Black Cohosh
Also known as actaea racemosa, black cohosh, black cohosh root, black cohosh root extract
Key takeaways
- Meta-analysis of randomized controlled trials found no evidence of hepatotoxicity for isopropanolic black cohosh extract (PMID: 21228727).
- Network meta-analysis of vasomotor symptoms in natural menopause indicates varying treatment effects across different interventions (PMID: 28276200).
- Updated pairwise meta-analysis continues to evaluate the efficacy of extracts in women with menopausal symptoms (PMID: 37192826).
What the research shows
AI-synthesized from 31 peer-reviewed sources · Updated 2025
Black Cohosh is a herbal supplement primarily used to manage menopausal symptoms. Research indicates mixed results, with some evidence suggesting it may reduce vasomotor symptoms, though high-quality meta-analyses often show limited or inconsistent efficacy compared to placebos.
By condition
Menopausal symptoms (Vasomotor)
Moderate
Multiple meta-analyses and systematic reviews suggest a potential for reducing hot flashes, though results vary significantly across different extract types and study designs.
Low estrogen status (Postoperative GnRHa treatment)
Weak
A systematic review suggests efficacy in improving low estrogen status in patients with endometriosis undergoing specific treatments.
Urogenital menopause symptoms
Weak
Systematic review of phytoestrogens, including black cohosh, shows limited impact on urogenital symptoms.
Effective doses
Specific dose ranges were not provided in the provided abstracts.
Safety & interactions
Generally considered safe in RCTs, with specific meta-analysis finding no evidence of hepatotoxicity for isopropanolic extracts; however, individual caution is advised.
Limitations
Research is limited by the use of different extract preparations and inconsistent results across systematic reviews. There is a need for more standardized, high-quality RCTs to confirm efficacy.
Top-rated Black Cohosh products
Ranked by safety score and evidence coverage
Drug–supplement interactions
31 documented interactions
| Drug | Severity | Mechanism | Evidence |
|---|---|---|---|
| Antiarrhythmics | Critical | Black Cohosh is a weak inhibitor of CYP2C9, which decreases metabolism of CYP2C9 | cyp-inferred |
| Anticonvulsants | Critical | Black Cohosh is a moderate inhibitor of CYP3A4, which decreases metabolism of CY | cyp-inferred |
| GI Prokinetics | Critical | Black Cohosh is a moderate inhibitor of CYP3A4, which decreases metabolism of CY | cyp-inferred |
| Immunosuppressants | Critical | Black Cohosh is a moderate inhibitor of CYP3A4, which decreases metabolism of CY | cyp-inferred |
| Theophylline | Critical | Black Cohosh is a moderate inhibitor of CYP3A4, which decreases metabolism of CY | cyp-inferred |
| Warfarin | Critical | Black Cohosh is a moderate inhibitor of CYP3A4, which decreases metabolism of CY | cyp-inferred |
| ADHD Medications | Moderate | Black Cohosh is a moderate inhibitor of CYP2D6, which decreases metabolism of CY | cyp-inferred |
| ARB | Moderate | Black Cohosh is a weak inhibitor of CYP2C9, which decreases metabolism of CYP2C9 | cyp-inferred |
| Antibiotics | Moderate | Black Cohosh is a moderate inhibitor of CYP3A4, which decreases metabolism of CY | cyp-inferred |
| Antidiabetic Drugs | Moderate | Black Cohosh is a moderate inhibitor of CYP3A4, which decreases metabolism of CY | cyp-inferred |
How it's sold
Data aggregated from 160 product labels
Research evidence
Showing top 10 of 31 sources, sorted by quality
