Black Cohosh

Black Cohosh

Supplement Forms/Alternate Names:

Black bugbane; black snakeroot; black baneberry; actaea racemose; cimicifuga racemosa


Black cohosh is an herb that grows in North America. It has been used to treat symptoms of menopause. It can be taken as an extract, pill, or powder.


20 milligrams 1 to 2 times per day

What Research Shows

Likely Effective

May Be Effective

Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.

Safety Notes

It may be safe to take black cohosh for a short time. Some evidence suggests that black cohosh may cause liver damage. Not enough studies have been done to say whether it is safe to take for a long period.


Talk to your doctor about any supplements or therapy you would like to use. Black cohosh can interfere with treatment or make conditions worse, such as:

  • Black cohosh can make certain medicine less effective. People taking medicine to suppress their immune system should talk to their doctors before taking black cohosh.


A. Infertility

A1. Shahin AY, Mohammed SA. Adding the phytoestrogen Cimicifugae racemosae to clomiphene induction cycles with timed intercourse in polycystic ovary syndrome improves cycle outcomes and pregnancy rates-a randomized trial. Gynecol Endocrinol. 2014;30(7):505-510.

B. Menopause

B1. Shams T, Setia MS, et al. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Altern Ther Health Med. 2010;16(1):36-44.

B2. Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012 Sep 12;(9):CD007244.

B3. Ross SM. Menopause: a standardized isopropanolic black cohosh extract (remifemin) is found to be safe and effective for menopausal symptoms. Holist Nurs Pract. 2012;26(1):58-61.

B4. Schellenberg R, Saller R, et al. Dose-dependent effects of the cimicifuga racemosa extract ze 450 in the treatment of climacteric complaints: A randomized, placebo-controlled study. Evid Based Complement Alternat Med. 2012;2012:260301.

B5. Zheng TP, Sun AJ, et al. Efficacy and safety on Cimicifuga foetida extract on menopausal syndrome in Chinese women. Chin Med J. 2013;126(11):2034-2038.

B6. Jiang K, Jin Y, et al. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric. 2015;18(4):559-567.

B7. Tanmahasamut P, Vichinsartvichai P, et al. Cimicifuga racemosa extract for relieving menopausal symptoms: a randomized controlled trial. Climacteric. 2015 Feb;18(1):79-85.

C. Depression

C1. Yeung KS, Hernandez M, Mao JJ, Haviland I, Gubili J. Herbal medicine for depression and anxiety: A systematic review with assessment of potential psycho-oncologic relevance. Phytother Res. 2018 May;32(5):865-891.

D. Safety

D1. Teschke R, Bahre R, et al. Suspected black cohosh hepatotoxicity--challenges and pitfalls of causality assessment. Maturitas. 2009 Aug 20;63(4):302-314.

D2. Teschke R, Bahre R, et al. Black cohosh hepatotoxicity: quantitative causality evaluation in nine suspected cases. Menopause. 2009 Sep-Oct;16(5):956-965.

D3. Teschke R. Black cohosh and suspected hepatotoxicity: inconsistencies, confounding variables, and prospective use of a diagnostic causality algorithm. A critical review. Menopause. 2010 Mar;17(2):426-440.

D4. Teschke R, Schwarzenboeck A, et al. Herb induced liver injury presumably caused by black cohosh: a survey of initially purported cases and herbal quality specifications. Ann Hepatol. 2011 Jul-Sep;10(3):249-259.

D5. Izzo AA. Interactions between herbs and conventional drugs: overview of the clinical data. Med Princ Pract. 2012;21(5):404-28.

D6. Bunchorntavakul C, Reddy KR. Review article: herbal and dietary supplement hepatotoxicity. Aliment Pharmacol Ther. 2013 Jan;37(1):3-17.

D7. Teschke R, Schulze J, et al. Herbal hepatotoxicity: suspected cases assessed for alternative causes. Eur J Gastroenterol Hepatol. 2013 Sep;25(9):1093-1098.

D8. Amer MR, Cipriano GC, et al. Safety of Popular Herbal Supplements in Lactating Women. J Hum Lact. 2015 Aug;31(3):348-353.

D9. Brown AC. Liver toxicity related to herbs and dietary supplements: Online table of case reports. Part 2 of 5 series. Food Chem Toxicol. 2017 Sep;107(PtA):472-501.

Last reviewed July 2019 by EBSCO NAT Review Board Eric Hurwitz, DC

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