal symptoms: a randomized double-blind study.Korean J Fam Med. 2019;40(6):362-367. doi:10.4082/kjfm.18.0067
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institutes of Health’s Office of Dietary Supplements.Black cohosh.Kargozar R, Azizi H, Salari R.A review of effective herbal medicines in controlling menopausal symptoms.Electron Physician. 2017 Nov 25;9(11):5826-5833. doi:10.19082/5826.National Institutes of Health’s Office of Dietary Supplements.Black cohosh.Kenda M, Glavač NK, Nagy M, Sollner Dolenc M, On Behalf Of The Oemonom.Herbal Products Used in Menopause and for Gynecological Disorders.Molecules. 2021 Dec 8;26(24):7421. doi:10.3390/molecules26247421.Mehrpooya M, Rabiee S, Larki-Harchegani A, et al.A comparative study on the effect of “black cohosh” and “evening primrose oil” on menopausal hot flashes.J Educ Health Promot. 2018;7:36. doi:10.4103/jehp.jehp_81_17Franco OH, Chowdhury R, Troup J, et al.Use of plant-based therapies and menopausal symptoms: a aystematic review and meta-analysis.JAMA. 2016;315(23):2554-2563. doi:10.1001/jama.2016.8012Roozbeh N, Kashef R, Ghazanfarpour M, Kargarfard L, Darvish L, Khadivzadeh T,et al.Overview of the Effect of Herbal Medicines and Isoflavones on the Treatment of Cognitive Function.J Menopausal Med. 2018 Aug;24(2):113-118. doi: 10.6118/jmm.2018.24.2.113.North American Menopause Society.Natural Remedies for Hot Flashes.Fan CW, Cieri-Hutcherson NE, Hutcherson TC.Systematic review of black cohosh (Cimicifuga racemosa) for management of polycystic ovary syndrome-related infertility.J Pharm Pract. 2022;35(6):991-999. doi:10.1177/08971900211012244.National Center for Complementary and Integrative Health.Black cohosh.Naser B, Castelo-Branco C, Meden H, et al.Weight gain in menopause: systematic review of adverse events in women treated with black cohosh.Climacteric. October 5, 2021:1-8. doi:10.1080/13697137.2021.1973993Yu Y, Tan J, Nie J, Lv C, Lu J.Fibrous Roots of Cimicifuga Are at Risk of Hepatotoxicity.Molecules. 2022 Jan 29;27(3):938. doi:10.3390/molecules27030938.Asher GN, Corbett AH, Hawke RL.Common herbal dietary supplement–drug interactions.AFP. 2017;96(2):101-107.Kanadys W, Barańska A, Błaszczuk A, Polz-Dacewicz M, Drop B, Kanecki K,et al.Evaluation of clinical meaningfulness of red clover (Trifolium pratenseL.) extract to relieve hot flushes and menopausal symptoms in peri- and post-menopausal women: a systematic review and meta-analysis of randomized controlled trials.Nutrients. 2021;13(4):1258. doi:10.3390/nu13041258.Facchinetti F, Appetecchia M, Aragona C, Bevilacqua A, Bezerra Espinola MS, Bizzarri M.Experts’ opinion on inositols in treating polycystic ovary syndrome and non-insulin dependent diabetes mellitus: a further help for human reproduction and beyond.Expert Opin Drug Metab Toxicol. 2020;16(3):255-274. doi:10.1080/17425255.2020.1737675Larmo PS, Yang B, Hyssälä J, Kallio HP, Erkkola R.Effects of sea buckthorn oil intake on vaginal atrophy in postmenopausal women: a randomized, double-blind, placebo-controlled study.Maturitas. 2014;79(3):316-321. doi:10.1016/j.maturitas.2014.07.010.Naseri R, Farnia V, Yazdchi K, Alikhani M, Basanj B, Salemi S.Comparison of Vitex agnus-castus extracts with placebo in reducing menopausal symptoms: a randomized double-blind study.Korean J Fam Med. 2019;40(6):362-367. doi:10.4082/kjfm.18.0067
