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Industry Insight

Black Cohosh: Uses, Side Effects, Interactions and Warnings

Black Cohosh is a herb native to North America that has traditionally been used for cognitive and inflammatory conditions, but has grown in popularity due to it's ability to treat vasomotor symptoms of menopause; primarily hot flashes and night sweats. It is one of the most popular and highest sold supplements in the Western world (10th place in 2008), according to some surveys.


Studies on the matter are highly mixed. The larger body of evidence favors the efficacy of Black Cohosh for treatment of vasomotor symptoms but consists largely of unblinded studies; as the placebo effect can reduce menopausal complaints, blinding is needed. Efficacy has been demonstrated with blinded studies on Black Cohosh as well, but many of them are confounded with consumption of other compounds. A few blinded studies on Black Cohosh without any other compounds have been conducted, and are basically split right down the middle on efficacy if not favoring 'no significant effects' a little bit more due to quality of data and sample size.


Beyond the questionable efficacy, Black Cohosh appears to be safe. It is non-estrogenic (despite being thought to influence estrogen in the past) and may act centrally (in the brain) via serotonin, dopamine or opioids. Stomach upset has been reported and seems to be attributable to Black Cohosh in some people, but reports of liver toxicity do not appear to be related to the Black Cohosh herb. These reports do exist, but they cannot be linked to Black Cohosh logically.


  • Things to Know


  • Also Known As


Cimicifuga racemosa, Bugbane, Bugroot, Snakeroot, Rattleroot, Blackroot, Black Snake Root


  • Do Not Confuse With


Blue Cohosh (completely different herb)


  • Things to Note


Black Cohosh has been reported to be associated with liver disease (general hepatotoxicity or auto-immune liver disease), but trials and reviews into the matter have come back inconclusive. Black Cohosh does not appear to be related to these case studies, and tampering of supplements with other herbs in the same genus cannot be ruled out

Might be good to take with a meal, as upset stomachs have been reported at a low rate but consistently in blinded studies

Anecdotes, and some studies, suggest the benefits may be delayed and take a few weeks to kick in

Goes Well With


St.John's Wort (not synergistic, but both together have shown added efficacy in treating vasomotor symptoms of menopause)

Caution Notice 


  • How to Take


Recommended dosage, active amounts, other details


If using an isopropanolic extract (usually sold under the brand name of Remifemin), 20-40mg daily is used in doses of 20mg; taking 20mg results in a once daily dosing, whereas taking 40mg is twice daily dosing of the 20mg. This dosage (20-40mg) confers 1-2mg of triterpenoid glycosides.


If using an aqueous:ethanolic extract of black cohosh root (ie. not Remifemin) then doses range from 64-128mg daily which are usually taken in two divided doses. This contributed about the same amount of triterpenoid glycosides.


It is not known whether or not black cohosh needs to be taken with food, although it is sometimes recommended to do so out of prudency.