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. 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

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”.7

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…”.8

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”.9

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”.10 

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”.11

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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  40. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Treating Menopause Symptoms [+ Video] [Other Languages and Formats]
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  72. Office of Dietary Supplements [United States]: Background Information: Dietary Supplements
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  75. Online Events [International Menopause Society]: Past Webinars – 2025: Lifestyle Medicine
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  77. Online Events [International Menopause Society]: Past Webinars – 2026: New IMS Recommendations: Evidence-Based Management of Vasomotor Symptoms
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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: 29 June 2026
  2. Black Cohosh: Introduction. Updated: 30 June 2020. Office of Dietary Supplements https://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/ Accessed: 29 June 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: 29 June 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: 29 June 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: 29 June 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: 29 June 2026
  7. 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: 29 June 2026
  8. 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: 29 June 2026
  9. 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: 29 June 2026
  10. 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: 29 June 2026
  11. 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: 29 June 2026
Topic Last Updated: 29 June 2026 – Topic Last Reviewed: 29 June 2026

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