Black cohosh is an herb. The root of this herb is used for medicinal purposes. Black cohosh was first used for medicinal purposes by Native American Indians, who introduced it to European colonists. Black cohosh became a popular treatment for women's health issues in Europe in the mid-1950s.
Since that time, black cohosh has commonly been used to treat symptoms of menopause, premenstrual syndrome (PMS), painful menstruation, weakened bones (osteoporosis), and for starting labor in pregnant women. It is also used to promote sleep, for breast cancer, heart disease, to improve mental function, for infertility, arthritis, and indigestion.
Black cohosh has also been tried for a lot of additional uses, such as anxiety, fever, sore throat, and cough, but it is not often used for these purposes these days.
Some people also apply black cohosh directly on the skin. This is because there was some thought that black cohosh would improve the skin's appearance. Similarly, people used black cohosh for other skin conditions such as acne, wart removal, and even the removal of moles, but this is seldom done anymore.
Black cohosh also goes by the name "bugbane" because it was once used as an insect repellent. It is no longer used for this purpose. Frontiersmen had said that black cohosh was useful for rattlesnake bites, but no modern researchers have tested this.
Do not confuse black cohosh with blue cohosh or white cohosh. These are unrelated plants. The blue and white cohosh plants do not have the same effects as black cohosh, and may not be safe.
Natural Medicines rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.
The effectiveness ratings for Black Cohosh are as follows:
Menopausal symptoms. Research shows that some black cohosh extracts can reduce some symptoms of menopause when taken by mouth. Most of this research is for a specific commercial black cohosh product, Remifemin. Research shows that the effects of Remifemin on menopausal symptoms are comparable to hormone therapy. The benefits may not occur with all products that contain black cohosh.
Research using black cohosh products other than Remifemin has not always shown benefits for menopausal symptoms. Some studies show that other black cohosh products do not reduce hot flashes or menopausal symptoms any better than a sugar pill ("placebo").
In some studies, products containing black cohosh and other ingredients have been investigated. Products containing black cohosh plus St. John's wort seem to reduce menopausal symptoms. Similar results have been observed for products containing black cohosh, Panax ginseng, soy, and green tea extract or black cohosh, kava, hops, and valerian extract. However, a homeopathic product containing black cohosh doesn't seem to be effective at reducing overall menopausal symptoms, although it may reduce hot flashes.
Some women take black cohosh for hot flashes related to breast cancer treatment. Women with breast cancer should not use black cohosh without talking to their cancer specialist or other health provider. Some early research suggested that black cohosh might reduce hot flashes in breast cancer patients, but more recent and higher quality research shows that black cohosh does not reduce hot flashes in women with breast cancer. There is some question as to whether black cohosh is safe for women with breast cancer. It is important for a woman with breast cancer to discuss any use of black cohosh with her health provider before using it.
More evidence is needed to rate black cohosh for these uses.
The root of black cohosh is used for medicinal purposes. Black cohosh root contains several chemicals that might have effects in the body. Some of these chemicals work on the immune system and might affect the body's defenses against diseases. Some might help the body to reduce inflammation. Other chemicals in black cohosh root might work in nerves and in the brain. These chemicals might work similar to another chemical in the brain called serotonin. Scientists call this type of chemical a neurotransmitter because it helps the brain send messages to other parts of the body.
Black cohosh root also seems to have some effects similar to the female hormone, estrogen. In some parts of the body, black cohosh might increase the effects of estrogen. In other parts of the body, black cohosh might decrease the effects of estrogen. Estrogen itself has various effects in different parts of the body. Estrogen also has different effects in people at different stages of life. Black cohosh should not be thought of as an "herbal estrogen" or a substitute for estrogen. It is more accurate to think of it as an herb that acts similar to estrogen in some people.
Black cohosh is POSSIBLY SAFE when taken by mouth appropriately by adults for up to one year.
Black cohosh can cause some mild side effects such as stomach upset, cramping, headache, rash, a feeling of heaviness, vaginal spotting or bleeding, and weight gain.
There is also some concern that black cohosh may be associated with liver damage. It is not known for sure if black cohosh actually causes liver damage. Researchers are studying this. Until more is known, people who take black cohosh should watch for symptoms of liver damage. Some symptoms that may suggest liver damage are yellowing of the skin and eyes (jaundice), unusual fatigue, or dark urine. If these symptoms develop, black cohosh should be stopped and a health provider should be contacted. People who take black cohosh should talk with their health provider about getting tests to make sure their liver is working well.
Pregnancy or breast-feeding: Black cohosh is POSSIBLY UNSAFE when used during pregnancy or breast-feeding. Since black cohosh acts somewhat like a female hormone it might increase the risk of miscarriage.
Breast cancer: There is some concern that black cohosh may worsen existing breast cancer. Women who have breast cancer or who have had breast cancer in the past, and women at high-risk for breast cancer, should avoid black cohosh.
Hormone-sensitive conditions, including endometriosis, fibroids, ovarian cancer, uterine cancer, and others: Black cohosh acts somewhat like the female hormone, estrogen, in the body. There is some concern that it could worsen conditions that are sensitive to female hormones. Do not take black cohosh if you have a condition that could be affected by female hormones. These conditions include ovarian cancer, uterine cancer, endometriosis, fibroids, and other conditions.
