Black Cohosh

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Black cohosh


Black cohosh (Cimicufuga racemosa ) is a member of the Ranunculaceae family. Its nicknames of squawroot and snakeroot denote its Algonquian heritage and differentiate it from the common snake root plant (Aristolochia serpentaria ). It should also not be confused

with blue cohosh (Caulophyllum thalictroides ); their only similarity is that both are roots.

Black cohosh grows from a gnarled black root, hence its name; it has a smooth stem and big multiple leaves with jagged edges. In summer, white flowers develop from what are called racemes. These flowers emit a stinky odor. The plant, which can grow to 9 ft (1 m) tall, is a native North American plant found on hills and in forests located at high levels. It is found from Ontario, Canada to Maine to the southern states of Georgia and Missouri.

Black cohosh contains several components, as outlined by James F. Balch, MD and Phyllis A. Balch, CNC in their book Prescription for Nutritional Healing, Second Edition :

  • actaeine
  • cimicifugin
  • estrogenic substances
  • isoferulic acid
  • oleic acid
  • palmitic acid
  • pantothenic acid
  • phosphorus
  • racemosin
  • tannins
  • triterpenes
  • vitamin A

General use

Black cohosh has a history of usage for women's health problems, dating back to the Algonquian natives living in the Ohio Valley. However, according to Michael Castleman in The Healing Herbs, the Algonquians also boiled the roots in water and drank the concoction for fatigue , arthritis, sore throat , and a typical occurrence of that time, rattlesnake bites. The Eclectic doctors of the 1800s also recommended black cohosh for what they called "hysterical" diseases, i.e. female reproductive diseases as well as fevers, rashes , sleeplessness and malaria . A popular patent medicine company of the same era, the Lydia E. Pinkham's Vegetable Compound, sold a potion containing black cohosh for menstrual complaints.

Today, black cohosh is still used for gynecological problems from menstruation to menopause , with several studies over the past 40 years backing up this pattern of usage. Michael T. Murray, ND, a well-known natural medicine author, outlines some of this research regarding menopause in his paper Hormone Replacement Therapy vs. Black Cohosh in Menopause. Growing numbers of menopausal women are turning to black cohosh rather than allopathic treatment to manage their symptoms. A 2002 study of menopausal women in the San Francisco Bay area found that women taking black cohosh and other herbal remedies for their symptoms reported higher satisfaction with their treatment than women receiving conventional allopathic therapy.

The most famous research was a 1982 open study in which 629 women took 80 mg of black cohosh over a period of six to eight weeks. Over 80% of the women experienced relief from several menopausal symptomshot flashes, perspiration, headaches, vertigo, heart palpitations, irritability, sleep disturbances and depression . A later random study focused on 60 women under 40 years of age who had hysterectomies, with one ovary remaining. The women were either given black cohosh or hormone replacement therapy (HRT) of estrogen or estrogen-progestin combinations. Although the HRT met with better results, the study concluded that black cohosh was a favorable natural alternative for post hysterectomy.

A 1998 German clinical study showed that black cohosh has good therapeutic results in treating symptoms of menopause and also that black cohosh did not show any hormone-like activity as previously thought. A second German study, published in 2002, reported that black cohosh has antiestrogenic effects.

Because the collective results of a number of studies show synthetic hormone replacement therapy, which contains estrogen, increases breast cancer risk by 130%, black cohosh is being considered as an alternative. A 1998 study at the University of Bridgeport in Connecticut reviewed eight previous studies of black cohosh as treatment for menopausal symptoms. This study stated that black cohosh is a safe alternative to estrogen replacement therapy (ERT) for women where ERT is contraindicated or declined. Some contraindicated conditions from ERT include a history of estrogen-dependent cancer , unidentified uterine bleeding, liver disease, gallbladder disease, endometriosis, uterine fibroids and fibrocystic breast disease .

In a 1999 in vitro study at the New York College of Osteopathic Medicine, several herbs, including black cohosh, hops , and vitex, were shown to inhibit the growth of T-47D cells. The study concluded that these herbs may be useful in preventing breast cancer.

A 1999-2000 study at Cedars-Sinai Hospital in Los Angeles, California, focused on the efficacy and safety of several traditional phytomedicines, including black cohosh root extract, to treat women's gynecological conditions, such as PMS and menopause. This study concluded that both dong quai and black cohosh are safe to use to relieve menopausal symptoms, but only black cohosh showed efficacy. The study stated that information regarding safety for use during pregnancy and lactation is still small in amount and suggested pharmacists study scientific literature to help decide the value of recommending these herbs for use.

A 1999 national survey of 500 midwives belonging to the American College of Nurse-Midwives and 48 nurse-midwife education programs was undertaken by the West Virginia University School of Medicine. The purpose was to determine if colleges were educating their students in the use of herbs to stimulate labor. Of the 172 surveys returned, 90 used herbal preparations and 82 did not. Herbal usage was broken down as: black cohosh (45%), evening primrose oil (60%), blue cohosh (64%), and castor oil (93%). Those who used these herbs did so because they are natural, and those who refrained from using them cited the lack of sufficient research about the safety.

