Black Cohosh

Actaea racemosa · Cimicifuga racemosa · Black Snakeroot

Snapshot

Indications	Contraindications
Menopausal symptoms^{1, 2} Hot flashes¹ Menopausal sleep disturbance³ Menstrual cramps⁴ Premenstrual syndrome⁴	Pregnancy⁵ Liver disorder⁶

Black cohosh (Actaea racemosa) is a North American buttercup-family root whose supplements act through unknown constituents and mechanisms, with serotonergic pathways proposed⁶. It is taken mainly by perimenopausal and postmenopausal women for hot flashes, night sweats, general menopausal symptoms, and sleep disturbance^{1, 3}. It is also promoted for menstrual cramps and premenstrual syndrome, where reliable data are lacking⁴.

The evidence is split: a Cochrane review found no placebo difference in hot flush frequency⁷, while a 2023 meta-analysis found hot flash gains but not anxiety or depression gains¹. A 2026 systematic review of randomized trials in fertility care found most dietary supplement studies, black cohosh among them, reported no significant difference in live birth⁸. Products listing black cohosh are sold as root powders, liquid extracts, and dried extract tablets or capsules that differ in composition; see Form comparison⁶.

LiverTox rates black cohosh a well-established cause of clinically apparent liver injury, though the responsible component is unclear and mislabeled Actaea species may account for some cases⁹. Health Canada labels ask for a practitioner's advice before use with a liver disorder or while breastfeeding⁵. A case report described serotonin toxicity and rhabdomyolysis in a woman taking black cohosh alongside two long-term antidepressants¹⁰.

Last updated October 16, 2026. Read how we make monographs.

In the full monograph

69 sources, 54 studies

When to useThe situations practitioners use it for, each with the reason and the study behind it.
SafetyWho should avoid it, who needs extra care, and the side effects reported in studies.
InteractionsThe medicines and supplements it interacts with, the effect of each, and what labeling says to watch.
Protocol notesThe doses used in studies, how and when they were taken, and how the forms on the market compare.
How it worksWhat it is and how it works in the body, in plain terms.
Published studiesThe studies behind each use, popular claims checked against them, and trials still under way.
Word of mouthWhat patients and practitioners report online, kept separate from the clinical evidence.
Clinical perspectiveA closing read of where the evidence is solid, where it is thin, and what has not been studied.

Snapshot

In the full monograph

Sources