Black Cohosh


Herbal Support For Women's Needs


Black cohosh is known as a woman’s herb due to its natural properties that may help support the body during hormonal changes that occur monthly and as women age. During these changes disruptions to normal hormone production and regulation occur causing imbalances in an otherwise healthy body. This imbalance may result in a negative health state that affects mood and behavior, (1) the central nervous system, and pain transmission. Symptoms of hormonal changes can be headaches, dizziness, nausea, depression, bone density changes, vascular function imalances, and immune cell self-recognition and activation. (2)

Supplements that contain black cohosh are made from the roots and rhizomes of the plant. Some supplements also contain standardized chemical extracts from the herb. While the supplement form of black cohosh is relatively new, the herb has been used for several hundred years. How and why black cohosh works in the body is not well understood. Early studies have begun to uncover how black cohosh interacts with hormonal pathways and receptors in a healthy body. Additionally, these studies are also trying to identify whether black cohosh may provide alternative or complementary factors to traditional hormone therapies given to women during normal aging.

What is Black Cohosh?


Black cohosh, known by its scientific name Cimicifuga racemosa, belongs in the buttercup family of plants. (3) Black cohosh has a slender, erect stem that reaches a height of up to eight inches. The smooth stem has spear-shaped leaves that reach out from terminal branches. Each leaf is around three inches long and contains one or two lobes with spike-like cuts around the perimeter.

The primary feature of this herb is the slender stem that sprouts from the top and produces small, orb-like buds. (4) Once in bloom, these orbs produce white filament petals that are sometimes described as feathers. However, the part of the plant that is prized for its medicinal properties is its rhizome. The rhizome, or “underground parts,”is a modified stem found underground and sprouts roots or shoots. The rhizome, however, is commonly mistaken as the root of a plant.

Black cohosh is native to deciduous forests in the eastern parts of the United States and Canada. (5) It can be found growing in deep shade of moist hillsides south of Ontario and down to Georgia, to the West in Arkansas, and up to Wisconsin.

Black cohosh is known by numerous nicknames like snakeroot, rattleweed, macrotys, and rheumatism weed. Bugbane is its more common name as it has historically been used as an insect repellent. In fact, the genus Cimicifuga combines the Latin word ‘cimex,’ meaning bed bug, and ‘fuga,’ meaning to drive away.

Native Americans are thought to have been the first to use black cohosh and initially used it for many maladies. More specifically, it is believed the herb was used for challenges of the kidneys, throat, and for women’s health. In folk medicine during the early 1800s, black cohosh is believed to have been administered by physicians for similar health challenges. Also during this era some forms of this plant would be prescribed to support menstruation, induce labor, and ease pain after childbirth.

Uses of Black Cohosh


Black cohosh supplements are available as a whole herb, liquid extract, or in pill or capsule form. (6) Black cohosh supplements are typically formulated to help address concerns of healthy women during monthly challenges and normal aging. How specifically black cohosh works to support a woman’s body is not entirely know. Research into the compounds found in the plant have identified a range of chemicals like “triterpene glycosides such as actein, 23-epi-26-deoxyactein, and cimicifugoside; resins, such as cimicifugin; and aromatic acid derivatives such as caffeic, isoferulic, and fukinolic acids.” It is believed that some of these compounds may act as a modulator of estrogen receptors, serotonergic and inflammatory pathways, or act as an antioxidant. When found in a supplement, one or more of these compounds is believed to be a contributing factor to its potential medicinal benefits which may include support for:

  • Hot flashes
  • Night sweats
  • Menstruation
  • Reproductive health
  • Sleep cycle
  • Hormone production
  • Healthy bones
  • Anxiety
  • Abdominal comfort
  • Temporary relief from occasional pain
  • Blood sugar already within the normal range
  • Tissue development in the ovaries and uterus

Most of these challenges are commonly associated with menopause or other hormone changes that can occur during normal aging in women. (7) Menopause is defined as a state where no menstrual period occurs for 12 months. Normally, these hormone changes occur in an age range between the late 30s and into the early 60s. Women on average experience menopause around the age of 51. Menopause is preceded by perimenopause, which begins 4 to 8 years before menopause. (8) Following menopause, the body transitions into postmenopause, which is a point where estrogen levels reach their lowest point as the ovaries stop producing hormones. There is currently no established test that can reliably determine when an individual will begin menopause.

