Black Cohosh

“A substantial number of studies in people
have evaluated black cohosh for menopause symptoms.
Much less research has been done on black cohosh for…”.1

Umbrella

What may the Black Cohosh Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Actaea Racemosa
  • Black Bugbane
  • Black Cohosh
  • Black Snakeroot
  • Bugbane
  • Bugwort
  • Cimicifuga Racemosa
  • Fairy Candle
  • Macrotys
  • Rattleroot
  • Rattleweed

Definition

What is black cohosh?

DotS the definition of black cohosh may vary. In Black Cohosh: Introduction the definition used by (United States) Office of Dietary Supplements (ODS) is:

“Black cohosh (Actaea racemose or Cimicifuga racemosa), a member of the buttercup family, is a perennial plant native to North America”.2

Studies

What have studies found about the effectiveness of black cohosh for menopausal symptoms?

In Menopause–Biology, Consequences, Supportive Care, and Therapeutic Options: Current Therapeutic Options – Complementary and Herbal Therapies, published 06 September 2023, the authors elaborate on:

“In numerous trials, black cohosh, not to be confused with blue cohosh, which has known liver toxicity, has been shown to be safe with limited efficacy in some single-site clinical trials. However, the HALT study, which was the most rigorous and comprehensive clinical trial to date, consisting of 351 participants, demonstrated no improvement with black cohosh over placebo among perimenopausal women experiencing VMS”.3

Menopause Symptoms

Is black cohosh an effective treatment for menopausal symptoms?

In Black Cohosh: How Much Do We Know? last updated November 2024, the (United States) National Center for Complimentary and Integrative Health (NCCIH) note:

  • “A substantial number of studies in people have evaluated black cohosh for menopause symptoms. Much less research has been done on black cohosh for other conditions”.4

In Black Cohosh: What Have We Learned? the NCCIH also note:

  • “A 2023 review of 22 studies of products containing black cohosh extracts, alone or in combination with other herbs, found that they were potentially beneficial for overall menopause symptoms. Data on specific symptoms showed improvements in hot flashes but not anxiety or depressive symptoms
  • It’s uncertain whether black cohosh can reduce hot flashes related to breast cancer treatment
  • There aren’t enough reliable data to show whether black cohosh is effective for other uses”.5

In Complementary Medicines and Therapies for Hot Flushes: Specific Herbal and Botanical Therapies – Black Cohosh (Cimicifuga Racemosa or Actaea Racemosa), updated April 2025, the Australasian Menopause Society explain:


Black Cohosh
“Specific extracts of black cohosh (isopropanolic), and higher therapeutic doses may improve menopausal symptoms, including hot flushes, as shown in a recent systematic review and meta-analysis. It should be noted that most of the included studies were conducted over short time frames (i.e. 3-6 months) and on small numbers of patients. In addition, although many were placebo-controlled trials, no studies compared black cohosh to conventional MHT.

There were originally reports of liver toxicity from the use of black cohosh. A review of the 69 cases of suspected black cohosh-induced liver disease concluded that data does not support a direct causal relationship, with no signal of safety concern. Another meta-analysis found no evidence of black cohosh adversely affecting liver function, although studies were only up to 6 months of treatment”.6

Hot Flushes

Does black cohosh help to manage hot flushes?

In Treatments for Menopause: Natural Therapies for Menopause – Natural Therapies for Hot Flushes and Night Sweats the (Australian) Jean Hailes for Women’s Health (JH) note:

“Some evidence suggests that the herb black cohosh helps to manage hot flushes.

When the herb St John’s wort is combined with black cohosh or passionflower, it may reduce hot flushes and improve your mood”.7

Vaginal Dryness

Is black cohosh useful for treating vaginal dryness?

In Treatments for Menopause: Natural Therapies for Menopause – Natural Therapies for Vaginal Changes the JH explain:

“Black cohosh may be useful for treating vaginal dryness. Ask your health practitioner about black cohosh pessaries and vaginal cream”.8

Effective or Not

Is black cohosh effective for the treatment of menopausal symptoms?

