Common Names: black cohosh, bugbane, bugwort, black snakeroot, macrotys, rattleroot, rattleweed

Scientific Names: Actaea racemosa, Cimicifuga racemosa

Background

• Black cohosh, belonging to the buttercup family, is native to North America. It was traditionally applied by Native American communities to manage issues such as kidney problems, fevers, throat pain, and menstrual discomfort. It has enjoyed a history of medicinal use in Germany since the late 1800s.

• Today, black cohosh is marketed primarily as a supplement to help ease menopause symptoms. It’s also used for menstrual concerns like cramps and premenstrual discomfort and has sometimes been considered to support labor induction.

• The main part of the plant used for medicinal purposes is the root or rhizome (an underground part of the stem).

How Much Do We Know?

• Numerous clinical studies have been conducted to explore the effectiveness of black cohosh in relieving symptoms of menopause. However, there is far less scientific investigation into its impact on other health conditions.

What Have We Learned?

• A 2023 analysis examining 22 studies on products featuring black cohosh—some combined with other herbs—suggested potential overall relief for menopausal symptoms. Specifically, improvements were seen in reducing hot flashes, but limited effects were noted concerning mood issues like anxiety or depression.

• It remains unclear whether black cohosh can lessen the hot flashes caused by treatments for breast cancer.

• Solid evidence is still lacking when it comes to using black cohosh effectively for conditions outside of menopause-related symptoms.

What Do We Know About Safety?

• Clinical studies have used black cohosh safely for up to a year, and most people tolerate it well. However, there have been occasional reports linking black cohosh to liver damage. These incidents are rare and it’s never been definitively proven that black cohosh was the cause. If you notice symptoms like dark-colored urine or extreme tiredness while taking it, seek medical advice promptly.

• Some products sold as black cohosh may include other herbs or contain misidentified plant material, which might contribute to cases of liver problems. The precise cause is still uncertain.

• It’s important not to confuse black cohosh with blue cohosh (Caulophyllum thalictroides), a completely distinct plant known to trigger issues like high blood pressure, increased blood sugar, and chest discomfort. Blue cohosh has been associated with dangerous effects in newborns when used to start labor.

• The safety of black cohosh in women with hormone-sensitive ailments, such as cancers of the breast or uterus, is yet to be clearly established.

• If you’re on any medication, consult a healthcare provider prior to using black cohosh or other botanical supplements, as they might interact negatively with other drugs.

• It is not recommended to use black cohosh while pregnant or breastfeeding, as its safety in these circumstances is not proven.

Keep in Mind

• Be proactive in your healthcare. Always discuss complementary or alternative remedies with your medical provider. Making shared, knowledgeable choices is essential for your safety and wellbeing.

• Regulation of herbal items depends on their ingredients, application, and form of use (oral or topical). Many are sold as dietary supplements, which face less stringent regulations compared to prescription drugs.

• Dietary supplements do not require approval from the U.S. Food and Drug Administration (FDA) before they become available to consumers. If concerns arise about a supplement’s safety, the FDA can take measures to protect the public. It’s the responsibility of supplement manufacturers to ensure their product labeling and safety meet all established standards before sale.

For More Information

• Practical Tips on Using Dietary Supplements Safely

• Educational Resources on Interactions Between Medications and Herbs

• Understanding Scientific Research Articles More Clearly

NCCIH Clearinghouse

The NCCIH Clearinghouse offers information on integrative and complementary health, with access to official resources and scientific literature searches. Note that it does not offer personalized medical advice, diagnoses, or referrals.

Toll-free: 1-888-644-6226

TRS: 7-1-1

Email: [email protected]

PubMed®

Hosted by the National Library of Medicine, PubMed® includes summaries and references for a wide array of scientific journal articles. NCCIH provides instructions on searching for relevant complimentary health research through this database.

Office of Dietary Supplements (NIH)

The Office of Dietary Supplements works to improve understanding of supplement use by funding research, sharing findings, and educating the public. Its library includes detailed fact sheets on individual ingredients like vitamin D and multivitamins.

Email: [email protected]

Key References

• Black cohosh. Drugs and Lactation Database (LactMed), National Institute of Child Health and Human Development. Last revised May 17, 2021.

• Black cohosh. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury, National Institute of Diabetes and Digestive and Kidney Diseases. Last updated November 4, 2020.

• Black cohosh. NatMed Pro database. Accessed August 31, 2023. [Subscription required]

• Blue cohosh. NatMed Pro database. Accessed September 19, 2023. [Subscription required]

• Fabricant DS, Krause EC, Farnsworth NR. Black cohosh. Encyclopedia of Dietary Supplements, 2nd ed. Informa Healthcare; 2010: pp. 60–74.

• Frommenwiler DA, Reich E, Sharaf MHM, et al. Evaluating herbal product quality using HPTLC. Frontiers in Pharmacology. 2022;13:925298.

• National Cancer Institute. Black Cohosh (PDQ)—Health Professional Version. Accessed September 1, 2023.

• Office of Dietary Supplements. Black Cohosh: Fact Sheet for Health Professionals. Accessed September 5, 2023.

• Sadahiro R, Matsuoka LN, Zeng B-S, et al. Black cohosh for menopausal symptoms: meta-analysis. Menopause. 2023;30(7):766–773.

This document is in the public domain and may be copied freely.

Information provided here is for general knowledge only and does not take the place of medical advice from a qualified healthcare provider. You should consult your provider regarding any treatment or healthcare decisions. Mention of any product or therapy does not imply endorsement by NCCIH.