Black cohosh is an herb that grows in North America. It has been used to treat symptoms of menopause. It can be taken as an extract, pill, or powder.


20 milligrams 1 to 2 times per day

What Research Shows

Likely Effective

  • Menopause—likely to ease symptoms and improve quality of lifeB1-B7

May Be Effective

Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.

Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.

Safety Notes

It may be safe to take black cohosh for a short time. Some evidence suggests that black cohosh may cause liver damage. Not enough studies have been done to say whether it is safe to take for a long period.


Talk to your doctor about any supplements or therapy you would like to use. Black cohosh can interfere with treatment or make conditions worse, such as:

  • Black cohosh can make certain medicine less effective. People taking medicine to suppress their immune system should talk to their doctors before taking black cohosh.


REFA Infertility

REFA1 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;30(7):505-510.

REFB Menopause

REFB1 Shams T, Setia MS, et al. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Altern Ther Health Med. 2010;16(1):36-44.

REFB2 Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012 Sep 12;(9):CD007244.

REFB3 Ross SM. Menopause: a standardized isopropanolic black cohosh extract (remifemin) is found to be safe and effective for menopausal symptoms. Holist Nurs Pract. 2012;26(1):58-61.

REFB4 Schellenberg R, Saller R, et al. Dose-dependent effects of the cimicifuga racemosa extract ze 450 in the treatment of climacteric complaints: A randomized, placebo-controlled study. Evid Based Complement Alternat Med. 2012;2012:260301.

REFB5 Zheng TP, Sun AJ, et al. Efficacy and safety on Cimicifuga foetida extract on menopausal syndrome in Chinese women. Chin Med J. 2013;126(11):2034-2038.

REFB6 Jiang K, Jin Y, et al. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric. 2015;18(4):559-567.

REFB7 Tanmahasamut P, Vichinsartvichai P, et al. Cimicifuga racemosa extract for relieving menopausal symptoms: a randomized controlled trial. Climacteric. 2015 Feb;18(1):79-85.

REFC Depression

REFC1 Yeung KS, Hernandez M, Mao JJ, Haviland I, Gubili J. Herbal medicine for depression and anxiety: A systematic review with assessment of potential psycho-oncologic relevance. Phytother Res. 2018 May;32(5):865-891.

REFD Safety

REFD1 Teschke R, Bahre R, et al. Suspected black cohosh hepatotoxicity--challenges and pitfalls of causality assessment. Maturitas. 2009 Aug 20;63(4):302-314.

REFD2 Teschke R, Bahre R, et al. Black cohosh hepatotoxicity: quantitative causality evaluation in nine suspected cases. Menopause. 2009 Sep-Oct;16(5):956-965.

REFD3 Teschke R. Black cohosh and suspected hepatotoxicity: inconsistencies, confounding variables, and prospective use of a diagnostic causality algorithm. A critical review. Menopause. 2010 Mar;17(2):426-440.

REFD4 Teschke R, Schwarzenboeck A, et al. Herb induced liver injury presumably caused by black cohosh: a survey of initially purported cases and herbal quality specifications. Ann Hepatol. 2011 Jul-Sep;10(3):249-259.

REFD5 Izzo AA. Interactions between herbs and conventional drugs: overview of the clinical data. Med Princ Pract. 2012;21(5):404-28.

REFD6 Bunchorntavakul C, Reddy KR. Review article: herbal and dietary supplement hepatotoxicity. Aliment Pharmacol Ther. 2013 Jan;37(1):3-17.

REFD7 Teschke R, Schulze J, et al. Herbal hepatotoxicity: suspected cases assessed for alternative causes. Eur J Gastroenterol Hepatol. 2013 Sep;25(9):1093-1098.

REFD8 Amer MR, Cipriano GC, et al. Safety of Popular Herbal Supplements in Lactating Women. J Hum Lact. 2015 Aug;31(3):348-353.

REFD9 Brown AC. Liver toxicity related to herbs and dietary supplements: Online table of case reports. Part 2 of 5 series. Food Chem Toxicol. 2017 Sep;107(PtA):472-501.

Revision Information

  • Reviewer: EBSCO NAT Review Board Eric Hurwitz, DC
  • Review Date: 07/2019
  • Update Date: 09/09/2019