Black Cohosh 

This fact sheet provides basic information about the herb black cohosh—common 

names, uses, potential side effects, and resources for more information. Black cohosh, 

a member of the buttercup family, is a plant native to North America. It was used in 

Native American medicine and was a home remedy in 19th-century America. 

Common Names—black cohosh, black snakeroot, macrotys, bugbane, 

bugwort, rattleroot, rattleweed 

Latin Names—Actaea racemosa, Cimicifuga racemosa 

What It Is Used For 

•	 Black cohosh has a history of use for rheumatism (arthritis and muscle pain) 

but has been used more recently to treat hot flashes, night sweats, vaginal 

dryness, and other symptoms that can occur during menopause. 

•	 Black cohosh has also been used for menstrual irregularities and 

premenstrual syndrome, and to induce labor. 

How It Is Used 

The underground stems and roots of black cohosh are commonly used fresh or 

dried to make strong teas (infusions), capsules, solid extracts used in pills, or 

liquid extracts (tinctures). 

What the Science Says 

•	 Study results are mixed on whether black cohosh effectively relieves menopausal 

symptoms. An NCCAM-funded study found that black cohosh, whether used 

alone or with other botanicals, failed to relieve hot flashes and night sweats in 

postmenopausal women or those approaching menopause. 

•	 Most studies to date have been less than 6 months long, so the safety of 

long-term use is unknown. 

•	 NCCAM is funding studies to further understand the potential effects of 

black cohosh on hot flashes and other menopausal symptoms. 

•	 There are not enough reliable data to determine whether black cohosh is 

effective for rheumatism or other uses. 

Side Effects and Cautions 

•	 United States Pharmacopeia experts suggest women should discontinue use of 

black cohosh and consult a health care practitioner if they have a liver disorder 

or develop symptoms of liver trouble, such as abdominal pain, dark urine, or 

jaundice. There have been several case reports of hepatitis (inflammation of the 

liver), as well as liver failure, in women who were taking black cohosh. It is not 

known if black cohosh was responsible for these problems. Although these cases 

are very rare and the evidence is not definitive, scientists are concerned about the 

possible effects of black cohosh on the liver. 
 

 

 

•	 Black cohosh can cause headaches and stomach discomfort. In clinical trials comparing the effects of 

the herb and those of estrogens, a low number of side effects were reported, such as headaches, 

gastric complaints, heaviness in the legs, and weight problems. 

•	 No interactions have been reported between black cohosh and prescription medicines. 

•	 It is not clear if black cohosh is safe for women who have had breast cancer or for pregnant women. 

•	 Black cohosh should not be confused with blue cohosh (Caulophyllum thalictroides), which has different 

properties, treatment uses, and side effects than black cohosh. Black cohosh is sometimes used with 

blue cohosh to stimulate labor, but this therapy has caused adverse effects in newborns, which 

appear to be due to blue cohosh. 

•	 Tell your health care providers about any complementary and alternative practices you use. 

Give them a full picture of what you do to manage your health. This will help ensure 

coordinated and safe care. 

Sources 

Mahady GB, Low Dog T, Barrett ML, et al. United States Pharmacopeia review of the black cohosh case reports of 

hepatotoxicity. Menopause. 2008;15(4 Pt 1):628-638. 

Newton KM, Reed SD, LaCroix AZ, et al. Treatment of vasomotor symptoms of menopause with black cohosh, 

multibotanicals, soy, hormone therapy, or placebo: a randomized trial. Annals of Internal Medicine. 2006;145(12):869-879. 

Office of Dietary Supplements and National Center for Complementary and Alternative Medicine. Questions and Answers 

About Black Cohosh and the Symptoms of Menopause. Office of Dietary Supplements Web site. Accessed at 

http://ods.od.nih.gov/factsheets/blackcohosh.asp on July 2, 2007. 

National Center for Complementary and Alternative Medicine and Office of Dietary Supplements. Workshop on the Safety 

of Black Cohosh in Clinical Studies. National Center for Complementary and Alternative Medicine Web site. Accessed at 

http://nccam.nih.gov/news/pastmeetings/blackcohosh_mtngsumm.pdf on July 2, 2007. 

Black cohosh. Natural Medicines Comprehensive Database Web site. Accessed at http://www.naturaldatabase.com on 

June 29, 2007. 

Black cohosh (Cimicifuga racemosa [L.] Nutt.). Natural Standard Database Web site. Accessed at 

http://www.naturalstandard.com on June 28, 2007. 

Black cohosh root. In: Blumenthal M, Goldberg A, Brinckman J, eds. Herbal Medicine: Expanded Commission E Monographs. 

Newton, MA: Lippincott Williams & Wilkins; 2000:22-26. 

For More Information 

Visit the NCCAM Web site at nccam.nih.gov and view: 

•	 What’s in the Bottle? An Introduction to Dietary Supplements at nccam.nih.gov/health/bottle/ 

•	 Herbal Supplements: Consider Safety, Too at nccam.nih.gov/health/supplement-safety/ 

NCCAM Clearinghouse 

Toll-free in the U.S.: 1-888-644-6226 

TTY (for deaf and hard-of-hearing callers): 1-866-464-3615 

E-mail: info@nccam.nih.gov 

CAM on PubMed 

Web site: nccam.nih.gov/camonpubmed/ 

NIH Office of Dietary Supplements 

Web site: www.ods.od.nih.gov 

This publication is not copyrighted and is in the public domain. Duplication is encouraged. 

NCCAM has provided this material for your information. It is not intended to substitute for the medical 

expertise and advice of your primary health care provider. We encourage you to discuss any decisions about 

treatment or care with your health care provider. The mention of any product, service, or therapy is not an 

endorsement by NCCAM. 

National Institutes of Health 

♦♦♦

U.S. Department of Health and Human Services 

D268 

Created July 2005 

Updated November 2008 

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