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Black Cohosh Supplement

Updated | 2021-01-26

Written and reviewed by the NatureClaim Team


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Black Cohosh

Overview of Black Cohosh

Scientific Name: Actaea racemosa / Cimicifuga racemosa

Order: Ranunculales

Family: Ranuculaceae

Do not confuse with Cimicifuga foetida.



Evidence

Strong:

insufficient information

Good:

  • Menopausal Complaints and Mood Changes, seems to improve the quality of life (black cohosh blends containing Saint John’s wort may also be effective, but a black cohosh blend containing soy may not be effective) [1-17]
    • Another plant, Cimicifuga foetida, may also be effective [18]

Promising:

insufficient information

Conflicting (Unclear):

  • Hot Flashes/Sleep Disturbances from Menopause, there are many conflicting results from clinical trials [19-31]
    • Clinical trials of black cohosh blends containing red clover or soy may not be effective, but blends containing red clover / conjugated equine estrogens / medroxyprogesterone; milk thistle / American ginseng / chaste tree / dong quai / red clover; or tamoxifen may be effective

Limited Evidence:

  • Fertility, black cohosh in combination with clomiphene citrate [32-33]
  • Menopausal Complaints of Breast Cancer Patients [34]
  • Migraines from Menstrual Cycle, a black cohosh blend containing soy / dong quai [35]
  • Osteoporosis (Bone Density Loss) [36-38]
  • Ovarian Cyst [39]

No Evidence:

No Clinical Research:

All other conditions.


Side Effects
Side effects may include:
  • Cramping
  • Dizziness
  • Headache
  • Heaviness in the Legs and Arms
  • Fluid Retention
  • Gastrointestinal Upset
  • Rashes
  • Sweating
  • Vomiting
  • Weakness
  • Weight Gain
Precautions and Adverse Events:
  • Avoid or contact a licensed healthcare practitioner, if you have breast cancer/tumors (and have had breast cancer/tumors), other hormone dependent conditions and cancers, liver problems or a have had liver problems.
  • Monitor your liver while using black cohosh; there is conflicting evidence of liver failure, liver damage, liver necrosis, chronic hepatitis, autoimmune hepatitis.
  • There have been reports of black cohosh causing muscle damage, severe weakness, seizures, pseudolymphoma (an inflammatory response), bradycardia (slow heart rate), abnormal blood clotting, hypotension (low blood pressure), fluid retention, visual disturbances.
[48-71]


Pregnant or Nursing

If you are pregnant or may be pregnant, using black cohosh can cause miscarriage or premature births. In general there is not enough research on the use of supplements containing black cohosh during pregnancy and breast-feeding, so consult a licensed healthcare practitioner before use or avoid use. Black cohosh is used to induce labor, but there is not enough research about how it may affect the newborn infant. [48-71]



Interactions

Major:

insufficient information

Moderate:

  • Drugs changed by Cytochrome P450s (CYPs) in the liver
  • Azathioprine
  • Cyclosporine (Ciclosprin)
[72-74]

Potential:

  • Anti-Hypertensive Drugs
  • Hormone-Like Drugs
  • Iron-Containing Products; since black cohosh contains tannins, take iron and black cohosh at least several hours apart to prevent non-absorption of iron
  • Tamoxifen
[72-74]


Dosage

Black cohosh is not a "drug", so the best doses have not been thoroughly established. Make sure to follow the specific product instructions and take as directed on the label, or consult a licensed healthcare practitioner before use.



Compounds
Black Cohosh compounds [Afendi et al. 2012]


References

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Black cohosh with or without St. John's wort for symptom-specific climacteric treatment--results of a large-scale, controlled, observational study. Maturitas. 2007 Aug 20;57(4):405-14. 5. Chung DJ, Kim HY, Park KH, Jeong KA, Lee SK, Lee YI, Hur SE, Cho MS, Lee BS, Bai SW, Kim CM, Cho SH, Hwang JY, Park JH. Black cohosh and St. John's wort (GYNO-Plus) for climacteric symptoms. Yonsei Med J. 2007 Apr 30;48(2):289-94. 6. Drewe J, Zimmermann C, Zahner C. The effect of a Cimicifuga racemosa extracts Ze 450 in the treatment of climacteric complaints--an observational study. Phytomedicine. 2013 Jun 15;20(8-9):659-66. 7. Frei-Kleiner S, Schaffner W, Rahlfs VW, Bodmer Ch, Birkhäuser M. Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial. Maturitas. 2005 Aug 16;51(4):397-404. 8. Juliá Mollá MD, García-Sánchez Y, Romeu Sarri A, Pérez-lópez FR. Cimicifuga racemosa treatment and health related quality of life in post-menopausal Spanish women. Gynecol Endocrinol. 2009 Jan;25(1):21-6. 9. Nappi RE, Malavasi B, Brundu B, Facchinetti F. Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol. Gynecol Endocrinol. 2005 Jan;20(1):30-5. 10. Osmers R, Friede M, Liske E, Schnitker J, Freudenstein J, Henneicke-von Zepelin HH. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol. 2005 May;105(5 Pt 1):1074-83. Erratum in: Obstet Gynecol. 2005 Sep;106(3):644. 11. Raus K, Brucker C, Gorkow C, Wuttke W. First-time proof of endometrial safety of the special black cohosh extract (Actaea or Cimicifuga racemosa extract) CR BNO 1055. Menopause. 2006 Jul-Aug;13(4):678-91. 12. Reed SD, Newton KM, LaCroix AZ, Grothaus LC, Grieco VS, Ehrlich K. 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