Black Cohosh

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), dated 22 September 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.7 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.8 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.9 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:

Links

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  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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  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 A Practitioner [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
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  39. Is Daily Black Cohosh Effective and Safe for Reducing Menopause Symptoms When Compared With Placebo?
  40. 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
  41. 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]
  42. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Treating Menopause Symptoms [+ Video] [Other Languages and Formats]
  43. Let’s Talk About Perimenopause
  44. Lots of Women Try Herbs Like Black Cohosh for Menopausal Symptoms Like Hot Flushes – But Does It Work?
  45. Managing Menopause Symptoms [+ Video Courtesy: Mayo Clinic News Network]
  46. Mayo Clinic Q and A: Perimenopause Transitions and Concerns
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  50. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Menopause Medication Tracker
  51. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Questions for Your Health Care Provider
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  52. Menopause Symptoms and Relief
  53. Menopause Symptoms: Mayo Clinic Expert Outlines Hormone and Nonhormonal Therapies
  54. Menopause, Perimenopause, Hormone Therapy and Other Treatments With Madelyn Butler, MD [Podcast]
  55. Menopause: Diagnosis & Treatment
  56. Menopause: Ensuring A Tranquil Transition
  57. Menopause: Identification and Management [NICE Guideline]
  58. Menopause: Identification and Management [NICE Guideline]Black Cohosh
  59. Menopause: Things You Can Do
  60. National Center for Complementary and Integrative Health
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  63. National Center for Complementary and Integrative Health: Black Cohosh
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  67. National Center for Complementary and Integrative Health: Natural Doesn’t Necessarily Mean Safer, or Better
  68. National Center for Complementary and Integrative Health: Placebo Effect
  69. Natural Therapies
  70. Navigating Menopause Care Resource Guide
  71. Non-Hormonal Management of Vasomotor Symptoms of Menopause
  72. Non-Hormonal Treatments Offer Relief for Genitourinary Syndrome of Menopause
  73. Nonhormone Treatments for Hot Flashes and Night Sweats
  74. Office of Dietary Supplements [United States]: Background Information: Dietary Supplements
  75. Office of Dietary Supplements [United States]: Dietary Supplement Fact Sheets
  76. Office of Dietary Supplements [United States]: Dietary Supplements: What You Need To Know
  77. Online Events [International Menopause Society]: Past Webinars – 2024: Non-Hormonal Pharmacological Interventions For VMS
  78. Online Events [International Menopause Society]: Past Webinars – 2024: Non-Pharmacological Interventions For VMS
  79. Online Events [International Menopause Society]: Past Webinars – 2025: Lifestyle Medicine
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  85. Review & Meta-Analysis: Isopropanolic Black Cohosh Extract iCR for Menopausal Symptoms – An Update on the Evidence
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  87. Tips To Help Manage Menopause Symptoms
  88. Treatments for Menopause: Natural Therapies for Menopause
  89. Vaginal Dryness
  90. Vaginal Dryness After Menopause: How To Treat It? I’m postmenopausal and often have vaginal dryness, which makes intercourse painful. Is there anything I can do about it?
  91. 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: 22 March 2026
  2. Black Cohosh: Introduction. Updated: 30 June 2020. Office of Dietary Supplements https://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/ Accessed: 22 March 2026
  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: 22 March 2026
  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: 22 March 2026
  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: 22 March 2026
  6. Complementary Medicines and Therapies for Hot Flushes: Specific Herbal and Botanical Therapies – Black Cohosh (Cimicifuga Racemosa or Actaea Racemosa). 22 September 2025. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/complementary-medicines-and-therapies-for-hot-flushes Accessed: 22 March 2026
  7. Treatments for Menopause: Natural Therapies for Menopause – Natural Therapies for Hot Flushes and Night Sweats. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-topics/menopause/treatments-for-menopause/#non-hormone-treatments-for-menopause Accessed: 22 March 2026
  8. Treatments for Menopause: Natural Therapies for Menopause – Natural Therapies for Vaginal Changes. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-topics/menopause/treatments-for-menopause/#non-hormone-treatments-for-menopause Accessed: 22 March 2026
  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: 22 March 2026
  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: 22 March 2026
  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: 22 March 2026
  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: 22 March 2026
  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: 22 March 2026
Topic Last Updated: 22 March 2026 – Topic Last Reviewed: 22 March 2026

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