In Hot Flashes: Diagnosis & Treatment – Alternative Medicine: Dietary Supplements the (United States) Mayo Clinic note:

  • “Black Cohosh. Many people use black cohosh to ease menopause symptoms. Studies of how well black cohosh works have had mixed results. And it’s rare, but there may be a link between black cohosh and liver damage”.9

Liver Damage

Is there an association between black cohosh and liver damage in some people?

In Black Cohosh: What Do We know About Safety? last updated November 2024, the NCCIH elaborate on:

  • “While black cohosh has been used safely in research studies that lasted as long as a year and is generally well tolerated, concerns have been raised that it may cause liver damage in some people.
    • Cases of liver damage—some very serious—have been reported in people taking products labeled as black cohosh. These problems are rare, and it’s uncertain whether black cohosh was responsible for them. If you take black cohosh, consult your health care provider if you develop symptoms of liver damage such as dark urine and fatigue…”.10

Breast or Uterine Cancer

Is black cohosh safe for women who have had hormone-sensitive conditions such as breast or uterine cancer?

In Black Cohosh: What Do We know About Safety? last updated November 2024, the NCCIH elaborate on:

  • “It’s uncertain whether black cohosh is safe for women who have had hormone-sensitive conditions such as breast or uterine cancer”.11

Health Care Provider

What if I choose to use black cohosh?

If you choose to use black cohosh, it may be in your best interest to also choose to talk to your health care providers about this.

In Lots of Women Try Herbs Like Black Cohosh for Menopausal Symptoms Like Hot Flushes – But Does It Work? published 20 September 2023, the authors note:

“Women experiencing troublesome menopausal symptoms, such as hot flushes, should talk to their doctor about the best treatment options for them”.12 

In Menopause–Biology, Consequences, Supportive Care, and Therapeutic Options: Current Therapeutic Options – Complementary and Herbal Therapies, the authors note:

“Consideration of over-the-counter remedy use should include a shared decision-making plan to perform intermittent monitoring of liver and renal function because such therapies are not regulated by most national regulating bodies and have been shown to contain doses that differ from that on the label and occasional impurities that could cause harm”.13

Health Topics A-Z

Where may I find Health Topics A-Z related to Black Cohosh?

In Health Topics A-Z you may find:

Health Topics A-Z

Links

Where may I find Links related to Black Cohosh?

Your Country may have Links similar to:

Black Women’s Menopause

Links

This Links List to third party websites is neither comprehensive nor exhaustive. Inclusion on this Links List does not imply endorsement or recommendation. Non-inclusion on this Links List does not imply non-endorsement or non-recommendation. Third party websites are not under the control of Meno Martha International Menopause Directory. Third party websites may contain explicit medical images and/or sexual references. Please read Meno Martha International Menopause Directory’s Links Policy before proceeding to a Link. Please contact Webmaster if you experience a problem with a Link.

