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Black Cohosh: Uses, Benefits, Side Effects and More!

By Dr Anuja Bodhare +2 more


Actaea racemosa is the botanical name for black cohosh, which belongs to the Ranunculaceae family. It is a perennial herb with a smooth erect stem and can grow up to eight feet tall. There is usually only one compound leaf per plant, and the leaves have a glossy dark green look. Black snakeroot, tall bugbane, black bugbane, macrotys, battle weed, columbine-leaved leontice, cordate rattle top, fake cohosh, papoose root are famous alternate names for black cohosh. Throughout the summer, feathery white flowers appear in an elongated raceme that can reach two feet in length. The flowers are notable for their striking beauty and their bittersweet smell. The fruit consists of an oval-shaped follicle. The rootstock is a thick, branching black rhizome with a mass of rootlets.1

black cohosh uses

Black cohosh is found in the north-eastern forests of North America, as well as Alabama in the south, Eastern Kansas in the west, and northern Canada. While it may be abundant locally, the species has been declining in recent decades as a result of habitat degradation and over-harvesting.1

Chemical Constituents of Black Cohosh:

Rhizomes of black cohosh have biological effects due to active chemicals such as triterpene glycosides, phenyl propan derivatives such as isoferulic acid, and quinolizidine alkaloids such as cytisine and methylcytisine. Phenolic compounds, chromones, triterpenoids, and nitrogen-containing components are well-known constituents.2 Tannins, resins, fatty acids, starch, and sugars are among the other ingredients present in black cohosh.1


Properties of Black cohosh:

Black cohosh has various potential uses due to its properties, such as:

  •         It may have anti-rheumatism activity
  •         It might have a liver-protective effect
  •         It might be an analgesic (pain-killing)
  •         It may be an anti-inflammatory
  •         It might have an anti-epileptic potential
  •         It might be anti-asthmatic
  •         It might have anti-ulcer properties
  •         It might be an antioxidant1
  •         It may act as an antidepressant
  •         It might be an anti-diabetic2
  •         It may be anti-allergic
  •       It might be anti-osteoporotic3

Also Read: Behada: Uses, Benefits, Side Effects & More!

Potential Uses of Black Cohosh:

Potential use of black cohosh for menopause:

It has been reported that black cohosh might have estrogen-like activity.  According to the literature, phytoestrogen, a component found in black cohosh extract, might be responsible for this activity. Black cohosh extract contains certain chemicals that might be helpful for the symptoms of postmenopausal syndrome (PMS). By binding to receptors in the brain might be involved in the thermoregulation mechanism (temperature regulation). As a result, black cohosh extract might reduce postmenopausal hot flashes through such a thermoregulation mechanism.3 However, more research is required to prove its effects for menopause.

Potential use of black cohosh for bone:

The extract of black cohosh might also help with postmenopausal osteoporosis. The bone structure was maintained by inhibiting bone loss and lowering bone reabsorption in an osteoporosis rat model.3

According to one study, the triterpenoids in black cohosh did not allow osteoclastic bone resorption in an animal model by decreasing osteoclast-like cells’ production and their resorbing activity, therefore boosting bone mineral density.3

The glycoside (actein) might help the bone against oxidative damage to osteoblasts in osteoporotic patients, and deoxyactein might cause a significant increase in cell growth, collagen content, alkaline phosphatase action, and mineralisation in the cells, thus protecting bone density.3 However, more evidence is required to prove these effects of black cohosh on bone.

Potential use of black cohosh for cancer:

According to laboratory studies, black cohosh extracts might have the potential to inhibit the growth of human breast cancer cells.1 Black cohosh extract’s possible cytotoxic and apoptotic (cell self-destruction) effect was observed on both androgen-dependent and independent prostate cancer cells.1

Another study that looked at the effects of black cohosh extract and its main component, triterpene glycoside (actein), on cell development and steroid hormone metabolism in human breast cancer cell lines found that it did not increase cell proliferation or have any effect on estrogen concentration. Alternatively, they might have increased androgen production to help adult women with menopausal symptoms.3 However, more research is required to understand the effect of black cohosh on cancer cells completely. Moreover, a serious condition like cancer must be properly diagnosed and treated by a doctor. Therefore, kindly consult a doctor.