When menopause begins, menopausal hormone therapies (MHT) are available to address disruptions in the body by supplementing the decrease of natural estrogen production in the body with estrogen from other sources. This can include a synthetic hormone known as progesterone. However, these therapies come with several risks. (9)

The Women’s Health Initiative, a division of The National Institutes of Health, the primary agency of the U.S. government responsible for biomedical and public health research, has indicated that MHT can be associated with urinary incontinence, dementia, stroke, blood clots, heart attack, breast, lung, and colorectal cancer. However, clinical research into the risks of MHT has not been properly established. This may be, in part, due to the facts that the use of MHT can span more than a decade. During this time, outside factors have been found to skew results, which makes connecting these therapies and potential health challenges unclear.


Potential Benefits of Black Cohosh


Black cohosh had been used to address the concerns of what we today know as health challenges related to changes in hormones. The medical field recognizes black cohosh and other herbs that seek to support hormone production and regulation as “complementary” or “alternative therapies.” Unfortunately, many of the clinical trials seeking to evaluate the efficacy of these therapies have not provided conclusive evidence as to its efficacy in supporting health during menstrual periods. (10) Yet many studies continue to research black cohosh in hope of better identifying any potential benefit that these alternative medicines may have in women during normal aging.

Black Cohosh for Menstrual Symptoms

Research from the Departments of Surgery and Biochemistry, University of Missouri-Columbia, Columbia, Mississippi, has examined the potential mechanisms of action in black cohosh extract (BCE) that allows it to support the regulation or interaction of hormones with receptors in the body. The result of these interactions may result in a health benefit that helps a woman during menopause or other hormone-related issue.

Research notes that there have been established observable effects of taking BCE to relieve menopausal symptoms in a way that is similar to other compounds such as selective serotonin reuptake inhibitors (SSRIs), which suggests that “BCE may work through a serotonergic mechanism. Many menopausal symptoms – hot flashes, mood swings, anxiety, insomnia – are mediated through the central nervous system (CNS) and may be alleviated through a variety of mechanisms. It is possible that BCE can act via multiple tissue-dependent mechanisms including estrogenic (or antiestrogenic), serotonergic, antioxidative, and inflammatory or anti inflammatory.”

BCE is also believed to have estrogenic activity. This may be the result of botanicals found in black cohosh that contain phytoestrogens. Earlier research has found that BCE can alleviate hot flashes in humans, (11) reduce depression in animal models and may help to protect bones from calcium loss and the weakening of bone structures. (12)(13)

After further analysis of the extracts found in black cohosh, researchers determined that existing literature and research models do not “support a direct estrogenic mechanism of BCE to explain its effects, but it may act through systems involving neurotransmitters and inflammatory pathways. The efficacy of BCE is supported by many, but not all, clinical trials, and there is little evidence of toxicity or severe adverse effects due to BCE.”

For individuals that take black cohosh in supplemental form, personal results may drive whether they continue with a black cohosh regime. For those that are unsure, research notes that further study into the effect of black cohosh is needed to add “absolute confidence on the subject.”

Black Cohosh for Postmenopausal Women

Research has found menopausal symptoms can continue into postmenopause. (14) To help evaluate the effect of black cohosh during postmenopause, researchers from the Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran, conducted a clinical trial with 84 postmenopausal women during an eight week period. The participants were randomly grouped into a control and an intervention group. The intervention group received one black cohosh tablet per day, while the control group would receive a placebo.