Kidney transplant: Taking a product containing black cohosh plus alfalfa has been linked to a report of kidney transplant rejection. It is not known if black cohosh is the cause of this rejection. Until more is known, people who have received a transplant should avoid black cohosh.
Liver disease: Some reports suggest that black cohosh might cause liver damage. It is not known for sure if black cohosh is the cause of liver damage in these cases. Until more is known, people with liver disease should avoid taking black cohosh.
Protein S deficiency: People with a condition called protein S deficiency have an increased risk of blood clots. Due to the hormone-like effects of black cohosh, there is some concern that black cohosh might also increase the risk of blood clots. There is a report linking blood clots in someone with protein S deficiency after taking black cohosh along with several other herbal products. Until more is known, people with protein S deficiency should avoid black cohosh.
Interaction Rating = Moderate Be cautious with this combination.
Talk with your health provider.
There is concern that black cohosh might harm the liver. Taking black cohosh with atorvastatin (Lipitor) might increase the chance of liver damage. However, there is not enough scientific information to know if this is an important concern. Before taking black cohosh talk to your healthcare provider if you take atorvastatin (Lipitor).
Cisplatin (Platinol-AQ) is used to treat cancer. There is some concern that black cohosh might decrease how well cisplatin (Platinol-AQ) works for cancer. Do not take black cohosh if you are taking cisplatin (Platinol-AQ).
Some medications are changed and broken down by the liver. Black cohosh might decrease how quickly the liver breaks down some medications. Taking black cohosh along with some medications that are change by the liver may increase the effects and side effects of your medication. Before taking black cohosh talk to your healthcare provider if you take any medications that are changed by the liver.
Some medications that are changed by the liver include amitriptyline (Elavil), clozapine (Clozaril), codeine, desipramine (Norpramin), donepezil (Aricept), fentanyl (Duragesic), flecainide (Tambocor), fluoxetine (Prozac), meperidine (Demerol), methadone (Dolophine), metoprolol (Lopressor, Toprol XL), olanzapine (Zyprexa), ondansetron (Zofran), tramadol (Ultram), trazodone (Desyrel), and others.
Interaction Rating = Minor Be watchful with this combination.
Talk with your health provider.
Some medications are moved by pumps in cells. Black cohosh might change how these pumps work and decrease how much of some medications get absorbed by the body. This might make these medications less effective.
Some medications that are moved by these transporters include aliskiren (Tekturna), amiodarone (Cordarone), atorvastatin (Lipitor), fexofenadine (Allegra), fluvastatin (Lescol), glyburide (Diabeta, Micronase), and rosuvastatin (Crestor).
There is concern that black cohosh might harm the liver. Taking black cohosh along with medication that might also harm the liver can increase the risk of liver damage. Do not take black cohosh if you are taking a medication that can harm the liver.
Some medications that can harm the liver include acetaminophen (Tylenol and others), amiodarone (Cordarone), carbamazepine (Tegretol), isoniazid (INH), methotrexate (Rheumatrex), methyldopa (Aldomet), fluconazole (Diflucan), itraconazole (Sporanox), erythromycin (Erythrocin, Ilosone, others), phenytoin (Dilantin), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), and many others.
Black cohosh might harm the liver. Taking black cohosh along with other herbs and supplements that might also harm the liver can increase the risk of liver damage. Do not take black cohosh if you are taking other herbs or supplements that can harm the liver.
Some of these products include androstenedione, chaparral, comfrey, DHEA, germander, kava, niacin, pennyroyal oil, red yeast, and others.
There are no known interactions with foods.
Actaea macrotys, Actaea racemosa, Actée à Grappes, Actée à Grappes Noires, Actée Noire, Aristolochiaceae Noire, Baie d'actée, Black Cohosh, Baneberry, Black Aristolochiaceae, Black Snakeroot, Bugbane, Bugwort, Cimicaire à Grappes, Cimicifuga, Cimicifuga Racemosa, Cimicifuge, Cohosh Negro, Cohosh Noir, Cytise, Herbe aux Punaises, Macrotys, Phytoestrogen, Phytoestrogène, Racine de Serpent, Racine de Squaw, Racine Noire de Serpents, Rattle Root, Rattle Top, Rattlesnake Root, Rattleweed, Rhizoma Cimicifugae, Sheng Ma, Snakeroot, Squaw Root.
Natural Medicines disclaims any responsibility related to medical consequences of using any medical product. Effort is made to ensure that the information contained in this monograph is accurate at the time it was published. Consumers and medical professionals who consult this monograph are cautioned that any medical or product related decision is the sole responsibility of the consumer and/or the health care professional. A legal License Agreement sets limitations on downloading, storing, or printing content from this Database. Except for any possible exceptions written into your License Agreement, no reproduction of this monograph or any content from this Database is permitted without written permission from the publisher. Unlawful to download, store, or distribute content from this site.
For the latest comprehensive data on this and every other natural medicine, health professionals should consult the Professional Version of the Natural Medicines. It is fully referenced and updated daily.
© Copyright 1995-2019. Therapeutic Research Faculty, publishers of Natural Medicines, Prescriber's Letter, and Pharmacist's Letter. All rights reserved.
Discover the different ways you can help
1-877 GO KOMEN(1-877-465-6636)
Give hope to others in your situation