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Institutes of Health’s Office of Dietary Supplements.Black cohosh.Kargozar R, Azizi H, Salari R.A review of effective herbal medicines in controlling menopausal symptoms.Electron Physician. 2017 Nov 25;9(11):5826-5833. doi:10.19082/5826.National Institutes of Health’s Office of Dietary Supplements.Black cohosh.Kenda M, Glavač NK, Nagy M, Sollner Dolenc M, On Behalf Of The Oemonom.Herbal Products Used in Menopause and for Gynecological Disorders.Molecules. 2021 Dec 8;26(24):7421. doi:10.3390/molecules26247421.Mehrpooya M, Rabiee S, Larki-Harchegani A, et al.A comparative study on the effect of “black cohosh” and “evening primrose oil” on menopausal hot flashes.J Educ Health Promot. 2018;7:36. doi:10.4103/jehp.jehp_81_17Franco OH, Chowdhury R, Troup J, et al.Use of plant-based therapies and menopausal symptoms: a aystematic review and meta-analysis.JAMA. 2016;315(23):2554-2563. doi:10.1001/jama.2016.8012Roozbeh N, Kashef R, Ghazanfarpour M, Kargarfard L, Darvish L, Khadivzadeh T,et al.Overview of the Effect of Herbal Medicines and Isoflavones on the Treatment of Cognitive Function.J Menopausal Med. 2018 Aug;24(2):113-118. doi: 10.6118/jmm.2018.24.2.113.North American Menopause Society.Natural Remedies for Hot Flashes.Fan CW, Cieri-Hutcherson NE, Hutcherson TC.Systematic review of black cohosh (Cimicifuga racemosa) for management of polycystic ovary syndrome-related infertility.J Pharm Pract. 2022;35(6):991-999. doi:10.1177/08971900211012244.National Center for Complementary and Integrative Health.Black cohosh.Naser B, Castelo-Branco C, Meden H, et al.Weight gain in menopause: systematic review of adverse events in women treated with black cohosh.Climacteric. October 5, 2021:1-8. doi:10.1080/13697137.2021.1973993Yu Y, Tan J, Nie J, Lv C, Lu J.Fibrous Roots of Cimicifuga Are at Risk of Hepatotoxicity.Molecules. 2022 Jan 29;27(3):938. doi:10.3390/molecules27030938.Asher GN, Corbett AH, Hawke RL.Common herbal dietary supplement–drug interactions.AFP. 2017;96(2):101-107.Kanadys W, Barańska A, Błaszczuk A, Polz-Dacewicz M, Drop B, Kanecki K,et al.Evaluation of clinical meaningfulness of red clover (Trifolium pratenseL.) extract to relieve hot flushes and menopausal symptoms in peri- and post-menopausal women: a systematic review and meta-analysis of randomized controlled trials.Nutrients. 2021;13(4):1258. doi:10.3390/nu13041258.Facchinetti F, Appetecchia M, Aragona C, Bevilacqua A, Bezerra Espinola MS, Bizzarri M.Experts’ opinion on inositols in treating polycystic ovary syndrome and non-insulin dependent diabetes mellitus: a further help for human reproduction and beyond.Expert Opin Drug Metab Toxicol. 2020;16(3):255-274. doi:10.1080/17425255.2020.1737675Larmo PS, Yang B, Hyssälä J, Kallio HP, Erkkola R.Effects of sea buckthorn oil intake on vaginal atrophy in postmenopausal women: a randomized, double-blind, placebo-controlled study.Maturitas. 2014;79(3):316-321. doi:10.1016/j.maturitas.2014.07.010.Naseri R, Farnia V, Yazdchi K, Alikhani M, Basanj B, Salemi S.Comparison of Vitex agnus-castus extracts with placebo in reducing menopausal symptoms: a randomized double-blind study.Korean J Fam Med. 2019;40(6):362-367. doi:10.4082/kjfm.18.0067
National Institutes of Health’s Office of Dietary Supplements.Black cohosh.