The severity of vasomotor symptoms (hot flashes, sweating, palpitation, anxiety, and chills) were analyzed with standard hormone tests. According to the research, by week 4, the intensity of symptoms began to decrease among the intervention group. By week 8, symptoms further decreased. Additionally, when compared to the control group, a significant difference was noted between the groups, with the control group still experiencing symptoms.

While the result appears promising, the researchers note that the study should be conducted for at least six months with hormone measurements, to better understand the long term potential of the herb.

Black Cohosh Dosage


Black cohosh is available in a variety of forms and dosages. Currently, information about safe dosing levels is not entirely known. A physician may recommend a dose in the range of 20 to 80 mg each day, with a standardized black cohosh chemical extracts that may include 27-deoxyactein, triterpene glycosides, or other extract that is believed to contribute to the potential medicinal benefits. (15)(16)

If taking black cohosh as a tea, mix about 20 grams of dried root in 34 ounces of water. Bring the water to a boil and let simmer for 20 to 30 minutes, or until water is reduced by a third. Strain out the remaining herb, and store the liquid leftovers in the fridge for up to 48 hours. Drink up to 3 cups daily.

Alternative to Traditional Therapies

The North American Menopause Society (NAMS) holds an evidence-based position on the nonhormonal management of menopause-associated vasomotor symptoms. (17) The NAMS board currently does not support the use of nonhormonal management options for the treatment of menopause symptoms. However, it is noted that nonhormonal management techniques may be required due to medical constraints or personal choice.

The organization writes, “Nonhormonal therapies include lifestyle changes, mind-body techniques, dietary management and supplements, prescription therapies, and others.” Additionally, before the use of nonhormonal treatments, other factors should be weighed against the potential effectiveness, such as “the costs, time, and effort involved as well as adverse effects, lack of long-term studies, and potential interactions with medications.”

Depending on an individual's current life situation and health, black cohosh may or may not provide a path to feelings of health and wellness. Consulting research, doctors, and evaluating individual states of health may be essential to identify whether it makes sense to use alternative therapies.



There is insufficient data on the risks associated with the use of black cohosh. (18) When taking any drug or supplement, potential for liver damage can occur. Always seek emergency care if signs of jaundice occur. Other side effects have been found in connection with black cohosh, but the frequency or severity of symptoms may vary. These can include vaginal bleeding, stimulation of menstrual flow, cardiovascular abnormalities, digestive disorders, hepatitis infections, muscle weakness, dizziness, inflammation, fatigue, irritability, depression, and weight gain. (19) Existing health challenges or hormone therapies may increase the risk or severity of symptoms.

It is not recommended to use the following herbs during a black cohosh regime.

  • Chaste-tree berries
  • Evening primrose oil
  • Blue cohosh
  • Pennyroyal
  • Ginkgo biloba
  • Garlic
  • Saw palmetto
  • Willow bark
  • St. John's wort

If any side effects occur or a condition worsens, stop taking the supplement and consult a primary care physician. Few studies have evaluated the use of black cohosh for more than a year. As such, long term use of black cohosh is not currently recommended. Do not take black cohosh during pregnancy as it may relax the uterus wall and stimulate labor. The hormonal effects of black cohosh may also result in changes to breast milk, so caution is advised. Black cohosh and blue cohosh should not be mixed or taken at the same time. Black cohosh naturally contains small amounts of salicylic acid, which is found in aspirin, and should be used with caution in individuals with salicylates allergy.

Consider a Black Cohosh Supplement

Many herbs are thought of as ancient if they have a history of use that dates back thousands of years. Black cohosh has gained popularity more recently. Despite being a new herb, Native American cultures and early European settlers used black cohosh to support the unique health challenges of women.

Black cohosh may not be ideal for everyone. However, early research into the medicinal properties may one day provide a complete understanding of its potential benefits. As black cohosh is understood today, some individuals have found it useful as a part of their daily regimen. Consult a primary care physician and begin experiencing black cohosh for yourself and see if it makes a difference in your life.