Black cohosh is a North American plant in the buttercup family whose root and rhizome (underground stem) are made into supplements. It is used mainly for menopause symptoms such as hot flashes and night sweats.
Also known as: Actaea racemosa, Cimicifuga racemosa, Remifemin, black snakeroot, bugbane.
Trials in a 2012 Cochrane review used 8 to 160 mg a day of various extracts (median 40 mg) for 8 to 54 weeks. Products are often standardized to at least 1 mg of triterpene glycosides a day; Remifemin is standardized to 40 mg of root a day (ODS). These are study protocols, not a recommendation.
It is sold in the US as a dietary supplement. Under the 1994 dietary supplement law (DSHEA), FDA does not approve dietary supplements before they are marketed, and the maker, not FDA, is responsible for safety and labeling. ODS says products vary widely in makeup, partly because the active compounds are not known.
What studies show is mixed. Per ODS, two high-quality trials (351 and 88 women) found black cohosh no better than placebo for hot flashes and night sweats, a 2012 Cochrane review of 16 trials found insufficient evidence for or against it, and a 2016 meta-analysis found no benefit. The American College of Obstetricians and Gynecologists says the data do not show herbal supplements like black cohosh work for hot flashes, and the North American Menopause Society advises against recommending it. NCCIH notes a 2023 review of 22 studies that found products containing black cohosh potentially helpful for overall menopause symptoms and hot flashes, but not anxiety or depression.
Safety: side effects in trials are mild (stomach upset, rash). At least 83 cases of liver damage, some very serious, have been reported with black cohosh products; a cause has not been proven, and some products contained the wrong herb (ODS, NCCIH). The US Pharmacopeia advises people with liver disorders to avoid it and anyone with abdominal pain, dark urine or jaundice to stop and contact a doctor. It may not be safe in pregnancy or breastfeeding, and it is uncertain whether it is safe after breast or uterine cancer (NCCIH). ODS says no clinically relevant drug interactions are known, though this has not been well studied. Black cohosh is not blue cohosh, a different herb with serious risks.
We could not find a single published half-life or time to peak for black cohosh that applies to a supplement dose, so we do not list one. Herbal products are mixtures of many plant compounds, so no single figure would describe them.
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