Herb library · Herb · Actaea racemosa (Cimicifuga racemosa)
Black cohosh
A North American root sold mainly for menopause symptoms. A 2023 review found extracts potentially helpful for hot flashes and overall menopause symptoms; rare cases of serious liver damage have been reported with products labeled as black cohosh.
Serious warning
Cases of liver damage, some very serious, have been reported in people taking products labeled as black cohosh. They are rare and it is uncertain whether black cohosh caused them; some products have been found to contain the wrong herb or unlisted mixtures (NCCIH). See a clinician if you notice dark urine or unusual tiredness.
Traditional use
A member of the buttercup family from North America. Native Americans used it for kidney ailments, malaria, sore throat and menstrual cramps, and it has been used medicinally in Germany since the late 1800s. The root or rhizome is the part used. Today it is sold mainly for menopause symptoms, and also for menstrual cramps, premenstrual syndrome, and to start labor.
What studies show
- Limited
Menopause symptoms: a 2023 review of 22 studies of products with black cohosh extract, alone or with other herbs, found them potentially beneficial for overall menopause symptoms, with improvement in hot flashes but not in anxiety or low mood.
- Insufficient
Hot flashes from breast cancer care: it is uncertain whether black cohosh helps.
- Insufficient
Other uses (menstrual cramps, PMS, starting labor): there aren't enough reliable data to show whether it works.
Be careful of
Cautions
- NoteIt has been used safely in studies lasting up to a year and is generally well tolerated, but some products contain the wrong herb or unlisted herbs.
- NoteBlack cohosh and blue cohosh are different herbs. Blue cohosh can raise blood pressure and blood sugar and cause chest pain, and using it to start labor has been linked to life-threatening problems, including seizures, in the baby.
- ConditionIt is uncertain whether it is safe for people who have had hormone-sensitive conditions such as breast or uterine cancer.
- PregnancyIt may not be safe during pregnancy or while breastfeeding.
- Ask a clinicianTalk with a clinician or pharmacist before using this if you take prescription medicines, are pregnant or breastfeeding, or are giving it to a child.
From the old books
What herbals and dispensaries of the past printed. History, in their words.
“Cimicifuga, its present botanical name, is derived from cimex (bedbug), and fugare (to drive away), the European species having been used as a bug exterminator.”
“In large doses its action on the nervous system is very decided, producing vertigo, impaired vision, dilatation of the pupils, nausea, vomiting, and a reduction of the circulation, but no alarming narcotic effects.”
Sources
- Black Cohosh: Usefulness and Safety (opens in a new tab) · NCCIH · read September 25, 2026
Reviewed September 25, 2026.