Potential use of black cohosh for allergy:

Black cohosh extract might have the potential to inhibit the anaphylaxis reaction (an acute and severe allergic reaction to an antigen) induced by immunoglobulin E. It may also inhibit the cytokines mRNA, suggesting its possible anti-allergic effect.3 However, more investigations are needed to ascertain these claims.

Potential use of black cohosh for the brain:

The extract of black cohosh rhizome might have a kind of pain-killing effect in rats by acting on the opiate receptor.1 According to animal studies, the extract of black cohosh might also have antidepressant action.2 But, more research will be required to prove these effects of black cohosh.

Potential use of black cohosh for diabetes:

Black cohosh extract might have anti-diabetic properties by activating the protein kinase enzyme. In diabetic mice, the black cohosh extracts might have a potential to lower body weight, may increase glucose metabolism, and might improve insulin sensitivity.2 Ensure that you consult a doctor for proper diagnosis and treatment of conditions such as diabetes. Kindly do not self-medicate as these claims need to be ascertained by further research.

Potential use of black cohosh for inflammation:

The extract of black cohosh rhizomes might exert anti-inflammatory action on rats. Interleukin levels and neutrophil levels might have an effect when ferulic acid and isoferulic acid is administered to virus-infected mice.2 Therefore, it might be helpful in reducing inflammation, but more research is required to scientifically back-up these effects.

Though there are studies that show the potential use of black cohosh in various conditions, but these are insufficient and there is a need of further studies to establish the true extent of benefits of black cohosh on human health. 

In my experience, I have seen that in addition to managing hot flashes, black cohosh is commonly used to alleviate other menopausal symptoms. These may include night sweats (also known as vasomotor symptoms), vaginal dryness, heart palpitations, tinnitus (ringing in the ears), vertigo (dizziness), sleep disturbances, nervousness, and irritability. People may find black cohosh helpful against these various symptoms during menopause.

Dr. Siddharth Gupta, B.A.M.S, M.D (Ayu)

How to Use Black Cohosh?

Black cohosh can be used in the following ways:        Dried rhizome

  •         Dried root
  •         Roottincture
  •         Rhizometincture
  •         Rhizome extract
  •         Root extract
  •         Rhizome decoction1

Your Ayurvedic physician will prescribe you the form and dosage of black cohosh as and when needed based on your consultation with them. You must consult them before taking any herbal supplements. Do not discontinue or replace an ongoing treatment of modern medicine with an ayurvedic/herbal preparation without consulting a qualified doctor. 

I would like to highlight that it’s important for individuals with liver disorders to seek guidance from a doctor before using black cohosh products. Additionally, if someone experiences symptoms of liver trouble like abdominal swelling, dark urine, or jaundice while taking black cohosh, they should discontinue its use and promptly consult a doctor. These precautions are necessary to ensure the safe and appropriate use of black cohosh.

Dr. Rajeev Singh, BAMS

Also Read: What Causes High Estrogen Levels: A Comprehensive Explanation Based on Research

Side Effects of Black Cohosh:     

Some of the side effects noted with the use of black cohosh are:

  •         Inflammation of gastric and intestinal mucosa
  •         Nausea and vomiting
  •         Muscle damage
  •         Altered mental status
  •         Hyponatremia (low blood sodium level)
  •         Lung tumours
  •         Increase in the blood levels of creatinine phosphokinase and lactate dehydrogenase2

Precautions to Take With Black Cohosh:

According to the safety studies of black cohosh on pregnant and breastfeeding women, black cohosh usage is contraindicated during pregnancy and lactation..2 Therefore, it should only be taken under the supervision of a physician. No research has been done on the safety studies of black cohosh in children. Therefore, do not use black cohosh without a doctor’s prescription.

As I’ve noticed, in the use of herbs in Western tradition, black cohosh is potentially used for its pain-relieving properties in conditions such as arthritis and muscle-related issues. It is believed to help alleviate pain associated with these conditions.

