black cohosh

What Is It?
Health Benefits
Dosage Information
Guidelines for Use
General Interaction
Possible Side Effects
Evidence Based Rating Scale

What Is It?

Generations of American women have relied on the gnarled root of black cohosh (Cimicifuga racemosa) to relieve various "female problems," from PMS and menstrual cramps to menopausal symptoms. In the 1900s, this indigenous American wildflower, a member of the buttercup family, provided the main ingredient in a popular tonic for women. (The concoction--Lydia Pinkham's Vegetable Compound--is still sold, but it no longer contains the herb.) Black cohosh has also been used to treat a variety of other complaints, including insect bites and eczema.

After falling out of favor for several decades, black cohosh is once again being heralded as an herbal antidote for such menopausal symptoms as hot flashes. It has even been recommended as an alternative to standard hormone replacement therapy (HRT), which can produce unwanted side effects in many women. As the interest in black cohosh grows more research is being conducted into how it works on a cellular level. Scientists have made the exciting discovery that black cohosh is a Selective Estrogen Receptor Modifier (SERM) (1-3). What this means is that black cohosh only binds to certain estrogen receptors in women’s bodies namely those of the brain, vagina, and possibly those in bones. It does not however bind to breast or uterine cells which if over-stimulated can lead to increased risk of cancer. This make sblack cohosh a wonderful option for women who are seeking to treat menopausal symptoms both naturally and selectively.

The apparent healing properties of black cohosh root extend beyond its most common use for "women's problems." Thought to work as an anti-inflammatory and mild sedative, black cohosh may relieve menstrual syndrome realted muscle aches and pains. It has also been used to clear mucous membranes and lessen associated congestion and bothersome coughs.

Specifically, black cohosh may help to:

Relieve hot flashes and other menopausal and perimenopausal symptoms. As estrogen levels decline in a woman's body during middle age, she may experience hot flashes, vaginal dryness, depression, and other unpleasant symptoms. Black cohosh may offset this decline in estrogen by providing powerful plant compounds that selectively bind to brain, vaginal and bone cells thereby protecting against the ravages brought by declining estrogen.

A large scale high quality study conducted on 304 women found that black cohosh reduced hot flashes better than placebo (4). Many other similar trials have shown benefit of other forms of black cohosh preparations as well (5). However, all results have not been equivocal (6,7). The efficacy of black cohosh may depend on the severity of your symptoms, formulations used etc… More research is necessary to determine which formulations, dosages and treatment durations offer the most benefits. However, since black cohosh is generally well tolerated, it may offer a viable alternative for women who cannot tolerate traditional HRT.

Some women take black cohosh as an alternative to hormone replacement therapy. Unlike HRT, which has been linked to a slightly increased risk of breast cancer when taken long-term, black cohosh doesn't appear to stimulate the growth of breast tumors. Some researchers even think the phytoestrogens might prevent tumor growth by keeping the body's own estrogen from locking onto breast cells (8). Keep in mind, however, that the phytoestrogens in black cohosh will not offer the same level of protection from heart disease or osteoporosis that prescription HRT can provide.

Thicken vaginal lining during menopause. Since black cohosh has been shown to selectively target estrogen receptors in the vagina, it may also help to increase the thickness and moistness of your vaginal lining (9). The lining of your vagina often thins during menopause due to declining levels of estrogen. This can make sex painful and difficult. Adding black cohosh supplements to your diet may help alleviate this uncomfortable condition.

Help protect post-menopausal women from brittle bones. Some research studies have shown that black cohosh extracts protect human bone cells from the weakening associated with estrogen loss (10). As you age you become more susceptible to falls which can easily lead to fractures and broken bones, if you have poor bone health. This can lead to serious disability and suffering, and must be planned for in advance. Therefore, you should protect yourself from these perils at the first signs of menopause and not wait until it is too late.

Ease menstrual cramps. Black cohosh has antispasmodic properties that may lessen menstrual discomforts. In addition, by possibly increasing blood flow to the uterus, it may reduce the intensity of particularly painful cramps. By stabilizing hormone levels in various parts of the body it may even benefit women with premenstrual syndrome (PMS) (11).

Note: Black cohosh has also been found to be useful for a number of other disorders. For information on these additional ailments, see our Dosage Recommendations Chart for Black Cohosh.


  • tincture
  • tablet
  • dried herb/tea
  • capsule

Dosage Information

Special tips:

--Look for capsules or tablets with extracts standardized to contain 2.5% triterpenes glycosides, the active components in black cohosh root and the amount that has proved effective for many women in clinical trials.

--However, when buying the liquid form of black cohosh, look for products standardized for a slightly higher percentage--5%--of triterpene glycosides.

--Capsules containing the freeze-dried root are a smart choice because they're most likely to contain all of the herb’s key ingredients, including any compounds that scientists still haven't identified.