Kargozar R, Azizi H, Salari R.A review of effective herbal medicines in controlling menopausal symptoms.Electron Physician. 2017 Nov 25;9(11):5826-5833. doi:10.19082/5826.
Kenda M, Glavač NK, Nagy M, Sollner Dolenc M, On Behalf Of The Oemonom.Herbal Products Used in Menopause and for Gynecological Disorders.Molecules. 2021 Dec 8;26(24):7421. doi:10.3390/molecules26247421.
Mehrpooya M, Rabiee S, Larki-Harchegani A, et al.A comparative study on the effect of “black cohosh” and “evening primrose oil” on menopausal hot flashes.J Educ Health Promot. 2018;7:36. doi:10.4103/jehp.jehp_81_17
Franco OH, Chowdhury R, Troup J, et al.Use of plant-based therapies and menopausal symptoms: a aystematic review and meta-analysis.JAMA. 2016;315(23):2554-2563. doi:10.1001/jama.2016.8012
Roozbeh N, Kashef R, Ghazanfarpour M, Kargarfard L, Darvish L, Khadivzadeh T,et al.Overview of the Effect of Herbal Medicines and Isoflavones on the Treatment of Cognitive Function.J Menopausal Med. 2018 Aug;24(2):113-118. doi: 10.6118/jmm.2018.24.2.113.
North American Menopause Society.Natural Remedies for Hot Flashes.
Fan CW, Cieri-Hutcherson NE, Hutcherson TC.Systematic review of black cohosh (Cimicifuga racemosa) for management of polycystic ovary syndrome-related infertility.J Pharm Pract. 2022;35(6):991-999. doi:10.1177/08971900211012244.
National Center for Complementary and Integrative Health.Black cohosh.
Naser B, Castelo-Branco C, Meden H, et al.Weight gain in menopause: systematic review of adverse events in women treated with black cohosh.Climacteric. October 5, 2021:1-8. doi:10.1080/13697137.2021.1973993
Yu Y, Tan J, Nie J, Lv C, Lu J.Fibrous Roots of Cimicifuga Are at Risk of Hepatotoxicity.Molecules. 2022 Jan 29;27(3):938. doi:10.3390/molecules27030938.
Asher GN, Corbett AH, Hawke RL.Common herbal dietary supplement–drug interactions.AFP. 2017;96(2):101-107.
Kanadys W, Barańska A, Błaszczuk A, Polz-Dacewicz M, Drop B, Kanecki K,et al.Evaluation of clinical meaningfulness of red clover (Trifolium pratenseL.) extract to relieve hot flushes and menopausal symptoms in peri- and post-menopausal women: a systematic review and meta-analysis of randomized controlled trials.Nutrients. 2021;13(4):1258. doi:10.3390/nu13041258.
Facchinetti F, Appetecchia M, Aragona C, Bevilacqua A, Bezerra Espinola MS, Bizzarri M.Experts’ opinion on inositols in treating polycystic ovary syndrome and non-insulin dependent diabetes mellitus: a further help for human reproduction and beyond.Expert Opin Drug Metab Toxicol. 2020;16(3):255-274. doi:10.1080/17425255.2020.1737675
Larmo PS, Yang B, Hyssälä J, Kallio HP, Erkkola R.Effects of sea buckthorn oil intake on vaginal atrophy in postmenopausal women: a randomized, double-blind, placebo-controlled study.Maturitas. 2014;79(3):316-321. doi:10.1016/j.maturitas.2014.07.010.
Naseri R, Farnia V, Yazdchi K, Alikhani M, Basanj B, Salemi S.Comparison of Vitex agnus-castus extracts with placebo in reducing menopausal symptoms: a randomized double-blind study.Korean J Fam Med. 2019;40(6):362-367. doi:10.4082/kjfm.18.0067
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