Synonyms/Common Names/Related Substances:

• Actaea macrotys,Actaeapachypoda, Actaeapodocarpa, Actaea racemosa L., Actaearubra actaealactone, actee a grappes (French), amerikanisches Wanzenkraut (German), Appalachian bugbane, BCE, baneberry, black bugbane, black cohosh root extract Cr 99, black cohosh roots, black snakeroot, botrophis serpentaria, bugbane, bugwort, CR, CR BNO 1055, CR extract, caffeic acid, cohosh bugbane, Cimicifuga, Cimicifuga racemosa, Cimicifugae racemosae rhizoma, Cimicifugawurzelstock, cimicifugic acid A, cimicifugic acid B, cimicifugic acid D, cimicifugic acid E, cimicifugic acid F, cimicifugic acid G, cohosh bugbane, ferulic acid, fukinolic acid, herbe au punaise (French), ICR, isoferulic acid, isopropanolic black cohosh extract, isopropanolic extract, macrotys, Macrotys actaeoides, methyl caffeate, mountain bugbane, p-coumaric acid, phytoestrogen, protocatechualdehyde, protocatechuic acid, Ranunculaceae (family), rattle root, rattle snakeroot, rattlesnake root, rattle top, rattle weed, rattleweed, Remifemin®, rhizoma actaeae, rich weed, richweed, schwarze Schlangenwurzel (German), snakeroot, solvlys, squaw root, squawroot, Thalictrodes racemosa, Traubensilberkerze (German), triterpene glycosides, Wanzenkraut, Ze 450.
• Combination product examples: GYNO-Plus (black cohosh and St. John's wort), PNC (pennyroyal, red raspberry, lobelia, blue cohosh, black cohosh, blessed thistle), Phyto-Female Complex (standardized extracts of black cohosh, dong quai, milk thistle, red clover, American ginseng, chaste-tree berry), Reumalex® (contains 35mg black cohosh, 100mg white willow bark, 25mg sarsaparilla (4:1), 17mg poplar bark (7:1), and 40mg guaiacum resin).
• Note: Black cohosh (Cimicifuga racemosa) is not to be confused with blue cohosh (Caulophyllum thalictroides), which contains potentially cardiotoxic/vasoconstrictive chemicals. Black cohosh (Cimicifuga racemosa) is also not to be confused with Cimicifuga foetida, bugbane, fairy candles, or sheng ma; these are species from the same family (Ranunculaceae) with different therapeutic effects.

Clinical Bottom Line/Effectiveness

Brief Background:

• Black cohosh is one of the highest selling herbs in the United States and is popular as an alternative to hormonal therapy in the treatment of menopausal (climacteric) symptoms such as hot flashes, mood disturbances, diaphoresis, palpitations, and vaginal dryness (1;​2). Several controlled trials and case series have reported black cohosh to improve menopausal symptoms for up to six months. Although these initial studies are suggestive, they have been few in number and have universally suffered from methodological weaknesses.
• The mechanism of action of black cohosh remains unclear, and the effects on estrogen receptors or hormonal levels (if any) have not been fully elucidated. Recent publications suggest that there may be no direct effects on estrogen receptors, although this is an area of active controversy (3;​4;​5;​6;​7;​8;​9;​10). Safety and efficacy data beyond six months are not available, although recent reports suggest safety of short-term use, including in women experiencing menopausal symptoms for whom estrogen replacement therapy is contraindicated (11;​12). Nonetheless, due to a lack of long-term follow-up, caution is advisable until better-quality safety data are available. Use of black cohosh in high-risk populations (such as in women with a history of breast cancer) should be under the supervision of a licensed healthcare professional.
• Since the Women's Health Initiative Trial was halted early due to an excess risk of stroke and other adverse outcomes, millions fewer women are using prescription hormone replacement therapy. However, a 2005 survey has shown there has been no appreciable increase in alternative therapies, including black cohosh (13).

Dosing/Toxicology

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Precautions/Contraindications

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Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

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Mechanism of Action

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History

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Evidence Table

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Evidence Discussion

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Products Studied

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Author Information

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References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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