Black Cohosh: Properties and Contraindications

The root of the plant known as black cohosh is used in the treatment of menopausal symptoms. In addition, it's believed to help soothe other ailments.
Black Cohosh: Properties and Contraindications

Last update: 12 July, 2021

Black cohosh is a perennial plant of the buttercup family. It’s native to North America. Its roots and rhizomes are used in traditional medicine as a supplement to regulate hormonal activity, soothe menopausal symptoms, and reduce some ailments.

According to information from the National University of Natural Medicine (NUNM), since ancient times it’s been known as a tonic to support women’s reproductive health. This is because it’s not only useful during menopause but also helps to relieve menstrual disorders, endometriosis, and sterility problems.

Among other things, some even believe it’s useful against rattlesnake bites, to mitigate musculoskeletal pain and improve sleep quality.

What does science say about it? What are its contraindications?

Here are all the details!

Characteristics of black cohosh

Black cohosh, whose scientific name is Cimicifuga racemosa, is a perennial herbaceous plant that comes from the United States and Canada. Europe also cultivates it now, and people distribute it as a supplement in many parts of the world, either in powder, liquid extracts, or pills.

The plant has a furrowed stem that reaches up to 2.5 meters. It usually flowers between June and July but brings with it an unpleasant odor that lingers until the plant dries out.

Each flower has about 100 stamens, giving the appearance of a long cluster of flowers. In fact, in the past it was known as Macrotys racemosa, meaning a large cluster.

The root is the part of the plant that’s useful for natural medicine. Its taste is bitter and the leaves leave a rough sensation on the tongue.

Main active compounds

Specialists have identified a wide variety of active compounds in black cohosh. These are apparently behind its medicinal properties. According to data reported in the National Center for Biotechnology Information, its composition comprises the following:

  • Isoflavone formononetin
  • Isoferulic, caffeic, salicylic and fukinolic acids
  • Fatty acids
  • Tannins
  • Sugars
  • Triterpenic glycosides

Properties of black cohosh

A woman with menstrual pain
This plant may help with menstrual pain.

Since ancient times, black cohosh has been listed as an “ally for women’s health.” As a review of studies published in 2017 expounds, the plant has exhibited estrogenic, anti-inflammatory, analgesic, and antispasmodic properties. In fact, it also appears to act as a tranquilizer, expectorant, and antitussive.

However, there are mixed research results and divided opinions as to its efficacy. Entities such as the European Medicines Agency (EMA) have even opted to suppress the medical information associated with this plant, as there isn’t complete certainty about its safety profile.

What are its benefits?

The main benefits of black cohosh have to do with menopausal symptoms, hormonal balance, and women’s reproductive health. In this regard, specialists have conducted several types of research. However, for now, the evidence remains limited. However, let’s take a closer look at its uses.

Menopause

Some people use the isoflavone content of black cohosh as an adjuvant to mitigate menopausal symptoms. Consuming the plant’s supplements is useful to reduce hot flashes, night sweats, nervousness, vaginal dryness, and other discomforts associated with this stage.

In this regard, research reported in the Journal of Education and Health Promotion found that menopausal women who took 20 milligrams of black cohosh supplements reported fewer hot flashes and a greater sense of well-being. In addition, scientists obtained similar results in a recent study in the Archives of Gynecology and Obstetrics.

Fertility

Native Americans used this plant to enhance female fertility. Despite this, evidence is limited. Even so, the phytoestrogens it contains are thought to be useful in increasing the effectiveness of Clomid (clomiphene citrate), a drug used to stimulate fertility.

In a small study, shared in Gynecological Endocrinology, better pregnancy and ovulation rates were determined in infertile women who took this type of supplement along with the aforementioned drug.

Hormonal balance

Some have suggested the estrogenic activity of black cohosh as an adjuvant to restore hormonal balance in women. Research shows that phytoestrogens may be useful in regulating menstrual cycles in the face of conditions such as polycystic ovary syndrome.

Specialists also suggest it to help ease menstrual cramps, dysmenorrhea, and premenstrual syndrome. In addition, some test-tube studies found that extracts of this plant slowed the spread of breast cancer cells. However, we need more studies to evaluate these effects.

Mental health

Popular literature claims that black cohosh promotes the relief of stress and anxiety. For now, there are no conclusive studies in this regard. However, in a study shared in Post Reproductive Health, supplementation with this plant helped to improve psychological symptoms in peri- and postmenopausal women.

Muscle and joint pain

In traditional medicine, people also use extracts of this plant as a supplement to reduce pain and inflammation. It’s even claimed to have anti-inflammatory, analgesic, and antipyretic properties. Therefore, people use it as an ally to reduce musculoskeletal pain, arthritis, and headaches.

Sleep quality and well-being

Black cohosh alone or combined with lemon balm or hypericum acts as a nervous and muscular relaxant. Because of this, it increases the feeling of well-being and helps to improve the quality of sleep. It’s ideal for calming states of nervousness and irritability.

Risks and contraindications of black cohosh

A woman with allergies
Allergies are likely to occur when using this substance.

Through the Office of Dietary Supplements (ODS), specialists have reported that supplements of this plant for menopause treatment have a low incidence of adverse effects. Even so, they can cause gastrointestinal discomfort, nausea, skin rashes, pain or enlargement of the breasts, and irregular bleeding.

