The People's Perspective on Medicine

Black Cohosh

Black cohosh was used by native people in North America to ease inflammation (rheumatism) and backache. Can it ease menopausal symptoms such as hot flashes?
Black Cohosh: White Efflorescence, Green Nature Theme

This plant, native to North American forests, has a number of popular names: bugbane, black snakeroot, rattleroot, and squaw root.

It sends up graceful tall spires of white flowers; the black in its common name refers to the root or rhizome, as does cohosh, Algonquian for “rough.”

Native Americans prized black cohosh and used it for a variety of purposes. The settlers learned about it from the Indians, but by the middle of the nineteenth century it was renowned as being helpful for women’s problems, and other uses were more or less forgotten.

Black cohosh was a key ingredient in an immensely popular patent medicine, Lydia E. Pinkham’s Vegetable Compound.

Black cohosh has been used for menopausal symptoms in recent years. The portion of the plant used is underground: the rhizome and roots.

Active Ingredients

The main ingredients are triterpene glycosides, especially actein, related compounds, and cimigoside.

Black cohosh also contains tannins, fatty acids, and phytosterols. In a laboratory test of estrogenic activity, black cohosh extract did not bind to estrogen receptors.


In Europe, black cohosh is used for symptoms such as hot flashes, headaches, psychological difficulties, and weight gain associated with menopause. It is also reputed to be helpful for premenstrual problems and painful menstrual cramps.

American Indians treated sore throats and rheumatism with this herb, but these uses have not been scrutinized by modern medical studies.

Some of the evidence on the clinical effect of black cohosh is impressive.

In one study, sixty women under forty years of age who had undergone hysterectomy were divided into groups. One group got conjugated estrogen (available in the United States under the brand name Premarin), one was given estriol (another form of estrogen), a third received an estrogen-gestagen sequence, and the fourth group of women took a black cohosh extract.

Bothersome symptoms such as hot flashes disappeared slowly, over the course of four weeks, and at that point there was no difference in response among the four groups. This suggests that black cohosh may be as good at treating symptoms of menopause as are conventional estrogen treatments.

Animal research indicates that black cohosh can lower cholesterol and strengthen bone, as estrogen does. These promising results should be confirmed with clinical investigations in women.

Research should also be conducted on whether black cohosh increases the risk of breast or uterine cancer as estrogen can. Studies in the test tube and in animals are inconsistent regarding the effect of black cohosh on uterine tissue.


The usual daily dose is equivalent to 40 mg of the herb. It may take four weeks to get the maximum benefit; the herb should not be taken for more than six months until there is more information available on long-term effects.

A standardized German product is available in the United States under the brand name Remifemin, to be taken twice a day.

Special Precautions

Although black cohosh is not mutagenic or carcinogenic and does not cause birth defects in animals, authorities caution pregnant women not to use it. There is a report of premature birth associated with the herb and worries that it could trigger miscarriage.

It is not known whether women who have had breast cancer can safely use black cohosh as a substitute for HRT.

Adverse Effects

Stomachache, nausea, or other digestive distress has been reported.

A six-month study in rats at extremely high doses did not produce any toxicity. Overdose in humans has resulted in dizziness, vomiting, headache, increased perspiration, lowered blood pressure, and visual disturbances.

One woman taking a preparation that included black cohosh experienced seizures. Determining whether the herb was related to this event in any way could prove extremely difficult.

Possible Interactions

No interactions have been reported in the literature. It would seem illogical, however, to mix black cohosh with standard HRT regimens, and it could prove incompatible.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Is it safe to take black cohosh with evening primrose oil? I started taking them to increase my estrogen. The gels the Drs prescribe are so expensive. I’ve been taking them and feel difference I’m not so moody. I’m hoping this is helping me I just wanted to check and be sure it’s ok to take both of these.

To the person that was having problems with the black cohosh, Black Cohosh can lower blood pressure, so that might have been your problem.
As with any herb some people cannot take certain ones.
I am taking it right now to help with my blood pressure, I hope it helps with my pre menopause symptoms!

I am a senior male who was given a six month injection of Lupron to help lower my PSA. Hot Flashes were one of the side effects. I am presently in the mid-ninth month and the hot flashes have not gone away. I have them 24/7. By recommendation I went to a local health supply store and Black Cohosh was suggested as a possible help to reduce the hot flashes. In your experience can this product help me?