·  For menopausal or PMS symptoms, including menstrual cramps: Take 40 mg of black cohosh twice a day. Begin the regimen for PMS a week to 10 days before your period.

·  For muscle aches and pains: Apply warm compresses soaked in black cohosh tea to the affected area for 20 minutes. Make the tea by boiling the dried root in water for 20 to 30 minutes; allow the tea to cool slightly before using.

Guidelines for Use

·  You can use black cohosh at any time of day, but to reduce the chance of stomach upset, take it with meals. Try it with honey or lemon to disguise the bitter taste.

·  Allow up to eight weeks to see benefits for menopausal problems.

General Interaction

Black cohosh may interfere with the action of hormonal medications (birth control pills or HRT). Consult your doctor before combining.

Black cohosh may also interaction with conventional drugs prescribed for high blood pressure. See your doctor before adding black cohosh to your diet if you are taking these medications.

Note: For information on interactions with specific generic drugs, see our WholeHealthMD Drug/Nutrient Interactions Chart.

Possible Side Effects

·  When taken at commonly recommended doses, black cohosh is associated with few--if any--adverse reactions. However, some women do experience stomach upset, weight gain, and dizziness when taking black cohosh.

·   Very high doses can cause vomiting, headache, dizziness, excessively low blood pressure, and limb pain. Consult a doctor immediately if you suspect an overdose.


Because black cohosh is such a powerful herb, many experts recommend taking it for no longer than six months at a time.

·  If you suffer from heart disease, check with your doctor before trying black cohosh.

·  Because of its hormonal effects, don't use black cohosh if you're pregnant or breast-feeding, or if you have an estrogen-sensitive cancer.

·  If you are a woman of child-bearing age, take extra care to confirm that you haven't mistaken the herb blue cohosh for black cohosh. Blue cohosh (Caulophyllum thalictroides), also known as blueberry root, papoose root, or squawroot, has long been used to induce labor and today is sometimes sold as a menstrual remedy. A recent study reported that blue cohosh can cause significant birth defects in rats; it remains unclear whether the same will happen in humans, but caution is warranted. 


  1. Seidlova-Wuttke D, Wuttke W. Selective estrogen receptor modulator activity of Cimicifuga racemosa extract: clinical data. Phytomedicine. 2000;7(suppl 2):11.
  2. Seidlova-Wuttke D, Jarry H, Heiden I, et al. Effects of Cimicifuga racemosa on estrogen-dependent tissues. Phytomedicine. 2000;7(suppl 2):11–12.
  3. Wuttke W, Jarry H, Heiden I, et al. Selective estrogen receptor modulator (SERM) activity of the Cimicifuga racemosa extract BNO 1055: pharmacology and mechanisms of action [abstract]. Phytomedicine. 2000;7(suppl 2):12.
  4. Osmers R, Friede M, Liske E, et al. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol. 2005;105:1074–83.
  5. Nesselhut T, Schellhase C, Dietrich R, et al. Investigation into the growth-inhibitive efficacy of phytopharmacopia with estrogen-like influences on mammary gland carcinoma cells.Arch Gynecol Obstet. 1993;254:817–818.
  6. Dobson R. Popular herbal remedy for hot flushes is no better than placebo. BMJ. 2005 Oct 22;331(7522):924.
  7. North American Menopause Society. Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society. Menopause. 2004 Jan-Feb;11(1):11-33.
  8. Frei-Kleiner S, Schaffner W, Rahlfs VW, Bodmer Ch, Birkhauser M. Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial. Maturitas. 2005 Aug 16;51(4):397-404. Epub 2004 Dec 10.
  9. Wuttke W, Seidlova-Wuttke D, Gorkow C. The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers. Maturitas.2003;44(Suppl 1):S67–S77.
  10. Viereck V, Grundker C, Friess SC, Frosch KH, Raddatz D, Schoppet M, Nisslein T, Emons G, Hofbauer LC. Isopropanolic extract of black cohosh stimulates osteoprotegerin production by human osteoblasts. J Bone Miner Res. 2005 Nov;20(11):2036-43. Epub 2005 Jul 18.
  11. Girman A, Lee R, Kligler B. An integrative medicine approach to premenstrual syndrome. Am J Obstet Gynecol. 2003 May;188(5 Suppl):S56-65.

Evidence Based Rating Scale 

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies with what our clinical advisors have found to be efficacious in their personal practice. This tool is meant to simplify which supplements and therapies demonstrate promise in the treatment of certain conditions. This scale does not take into account any possible interactions with any medication/ condition/ or therapy which you may be currently undertaking. It is therefore advisable to ask your doctor before starting any new treatment regimen.




 A Warning  


WholeHealthMD recommends use of this supplement only under the guidance of a licensed clinician.














Date Published: 04/18/2005
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