Black cohosh 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. Several studies have reported black cohosh to improve menopausal symptoms for up to six months, although the current evidence is mixed.

The mechanism of action of black cohosh remains unclear and the effects on estrogen receptors or hormonal levels (if any) are not definitively known. Recent publications suggest that there may be no direct effects on estrogen receptors, although this is an area of active controversy. Safety and efficacy beyond six months have not been proven, although recent reports suggest safety of short-term use, including in women experiencing menopausal symptoms for whom estrogen replacement therapy is contraindicated. Nonetheless, 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.

Actaea macrotys, Actaea racemosa L., actee a grappes (French), amerikanisches Wanzenkraut (German), baneberry, BCE, black cohosh roots, black snakeroot, botrophis serpentaria, bugwort, cohosh bugbane, cimicifuga, Cimicifugae racemosae rhizoma, cimicifugawurzelstock (German), ethanolic aqueous extract, herbe au punaise (French), hydroxytyrosol, isoferulic, isopropanolic black cohosh extract, macrotys, Macrotys actaeoides, phytoestrogen, Ranunculaceae (family), rattle root, rattle snakeroot, rattle top, rattle weed, rhizome of black cohosh, rich weed, rhizoma actaeae richweed, schwarze Schlangenwurzel, snakeroot, solvlys, squaw root, squawroot, Thalictrodes racemosa, Traubensilberkerze, Wanzwnkraut (German).

Note: Do not confuse black cohosh (Cimicifuga racemosa) with blue cohosh (Caulophyllum thalictroides), which contains chemicals that may damage the heart and raise blood pressure. Do not confuse black cohosh (Cimicifuga racemosa) with Cimicifuga foetida, bugbane, fairy candles, or sheng ma; these are species from the same family (Ranunculaceae) with different effects.

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Arthritis pain (rheumatoid arthritis, osteoarthritis) (Grade: C)
There is not enough human research to make a clear recommendation regarding the use of black cohosh for painful joints in rheumatoid arthritis or osteoarthritis.

Breast cancer (Grade: C)
There is not enough human research to make a clear recommendation regarding the use of black cohosh for breast cancer.

Menopausal symptoms (Grade: C)
Black cohosh is a popular alternative to prescription hormonal therapy for the treatment of menopausal symptoms such as migraine headaches, sleep disturbances, hot flashes, mood problems, perspiration, heart palpitations, and vaginal dryness. Initial human research suggests that black cohosh may improve some of these symptoms for up to six months. However, the current evidence is mixed and more studies are needed to make a strong recommendation.

Migraine (menstrual) (Grade: C)
Approximately 30% of women afflicted with migraines have menstrual-related migraines. Black cohosh may be a potential treatment for these migraines, although additional study of black cohosh alone is needed to make a strong recommendation.