Black Cohosh

Health Tips / Black Cohosh

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  musculoskeletal or arthritic complaints.

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.

Health Benefits

The apparent healing properties of black cohosh root extend beyond its use for “women’s problems.” Thought to work as an anti-inflammatory and mild sedative, black cohosh may relieve 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 called phytoestrogens that mimic the hormone’s effects. These phytoestrogens bind to hormone receptors in the uterus, breast, and other parts of the body, possibly lessening hot flashes, vaginal dryness, headache, dizziness, depressive mood, and other hormone-related symptoms as a result.

A 1991 study women found that black cohosh may also help to minimize hot flashes by reducing levels of luteinizing hormone (LH), a compound produced by the brain’s pituitary gland that regulates the activities of a woman’s ovaries. The rise in LH has been been implicated as a cause of hot flashes.

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. Keep in mind, however, that the phytoestrogens in black cohosh will not offer the protection from heart disease or osteoporosis that prescription HRT can provide.

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, the herb’s phytoestrogens may even benefit women with premenstrual syndrome (PMS).

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.


dried herb/tea

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.

Note: For information on interactions with specific generic drugs, see our WholeHealth Chicago 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. Ailments Dosage Menopause 20-80 mg standardized extract twice a day, or 250-550 mg freeze-dried whole root twice a day; or 1/2 to 1 tsp. liquid extract twice a day Osteoporosis 20-80 mg standardized extract twice a day, or 250-550 mg freeze-dried whole root twice a day; or 1/2 to 1 tsp. liquid extract twice a day Perimenopause 20-80 mg standardized extract twice a day or 250-550 mg freeze-dried whole root twice a day; or 1/2 to 1 tsp. liquid extract twice a day

Doctor Recommendations
David Edelberg, M.D.

A favorite herbal remedy of Native American and pioneer women for subduing “female troubles,” black cohosh (Cimicifuga racemosa) is derived from the gnarled black root of a Native American wildflower related to the buttercup. Although it was abandoned as a medicine in America decades ago, black cohosh was adopted and studied with extraordinarily good results in Europe, where it’s now the hottest-selling herb for menopause. In 1997, no fewer than 10 million packages of black cohosh were sold in Germany alone.


Black cohosh seems particularly effective at reducing hot flashes, vaginal dryness, nervousness, and other perimenopausal symptoms. It appears to do this in two ways: by suppressing a hormone normally responsible for regulating activity in the ovaries, and by supplying phytoestrogens (plant estrogens) to compensate for the age-related decline in a woman’s natural estrogen supply. Women who may want to try black cohosh as an alternative to standard hormone replacement therapy (HRT) should talk to their doctor. It’s important to keep in mind, however, that the herb won’t provide any of the heart-healthy and bone-strengthening benefits of HRT.


All the studies using black cohosh were performed on a standardized commercial extract, marketed under the name Remifemin. I don’t think it’s necessarily superior, and in fact, it may be more convenient for you to take your black cohosh in a combination product with other so-called “women’s herbs,” such as chasteberry, dong quai, and Siberian ginseng.


You’ll probably have to take black cohosh for eight weeks or more before noticing any relief from symptoms. Capsules containing the freeze-dried root are a good choice because they are most likely to contain all of the herb’s key ingredients–those that have (and those that haven’t yet) been identified. Liquid extracts such as tinctures work well too.


The convincing studies on black cohosh used standardized extracts containing 2.5% triterpene glycosides, the active ingredient in the root. But when buying the liquid form of black cohosh, look for products standardized for a slightly higher percentage–5%–of triterpene glycosides.


Although it’s a powerful herb, most women seem to tolerate black cohosh quite well and experience few (if any) side effects. A few tips and cautions worth mentioning include: Sweeten to taste. The root is quite bitter, so if you’re taking the liquid form, try taking it with honey or lemon if the taste bothers you. And to reduce the chance of stomach upset, taking it with some food is also a good idea. Consult your doctor. Because the herb has its own estrogenlike effects, you should probably not combine it with actual estrogens (HRT or birth control pills) without consulting your physician. The same is true if you are pregnant, breast-feeding, or have an estrogen-sensitive cancer.

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Be well,
David Edelberg, MD