Black Cohosh (Cimicifuga Racemosa)

Medical Uses

Black cohosh is helpful in relieving menopausal symptoms, including mood swings, hot flashes, profuse sweating, and sleep disturbances. It has been the largest-selling herbal dietary supplement for menopause in the United States.

Historical Uses

In China, black cohosh root has been used for centuries for menopausal symptoms and women’s health in general. Native Americans and Eclectic physicians used black cohosh for rheumatism, menstrual difficulties, and sore throats. Native American women have used it for menopausal symptoms such as hot flashes, anxiety, and depression. Do not confuse it with blue cohosh.


Black cohosh is a member of the buttercup family. It is native to the northeastern U. S. and grows in sunny areas in temperate zones. An at-risk endangered herb, black cohosh can be grown in herb gardens. The roots maybe harvested after 2 years.

Black Cohosh: Part Used

• Root

Major Chemical Compounds

• Triterpene

• Glycosides

Black Cohosh: Clinical Uses

Studies show that black cohosh is safe and helpful in relieving menopausal symptoms, particularly mood swings, hot flashes, profuse sweating, and sleep disturbances. It is “a safe, effective alternative to estrogen replacement therapy for patients who canot take estrogen replacement therapy”. Black cohosh may help prevent breast cancer. It has been approved by the German Commission E for “PMS, menopausal symptoms, and dysmenorrhea”. It has been the largest-selling herbal dietary supplement for menopause in the U. S..

Mechanism of Action

Black cohosh is sometimes called a phytoestrogen. These substances are defined as “plant compounds that are structurally or functionally similar to steroidal estrogens produced by the body”. A phytoestrogen has estrogen-like action because it binds to estrogen receptors. Black cohosh suppresses luteinizing hormone with no effect on follicle-stimulating hormone. It exhibits no signs of estrogenic effects in animal models and may decrease endogenous estrogen levels rather than the level of estrogenic hormones.

Black Cohosh: Dosage

Tincture and tablets: 40 drops of standardized tincture or one 40-mg tablet twice daily, standardized to 4 mg triterpenes for up to 6 months.

Remifemin: The German product used in clinical studies is Remifemin, which is also distributed in the U.S. The suggested dose is 1 tablet twice a day.

Tea: For a decoction, bring 1 teaspoon of black cohosh root to a boil in 8 ounces of water, simmer about 15 minutes, strain, and drink up to 3 times a day.

Side Effects

Occasional gastrointestinal discomfort.


• Black cohosh is not recommended during pregnancy.

• It is not known whether this herb can be taken with hormone therapy.

• It is not recommended for children.

Herb-Drug Interactions

Use with hormone therapy has not been studied. The “extract augmented the anti-proliferative effect of tamoxifen”.

Pregnancy and Breast-Feeding

Do not use in pregnant women (although this herb has been used historically during labor) because it has uterine stimulant effects. In a survey of certified nursing midwives who used herbal preparations, 45 percent stated that they used black cohosh to stimulate labor.

Do not use in breast-feeding women.

Pediatric Patients

Black cohosh is not recommended for children.

Summary of Studies

Stoll (1987). This randomized, double-blind, comparative.placebo-controlled study included 80 female patients over a period of 12 weeks. The study compared the effects of two tablets of black cohosh extract b.i.d. with a daily dosage of 0.625 mg conjugated estrogens and placebo. Results: Black cohosh was well tolerated and subjects showed an increase in vaginal epithelium with significant improvements in psychological symptoms not experienced with estrogen and placebo.

Duker et al. (1991). This open, controlled, comparative study involved 110 female patients at a gynecologic clinic over an 8-week period. Results: Black cohosh was related to selective LH suppression in menopausal women with no effect on follicle-stimulating hormone levels.

McKenna et al. (2001). In a review article, these investigators stated that “Remifemin was most commonly prescribed as an effective alternative to hormone replacement therapy for menopause.”

Clinical studies of f 700 patients support the use of black cohosh for up to 6 months when hormone therapy is contraindicated.

Many clinical studies have been done using Remifemin with positive results.

Black Cohosh: Warnings

• This herb may cause occasional gastrointestinal discomfort.

• Don’t use black cohosh if you’re pregnant because this herb stimulates the uterus.

• Don’t use black cohosh if you’re breast-feeding.

• This herb isn’t recommended for children.

• The use of black cohosh with hormone therapy hasn’t been studied; check with your primary health-care practitioner before taking this combination.