However, the Spanish Agency of Medicines and Health Products (AEMPS) advises against the consumption of this plant in case of a history of liver disease or propensity to these. Specifically, specialists have observed a hepatotoxic effect that can be very harmful in these patients.

In addition, animal studies found that consumption of high doses of black cohosh may cause anemia, as it leads to damage to red blood cells. People should also avoid it in the following cases:

  • Pregnancy and lactation
  • Cancer and associated treatments
  • Blood pressure alterations
  • Treatments with hepatoprotective drugs
  • Allergic reaction to plants of the buttercup family

What should I remember about this plant?

Black cohosh is a medicinal plant with a long history as a supplement for women’s hormonal and reproductive health. In addition, people often use these supplements to greatly alleviate menopausal symptoms and fertility problems.

Despite this, some warn that its consumption can cause adverse effects on liver health, especially in people with a history of the disease. Therefore, you shouldn’t take it excessively or without medical supervision.

In conclusion, it’s important to consult with a professional to establish safe doses.

It might interest you...
4 Natural Therapies for Symptoms of Arthritis
Step To Health
Read it in Step To Health
4 Natural Therapies for Symptoms of Arthritis

Did you know that there are natural therapies for symptoms of arthritis that help mitigate pain and reduce stiffness caused by this condition?



  • Felter HM, Lloyd JU. 1898. Kings American Dispensatory. www.henriettes-herb.com.
  • Godfrey A, Saunders PR. Principles & practices of naturopathic botanical medicine. Toronto: Canadian College of Naturopathic Medicine Press; 2010.
  • Wobser RW, Takov V. Black Cohosh. [Updated 2020 Dec 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470187/
  • Henneicke-von Zepelin HH. 60 years of Cimicifuga racemosa medicinal products : Clinical research milestones, current study findings and current development. 60 Jahre Arzneimittel aus Cimicifuga racemosa : Meilensteine klinischer Forschung, aktuelle Studienergebnisse und derzeitige Entwicklung. Wien Med Wochenschr. 2017;167(7-8):147-159. doi:10.1007/s10354-016-0537-z
  • Mehrpooya M, Rabiee S, Larki-Harchegani A, Fallahian AM, Moradi A, Ataei S, Javad MT. A comparative study on the effect of “black cohosh” and “evening primrose oil” on menopausal hot flashes. J Educ Health Promot. 2018 Mar 1;7:36. doi: 10.4103/jehp.jehp_81_17. PMID: 29619387; PMCID: PMC5868221.
  • Friederichsen L, Nebel S, Zahner C, Bütikofer L, Stute P. Effect of CIMicifuga racemosa on metaBOLIC parameters in women with menopausal symptoms: a retrospective observational study (CIMBOLIC). Arch Gynecol Obstet. 2020 Feb;301(2):517-523. doi: 10.1007/s00404-019-05366-8. Epub 2019 Nov 16. PMID: 31734757; PMCID: PMC7033259.
  • Shahin AY, Ismail AM, Zahran KM, Makhlouf AM. Adding phytoestrogens to clomiphene induction in unexplained infertility patients–a randomized trial. Reprod Biomed Online. 2008 Apr;16(4):580-8. doi: 10.1016/s1472-6483(10)60465-8. PMID: 18413068.
  • Shahin AY, Mohammed SA. Adding the phytoestrogen Cimicifugae Racemosae to clomiphene induction cycles with timed intercourse in polycystic ovary syndrome improves cycle outcomes and pregnancy rates – a randomized trial. Gynecol Endocrinol. 2014 Jul;30(7):505-10. doi: 10.3109/09513590.2014.895983. Epub 2014 Mar 5. PMID: 24592984.
  • Kamel HH. Role of phyto-oestrogens in ovulation induction in women with polycystic ovarian syndrome. Eur J Obstet Gynecol Reprod Biol. 2013 May;168(1):60-3. doi: 10.1016/j.ejogrb.2012.12.025. Epub 2013 Jan 21. PMID: 23347605.
  • Huyen CTT, Luyen BTT, Khan GJ, Oanh HV, Hung TM, Li HJ, Li P. Chemical Constituents from Cimicifuga dahurica and Their Anti-Proliferative Effects on MCF-7 Breast Cancer Cells. Molecules. 2018 May 4;23(5):1083. doi: 10.3390/molecules23051083. PMID: 29734650; PMCID: PMC6102574.
  • Shahmohammadi A, Ramezanpour N, Mahdavi Siuki M, Dizavandi F, Ghazanfarpour M, Rahmani Y, Tahajjodi R, Babakhanian M. The efficacy of herbal medicines on anxiety and depression in peri- and postmenopausal women: A systematic review and meta-analysis. Post Reprod Health. 2019 Sep;25(3):131-141. doi: 10.1177/2053369119841166. PMID: 31630610.
  • Jiang K, Jin Y, Huang L, Feng S, Hou X, Du B, Zheng J, Li L. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric. 2015;18(4):559-67. doi: 10.3109/13697137.2015.1042450. Epub 2015 May 22. PMID: 26000551.