I have started menopause – periods about every 2-3 months. The hot flashes were awful. I would have to have a fan by my bed to even have a chance to sleep. This was in the middle of winter. I started taking Black Cohosh and the effect was immediate. The next day I experienced only a few “flashes”, but they only lasted a few seconds and the intensity was way down. After that I’ve not had a problem and my husband is much happier too.
I added Primrose oil, which also helps with sleeplessness. I’m now back on a normal sleep schedule.

I have been on a private brand of womens multivitamin containing Chaste Tree Berry, Black Cohosh, Dong Quai, Alfalfa leaf, Lycopene, Lutein, and Gamma Oryzanol (175mg total). A friend recommended it as she discovered it stopped her constant menstrual bleeding 26/28 days. I had the same problem, the multivitamin cleared up the problem, taken daily. Avoided hysterectomy for both of us. However, since taking it my breasts are lumpy and very painful 24/7, and I have had a cyst and continuing problems (but none cancerous). I suspect the Dong Quai, so I am isolating the ingredients to see if I can continue to have the blessings without the curses. Anyone else have related experience?

I’ve been taking Citrolopram for a good few years now and would like to try black cohosh for early menopause symptoms, mainly hot flushes and night sweats. I am concerned about the two being compatible.
Any advice or knowledge on this would be appreciated.

I too have been using Remifemin as it has had some studies showing improvement in menopausal symptoms. I underwent a full hysterectomy and did not want to risk hormones as breast cancer has killed some of my relatives. I was OK for a few days after surgery then I began to experience hot flashes and was unable to sleep. I was exhausted. I started taking Remifemin and my symptoms improved greatly but wasn’t fully convinced. I then experienced a a big increase in symptoms. I was so miserable and couldn’t figure out why but soon realized that I had forgotten to take my a.m. dose of Remifemin (you take it twice a day). As soon as I resumed this my Sx practically vanished. I also experienced no s/e and it did not affect my HTN.

I started using Remifemin (black cohosh, taken twice daily) at least 6 weeks ago. My most troublesome menopause symptom was insomnia. After 4 weeks on Remifemin I noticed I was sleeping better.

I have been using black cohosh and don quai for a number of years and as far as I can surmise, I have not had any adverse effects from taking this herb for such a long time. It does keep my flashes down to nothing. But I also exercise faithfully every day which also helps me to feel better.

I too have tried the Black Cohosh and have had good results. I would recommend taking a look at what you are eating that might be making your tired and sluggish. Our nutrition plays a big role in how our body feels each day.

I took Black Cohash for menopausal symptoms and it worked well. I was probably on it for about a year. My caution for it is to watch the blood pressure. The last time I took it my BP was 210/140 (asymptomatic). As it was the only drug I was on, I stopped it immediately. It took about 2 months for it to gradually return to normal.

I also take black cohosh for perimenopausal symptoms. I am 50, and my periods are down to every other month for about 2 or 3 days. But the sweating was just awful until I started the cohosh. I swear by it and recommend every one at least try it. Now the only problem I haven’t been able to get rid of is the horrible tiredness. I feel stiff and worn out no matter how much or good my sleep is. All lab work is perfect, so doctors just shrug their shoulders. But I am BEAT. Any suggestions for that would be truly appreciated.. Thanks, and good luck to all of us that we feel our best!

I took the recommended doses of black cohosh and had pain in my mid-back area after the third day. I don’t feel right. This obviously isn’t a problem herb for a lot of people, but it was for me. I have taken all sorts of things in the past and rarely have had any problems. I was also taking St. John’s Wort and Evening Primrose which I should not have done, as I have read that these two enhance the effects of black cohosh.
If you are taking either St. John’s Wort or Evening Primrose, I urge you to think about taking them at least 2 hours apart from one another, for safety.
I began feeling like I was going to pass out… like after I get my blood drawn, my pulse was really really low, I was shaking in my chest area (I have never had this sensation before–it wasn’t like low blood sugar or anything), then later that evening is when my mid-back started hurting.
I’m taking a milk thistle based liver cleanse now. Every time I take it the pain in my back stops. Very encouraging. It has been hurting for 2 days. Please be careful. Oh, and I also started feeling very depressed and drained with all this. And I felt happy before.

I am a long term study. I have used black cohosh for over ten years. I do not go on and off it after six months as this only causes my hot flashes and depression to come back. My (female) doctor is aware of this and she is not concerned. It works and women should not be told to fear it. American Indians and women in Germany also have used it long term.

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