**Peng et al., 2020** | Zhejiang Da Xue Xue Bao Yi Xue Ban | Systematic Review Peng Jie, Xu Wenfei, ... Wu Qiaoai. [Efficacy of black cohosh extracts for improving low estrogen status induced by postoperative GnRHa treatment in patients wit…
**Leach et al., 2012** | Cochrane Database Syst Rev | Meta Analysis Leach Matthew J, Moore Vivienne. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012-Sep-12;2012(9):CD007244. doi:10.1002/14651858.CD00…
**Sarri et al., 2017** | BJOG | Systematic Review Sarri G, Pedder H, ... Lumsden M A. Vasomotor symptoms resulting from natural menopause: a systematic review and network meta-analysis of treatment effects from the National Institute for He…
**Naser et al., 2011** | Menopause | Meta Analysis Naser Belal, Schnitker Jörg, ... Osmers Rüdiger. Suspected black cohosh hepatotoxicity: no evidence by meta-analysis of randomized controlled clinical trials for isopropanolic black cohosh …
**Castelo-Branco et al., 2021** | Climacteric | Meta Analysis Castelo-Branco C, Gambacciani M, ... Pickartz S. Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidence. Climacteric. …
**Morris et al., 2007** | BMJ Clin Evid | Systematic Review Morris Edward P, Rymer Janice. Menopausal symptoms. BMJ Clin Evid. 2007-Sep-01;2007 INTRODUCTION: Menopause is a physiological event. In the UK, the median age for onset of menopau…
**Burbos et al., 2011** | BMJ Clin Evid | Systematic Review Burbos Nikolaos, Morris Edward P. Menopausal symptoms. BMJ Clin Evid. 2011-Jun-15;2011 INTRODUCTION: Menopause is a physiological event. In the UK, the median age for onset of meno…
**Morris et al., 2010** | BMJ Clin Evid | Systematic Review Morris Edward P, Burbos Nikolaos. Menopausal symptoms. BMJ Clin Evid. 2010-Feb-25;2010 INTRODUCTION: Menopause is a physiological event. In the UK, the median age for onset of meno…
**Sadahiro et al., 2023** | Menopause | Meta Analysis Sadahiro Ryoichi, Matsuoka Lillian Nohara, ... Tseng Ping-Tao. Black cohosh extracts in women with menopausal symptoms: an updated pairwise meta-analysis. Menopause. 2023-Jul-01;30(7):76…
**Shams et al., 2010** | Altern Ther Health Med | Meta Analysis Shams Taghreed, Setia Maninder Singh, ... Ciampi Antonio. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Altern Ther Health Med. 2010…
Frequently asked questions
What is Black Cohosh and what is it used for?
Black Cohosh is a herbal supplement primarily used to manage menopausal symptoms, particularly vasomotor issues like hot flashes. While some research suggests it may help reduce these symptoms, high-quality meta-analyses often show limited or inconsistent efficacy compared to placebos, indicating that research results are mixed.
Does Black Cohosh work for hot flashes?
There is moderate evidence suggesting Black Cohosh may reduce hot flashes, though results vary significantly across different extract types and study designs. A network meta-analysis indicates varying treatment effects for vasomotor symptoms in natural menopause, so efficacy is not guaranteed for everyone.
What is the effective dose of Black Cohosh?
Specific effective dose ranges for Black Cohosh were not provided in the available evidence summaries. Because dosing standards are not clearly defined in the provided research, it is important to consult a healthcare provider for personalized guidance on usage.
Is Black Cohosh safe for my liver?
A specific meta-analysis of randomized controlled trials found no evidence of hepatotoxicity for isopropanolic Black Cohosh extracts. However, individual caution is still advised, and you should consult a healthcare provider if you have pre-existing liver conditions or concerns.
Does Black Cohosh interact with statin medications?
Yes, there is a moderate severity interaction possible between Black Cohosh and statins. Black Cohosh may inhibit CYP3A4, potentially increasing statin levels in the body, particularly for simvastatin and atorvastatin, so medical supervision is recommended.
Who should avoid taking Black Cohosh?
Individuals taking statin medications should exercise caution due to potential drug interactions. Additionally, because the evidence for urogenital symptoms is weak and efficacy for other conditions is not well-established, it is not recommended for self-treatment without professional medical advice.
Can Black Cohosh help with low estrogen levels after surgery?
There is weak evidence from a systematic review suggesting efficacy in improving low estrogen status in patients with endometriosis undergoing specific treatments like postoperative GnRHa. However, this evidence is limited, and it should not replace prescribed medical therapies.