Dr. Smita barode, B.A.M.S, M.S.

Interactions With Other Drugs:

  • Concomitant use of black cohosh with azathioprine or cyclosporine decreases immunosuppressive drugs’ effect and results in rapid rejection of the transplanted organ.2
  • Black cohosh affects the vagus nerve, causing hypotension and aggravating the effects of sedative medicines and general anaesthetic drugs. As a result, two weeks before any surgery, black cohosh should be avoided.2
  • When black cohosh is combined with anti-hypertensive medicines, the effects of these drugs may be amplified, and their concurrent use should be prohibited.2
  • When black cohosh and tamoxifen are used together, their effects may be increased.2

When black cohosh is combined with iron products, the tannins in the plant can interact with the iron and produce insoluble complexes. So, it should be taken at least two hours apart if you are taking iron supplements.2

Also Read: Vasavaleha – Benefits, Side Effects, Precautions & More!

Frequently Asked Questions:

What is black cohosh?

It is a perennial herb, botanically known as Actaea racemosa, belonging to the Ranunculaceae family.1

What are the benefits of black cohosh?

Black cohosh might be helpful for rheumatism, menstruation disorders, dropsy (tissue swelling), lung problems, cough, liver problems, sore throat, pain, inflammation, backache, insomnia, snakebite, convulsions, fits, epilepsy, nervous excitability, asthma, delirium, neuralgia (nerve pain), ulcers, scrofula, smallpox, cholera, and measles.1 However, more research is required to prove these potential effects of black cohosh on humans.

Is black cohosh good for menopause?

Menopausal women commonly use black cohosh due to its estrogenic activity. It has effects similar to estrogen and might be helpful for hot flashes, depression and bone loss.3 However, these effects need to be backed up by more scientific research.

How to use black cohosh?

Black cohosh is used in the form of dried rhizome,dried root, roottincture,, rhizometincture,rhizome extract,, root extract,, and rhizome decoction, as and when prescribed by your Ayurvedic physician.1

Can black cohosh be used during pregnancy and breastfeeding?

No, black cohosh usage is contraindicated during pregnancy and lactation.2

What are the side effects of black cohosh?

Black cohosh’s side effects are inflammation of gastric and intestinal mucosa,nausea and vomiting,muscle damage,, altered mental status,, hyponatremia, and lung tumours.2

Is black cohosh safe?

It is considered safe safe at the prescribed level except for pregnant and breastfeeding women.2

What are the common names of black cohosh?

Black snakeroot, tall bugbane, black bugbane, macrotys, battle weed, columbine-leaved leontice, cordate rattle top, fake cohosh, papoose root are the common names of black cohosh.1

Can black cohosh cause hot flashes?

No, black cohosh reduces the hot flashes. It binds to serotonin receptors in the brain (hypothalamus) and might help with reduce postmenopausal hot flashes through this thermoregulation mechanism.3


  1. Pengelly A and Bennett K. Appalachian plant monographs. Black cohosh Actaea racemosa L. 2012; 1-40. Available at: https://unitedplantsavers.org/wp-content/uploads/2013/06/Final-Reviewed-Black-Cohosh.pdf
  2. Salari S, Amiri MS, Ramezani M, Moghadam AT, Elyasi S, Sahebkar A, et al. Ethnobotany, phytochemistry, traditional and modern uses of Actaea racemosa L. (Black cohosh): a review. Pharmacological Properties of Plant-Derived Natural Products and Implications for Human Health. 2021: 403-449. Available at: https://www.researchgate.net/publication/350931576_Ethnobotany_Phytochemistry_Traditional_and_Modern_Uses_of_Actaea_racemosa_L_Black_cohosh_A_Review
  3. Mohapatra S, Iqubal A, Ansari MJ, Jan B, Zahiruddin S, Mirza MA, et al. Benefits of Black Cohosh (Cimicifuga racemosa) for Women Health: An Up-Close and In-Depth Review. Pharmaceuticals. 2022; 15(3): 278. Available at: https://www.mdpi.com/1424-8247/15/3/278

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