Black cohosh can sometimes bring relief from tinnitus (ringing in the ears) as James A. Duke, Ph.D. relates in The Green Pharmacy. He refers to a professional flutist who suffered this condition for many years and a black cohosh tincture caused his tinnitus to decrease considerably.

Black cohosh can also decrease blood pressure by "opening the blood vessels in the limbs (peripheral vasodilation)" according to a study referred to by Michael Castleman in The Healing Herbs. A person with hypertension should first consult a physician.

Other possible benefits of black cohosh are to alleviate muscle spasms, reduce neuralgia pain , and relieve bronchial infections by stopping the compulsion to cough . Black cohosh has also been recommend as a glandular tonic.


Black cohosh may be taken in capsule, extract, tea, or tincture.

To make a tea, boil 1/2 tsp powdered black cohosh root for each cup (250 ml) of water for 30 minutes. After it cools, it can be sipped with lemon and honey to mask its bitter taste.

One teaspoon of black cohosh tincture can be taken on a daily basis. Ten to 30 drops of extract mixed in water can be taken daily. Two to five capsules (40 mg/capsule) may be taken daily. The German Commission E recommends taking two 20-mg capsules daily, one in the morning and one at night. These tablets are available under the name Remifemin, a black cohosh extract. A 2002 German study found that these standard dosages are effective for most women and that there is no therapeutic benefit from higher dosages.


Black cohosh should not be used during pregnancy except at the time of birth. It should also not be taken by those with a chronic disease, or women taking birth control pills or HRT. Children under 12 years and adults over 62, should start with lower dosages.

The German Commission E recommends taking black cohosh for six months at a time only. However, recent studies with animals show no toxicity problems. It is always best to first consult a health care practitioner.

Side effects

An overdose (over 900 mg/day) could cause dizziness, nausea and vomiting, diarrhea , pain in the abdomen, headaches, joint pains, and a lowered heart rate. These conditions could also appear sometimes when taking low dosages of black cohosh. Large dosages can also cause poisoning symptoms.


Women taking black cohosh should not take it together with birth control pills; HRT; such sedatives as diazapam; or blood pressure medications.



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Castleman, Michael. The Healing Herbs. Rodale Press, 1991.

Duke, James A., PhD. The Green Pharmacy. Rodale Press, 1997.

Heinerman, John. Heinerman's Encyclopedia of Healing, Herbs & Spices. Prentice Hall, 1996.

Landis, Robin, with Karta Pukh Singh Khalsa. Herbal Defence. Warner Books, Inc. 1997.

Mindle, Earl. Earl Mindell's Herb Bible. Simon & Schuster, 1992.

Murray, Michael, ND. Encyclopedia of Nutritional Supplements. Prima Publishing, 1996.

Murray, Michael, ND. The Healing Power of Herbs, second edition. Prima Publishing, 1995.

Rothenberg, Mikel, MD, and Charles Chapman. Dictionary of Medical Terms, third edition. Barron's Educational Series, 1994.


Kam, I. W., C. E. Dennehy, and C. Tsourounis. "Dietary Supplement Use Among Menopausal Women Attending a San Francisco Health Conference." Menopause 9 (January-February 2002): 72-78.

Liske, E., W. Hanggi, H. H. Henneicke-von Zepelin, et al. "Physiological Investigation of a Unique Extract of Black Cohosh (Cimicifugae racemosae rhizoma ): A 6-month Clinical Study Demonstrates No Systemic Estrogenic Effect." Journal of Women's Health and Gender-Based Medicine 11 (March 2002): 163-174.

Stengler, Angela, ND and Mark Stengler, ND. "Black Cohosh." Natural Factors Research Information (September 10, 1998).

Tyler, Varro E., PhD, ScD. "Honest Herbalist: Five Herbs That Ease Menopause." Prevention Magazine (March 1999).

Zierau, O., C. Bodinet, S. Kolba, et al. "Antiestrogenic Activities of Cimicifuga racemosa Extracts." Journal of Steroid Biochemistry and Molecular Biology 80 (January 2002): 125-130.


Hardy, M. L. Herbs of special interest to women [Abstract]. Cedars-Sinai Integrative Medicine Medical Group, Cedars-Sinai Hospital, Los Angeles, CA. 2000.

Lieberman, S. A review of the effectiveness of Cimicifuga racemosa (black cohosh) for the symptoms of menopause [Abstract]. University of Bridgeport, Connecticut, USA. 1998.

McFarlin B.L, M.H. Gibson, J. O'Rear, and P. Harman. A national survey of herbal preparation use by nurse-midwives for labor stimulation. Review of the literature and recommendations for practice [Abstract]. West Virginia University School of Medicine, Department of Obstetrics and Gynecology, Morgantown, 1999.

Sharon Crawford

Rebecca J. Frey, PhD