New or Updated

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  6. Complementary & Alternative Therapies. Non Hormonal Treatments for Menopause Symptoms
  7. Complementary Medicines and Therapies for Hot Flushes
  8. Complementary Medicines and Therapies: Options for Menopausal Symptoms
  9. Consumer Video and Podcast Series: 2023 Consumer Videos and Podcasts – NAMS 2023 Nonhormone Therapies Position Statement for Bothersome Menopause Symptoms
  10. Consumer Video and Podcast Series: 2023 Consumer Videos and Podcasts – New FDA-Approved Nonhormone Option for the Treatment of Hot Flashes
  11. Consumer Video and Podcast Series: 2024 Consumer Videos and Podcasts – Cognitive Behavioral Therapy and Menopause
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  13. Did You Know? Supplements and Medications Can Interact In Unexpected Ways
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  19. Drugs and Supplements: Herbs, Supplements and Vitamins [Topics]
  20. Effectiveness of Natural Therapies
  21. Emerging Research In the Management of Menopausal Symptoms
  22. Exploring the Efficacy and Safety of Black Cohosh (Cimicifuga Racemosa) In Menopausal Symptom Management
  23. Find A Menopause Practitioner [United States and Other]
  24. Find An AMS Member [Australasian Menopause Society i.e. Australia and New Zealand]
  25. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  26. Frequently Asked Questions (FAQ)
  27. Genitourinary Syndrome of Menopause
  28. Genitourinary Syndrome of Menopause
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  36. Hot Flashes: What Can I Do? [+ Video: What Are the Signs and Symptoms of Menopause?]
  37. How To Manage Menopausal Insomnia
  38. How To Find Relief for Hot Flashes At Night
  39. How To Talk To Your Doctor About Menopause
    Black Cohosh
  40. Is Daily Black Cohosh Effective and Safe for Reducing Menopause Symptoms When Compared With Placebo?
  41. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause
  42. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Signs and Symptoms of Menopause [+ Video: Talking Menopause With Your GP] [Other Languages and Formats]
  43. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Treating Menopause Symptoms [+ Video] [Other Languages and Formats]
  44. Let’s Talk About Perimenopause
  45. Lots of Women Try Herbs Like Black Cohosh for Menopausal Symptoms Like Hot Flushes – But Does It Work?
  46. Managing Menopause Symptoms [+ Video Courtesy: Mayo Clinic News Network]
  47. Mayo Clinic Minute: Help With Hot Flashes Due To Menopause [+ Video Courtesy: Mayo Clinic News Network]
  48. Mayo Clinic Minute: How Lifestyle Changes May Help Manage Menopause Symptoms [+ Video]
  49. Mayo Clinic Q and A: Perimenopause Transitions and Concerns
  50. Menopause
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  52. Menopause
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  53. Menopause Management Options: Natural & Complementary Therapies – Herbal Therapies and Remedies for Menopause
  54. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Menopause Medication Tracker
  55. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Questions for Your Health Care Provider
    Black Cohosh
  56. Menopause Symptoms and Relief
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  59. Menopause, Perimenopause, Hormone Therapy and Other Treatments With Madelyn Butler, MD [Podcast]
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    Black Cohosh
  63. Menopause: Identification and Management: NICE Guideline [NG23] Published: 12 November 2015 Last Updated: 07 November 2024
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  66. Menopause: Understanding the Changes and Finding Relief | Dr Susan Davis | The Proof Podcast EP 256
  67. Mymenoplan.org [My Menoplan, United States]
  68. National Center for Complementary and Integrative Health
  69. National Center for Complementary and Integrative Health: 4 Tips: Start Talking With Your Health Care Providers About Complementary Health Approaches
  70. National Center for Complementary and Integrative Health: 6 Tips: How Herbs Can Interact With Medicines
  71. National Center for Complementary and Integrative Health: Black Cohosh
  72. National Center for Complementary and Integrative Health: Dietary and Herbal Supplements
  73. National Center for Complementary and Integrative Health: Herbs At A Glance
  74. National Center for Complementary and Integrative Health: How Safe Is This Product or Practice?
  75. National Center for Complementary and Integrative Health: Natural Doesn’t Necessarily Mean Safer, or Better
  76. National Center for Complementary and Integrative Health: Placebo Effect
  77. Natural Therapies
  78. Navigating Menopause: Expert Insights and Solutions | Dr Susan Davis | The Proof Podcast EP 245
  79. Non-Hormonal Management of Vasomotor Symptoms of Menopause
  80. Non-Hormonal Treatments Offer Relief for Genitourinary Syndrome of Menopause
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  82. Office of Dietary Supplements [United States]: Background Information: Dietary Supplements
  83. Office of Dietary Supplements [United States]: Dietary Supplement Fact Sheets
  84. Office of Dietary Supplements [United States]: Dietary Supplements: What You Need To Know
  85. Perimenopause and Menopause Checklist: Translated Checklists
  86. Perimenopause and Menopause Symptom Checklist
  87. Questions and Answers on Dietary Supplements
  88. Review & Meta-Analysis: Isopropanolic Black Cohosh Extract iCR for Menopausal Symptoms – An Update on the Evidence
  89. Safety of Natural Therapies
  90. The Truth About Menopause Supplements | Dr Sarah Berry
  91. Tips To Help Manage Menopause Symptoms
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  93. Using Natural Therapies In the Menopause Transition – Webinar
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  99. Your Guide To Black Cohosh [+ Video]

