Black Cohosh

© Steven Foster

This fact sheet provides basic information about black cohosh—

common names, what the science says, potential side effects and 

cautions, and resources for more information.

Common Names—black cohosh, black snakeroot, macrotys, 

bugbane, bugwort, rattleroot, rattleweed

Latin Names—Actaea racemosa, Cimicifuga racemosa

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. Black cohosh has a history of use 

for rheumatism (arthritis and muscle pain) but has been used more 

recently as a folk or traditional remedy for 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.

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 uncertain.

• 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.

• Some people taking black cohosh have experienced side effects such as stomach discomfort, headache, or 

rash. In general, clinical trials of black cohosh for menopausal symptoms have not found serious side effects.

• Although concerns have been raised about possible interactions between black cohosh and various 

medications, a 2008 review of studies to date concluded that the risk of such interactions appears to be small.

• It is not clear if black cohosh is safe for women who have had hormone-sensitive conditions such as 

breast cancer or for pregnant women or nursing mothers.

• 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 all your health care providers about any complementary health practices you use. Give them a full 

picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips 

about talking with your health care providers about complementary and alternative medicine, see 

NCCAM’s Time to Talk campaign at nccam.nih.gov/timetotalk/. 

Sources

Black cohosh. Natural Medicines Comprehensive Database Web site. Accessed at www.naturaldatabase.com on April 10, 2009.

Black cohosh (Cimicifuga racemosa [L.] Nutt.). Natural Standard Database Web site. Accessed at www.naturalstandard.com on April 10, 2009.

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.

Borrelli F, Ernst E. Black cohosh (Cimicifuga racemosa) for menopausal symptoms: a systematic review of its efficacy. Pharmacological 

Research. 2008;58(1):8-14.

Borrelli F, Ernst E. Black cohosh (Cimicifuga racemosa): a systematic review of adverse events. American Journal of Obstetrics & Gynecology. 

2008;199(5):455-466.

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. Dietary Supplement Fact Sheet: Black Cohosh. Office of Dietary Supplements Web site. Accessed at 

ods.od.nih.gov/factsheets/blackcohosh/ on April 4, 2012. 

For More Information

Visit the NCCAM Web site at nccam.nih.gov and view Using Dietary Supplements Wisely (nccam.nih.gov/health/supplements/wiseuse.htm).

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

PubMed®

Web site: www.ncbi.nlm.nih.gov/sites/entrez

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 April 2012