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Black Cohosh: How Much Do We Know? Last Updated: November 2024. National Center for Complimentary and Integrative Health https://www.nccih.nih.gov/health/black-cohosh Accessed: 04 September 2025
  2. Black Cohosh: Introduction. Updated: 30 June 2020. Office of Dietary Supplements https://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/ Accessed: 04 September 2025
  3. Davis, S. R, Pinkerton, JA., Santoro, N., Simoncini, T. Menopause–Biology, Consequences, Supportive Care, and Therapeutic Options: Current Therapeutic Options – Complementary and Herbal Therapies. Published 06 September 2023 https://www.cell.com/cell/fulltext/S0092-8674(23)00905-4 Accessed: 04 September 2025
  4. Black Cohosh: How Much Do We Know? Last Updated: November 2024. National Center for Complimentary and Integrative Health https://www.nccih.nih.gov/health/black-cohosh Accessed: 04 September 2025
  5. Black Cohosh: What Have We Learned? Last Updated: November 2024. National Center for Complimentary and Integrative Health https://www.nccih.nih.gov/health/black-cohosh Accessed: 04 September 2025
  6. Complementary Medicines and Therapies for Hot Flushes: Specific Herbal and Botanical Therapies – Black Cohosh (Cimicifuga Racemosa or Actaea Racemosa). Updated April 2025. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/complementary-medicines-and-therapies-for-hot-flushes Accessed: 04 September 2025
  7. Treatments for Menopause: Natural Therapies for Menopause – Natural Therapies for Vaginal Changes. Last Updated: 13 May 2025 | Last Reviewed: 22 April 2025. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/menopause-management#non-hormone-treatments-for-menopause Accessed: 04 September 2025
  8. Treatments for Menopause: Natural Therapies for Menopause – Natural Therapies for Hot Flushes and Night Sweats. Last Updated: 13 May 2025 | Last Reviewed: 22 April 2025. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/menopause-management#non-hormone-treatments-for-menopause Accessed: 04 September 2025
  9. Hot Flashes: Diagnosis & Treatment – Alternative Medicine: Dietary Supplements. 04 March 2025. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 04 September 2025
  10. Black Cohosh: What Do We Know About Safety? Last Updated: November 2024. National Center for Complimentary and Integrative Health https://www.nccih.nih.gov/health/black-cohosh Accessed: 04 September 2025
  11. Black Cohosh: What Do We Know About Safety? Last Updated: November 2024. National Center for Complimentary and Integrative Health https://www.nccih.nih.gov/health/black-cohosh Accessed: 04 September 2025
  12. Taylor, S. Davis, S. Lots of Women Try Herbs Like Black Cohosh for Menopausal Symptoms Like Hot Flushes – But Does It Work? 20 September 2023 https://theconversation.com/lots-of-women-try-herbs-like-black-cohosh-for-menopausal-symptoms-like-hot-flushes-but-does-it-work-211272 Accessed: 04 September 2025
  13. Davis, S. R, Pinkerton, JA., Santoro, N., Simoncini, T. Menopause–Biology, Consequences, Supportive Care, and Therapeutic Options: Current Therapeutic Options – Complementary and Herbal Therapies. Published 06 September 2023 https://www.cell.com/cell/fulltext/S0092-8674(23)00905-4 Accessed: 04 September 2025
Topic Last Updated: 04 September 2025 – Topic Last Reviewed: 04 September 2025

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