IngredientsBlack cohosh is a popular herbal medication derived from a plant of the buttercup family indigenous to North America (Actaea racemosa, syn. Cimicifuga racemosa), which is claimed to have estrogen-like effects and is used primarily for relief of symptoms of menopause. Black cohosh (Cimicifuga racemosa; Actaea racemosa) is a perennial plant indigenous to the eastern United States and Canada. The roots and rhizomes of black cohosh (Actaea racemosa L. syn. Cimicifuga racemosa [L.] Nutt., Ranunculaceae) have been used traditionally by Native Americans.
Also known as Black Cohosh, Squaw Root, Rattleweed, Black Snakeroot, and Macrotys, it is a member of the Buttercup Family native to North America, primarily east of the Mississippi. Other, mostly historical, names for this herb include snakeroot, black bugbane, rattleweed, macrotys, and rheumatism weed.
The species has a history of taxonomic uncertainty. The plant species has a history of taxonomic uncertainty. It was long placed in the genus Cimicifuga, and both names continue to appear in scientific and commercial literature. The part of the black cohosh plant used in herbal preparations is the root or rhizome (underground stem).
The roots and rhizomes are used in traditional medicine by Native Americans. Its extracts are manufactured as herbal medicines or dietary supplements. Modern commercial preparations include standardized dry extracts in tablet or capsule form, liquid extracts, and tinctures. Substances in black cohosh that may account for its activity include triterpene glycosides such as actein, 23-epi-26-deoxyactein, and cimicifugoside; resins, such as cimicifugin; and aromatic acid derivatives such as caffeic, isoferulic, and fukinolic acids.
Products containing black cohosh extract are frequently standardized to provide at least 1 mg triterpene glycosides per daily dose. Remifemin, a commercial black cohosh product used in several studies included in a 2012 Cochrane Review, is an extract currently standardized to be equivalent to 40 mg black cohosh root/rhizome (extracted with isopropyl alcohol) per daily dose of two tablets, but it is not standardized to triterpene glycoside content. The most commonly studied black cohosh extracts in clinical trials are Remifemin® and Menofem/Klimadynon®. Remifemin® has changed formulation from a 60% ethanol extract to a 40% isopropanol extract, and the extract preparation is not consistently reported in trials.
The C. racemosa extract BNO 1055 (Menofem/Klimadynon) is a 58% ethanolic extract by volume, corresponding to 21.5 mg root per tablet. Black cohosh extract is also available in tincture form; one reported dosage of the tincture is 2 mL twice daily of a 1:1 tincture in 90 percent alcohol.
Black cohosh has a long history of use. Native Americans used it, for example, to treat musculoskeletal pain, fever, cough, pneumonia, sluggish labor, and menstrual irregularities. European settlers used black cohosh as a tonic to support women's reproductive health.
Native Americans used black cohosh for treatment of a variety of conditions including kidney ailments, malaria, sore throat, and menstrual cramps. It has also been used medicinally in Germany since the late 19th century.
A flowering perennial that can grow nine feet tall, black cohosh has been used historically by Native Americans to treat gynecological disorders, kidney disorders, malaria, and sore throat, as well as snake bite and rheumatism, and as an insect repellent.
Several specific tribal traditions have been documented. The Delaware tribe was one of the Native American communities that used black cohosh. They combined it with other herbs like stoneroot. It was used to treat symptoms of menopause and rheumatism and as a tonic. The Cherokee people are believed to have used it for those conditions as well, as did the Iroquois. The Algonquins used it to treat kidney ailments.
Physicians made use of it in the 19th century to treat fever, menstrual cramps, and arthritis. In Europe, black cohosh has been used for over 40 years as a treatment for menstrual pain. Other traditional and folk uses were for treatment of sore throats and bronchitis. The plant appeared in the U.S. Pharmacopoeia under the name "black snakeroot" during the year 1830.
Traditionally, the plant material was prepared as a root decoction. Native American tribes, particularly those from the Eastern Woodlands, were among the first to harness the medicinal properties of black cohosh. They used it to treat a variety of conditions, including menstrual irregularities, childbirth complications, and even rheumatic pains. The herb was often prepared as a decoction or infusion, which allowed its potent compounds to be extracted and used in healing rituals.
In recent years, this material has been used as an alternative to mainstream hormone replacement therapy for treatment of menopause and premenstrual syndrome. The Women's Health Initiative found that combination estrogen and progesterone hormone replacement therapy increases breast cancer and cardiovascular disease risk, which compelled many women to seek herbal alternatives such as black cohosh extract (BCE) to relieve their menopausal symptoms.
Most of the phytochemical and biological research has focused on two abundant classes of compounds: the triterpene glycosides and phenolic acids.
The bioactive components are believed to be the triterpene glycosides, which constitute 2–6% of the herbal extracts isolated largely from dried rhizomes. It is currently common practice to standardize the content of commercially available black cohosh supplements to certain triterpene compounds related to actein, such as 23-epi-26-deoxyactein. The maximum-tolerated dose and pharmacokinetics of 23-epi-26-deoxyactein, the most abundant triterpene found in the plant, has been evaluated in a phase I clinical trial.
Detailed chemical profiling by HPLC has identified a broad range of individual triterpene glycosides. High-performance liquid chromatography revealed the presence of caffeic acid, ferulic acid, isoferulic acid, cimicifugoside H-1, cimiracemoside A, cimicifugoside H-2, (26R)-actein, 26-deoxycimicifugoside, (26S)-actein, 23-epi-26-deoxyactein, 23-OAc-shengmanol-3-O-beta-D-xyloside, 26-deoxyactein, 25-OAc-cimigenol-3-O-beta-L-arabinoside, 25-OAc-cimigenol-3-O-beta-D-xyloside, cimigenol-3-O-beta-L-arabinoside, and cimigenol-3-O-beta-D-xyloside.
Currently, more than 20 polyphenolic derivatives have been found in the roots of black cohosh, including caffeic acid, isoferulic acid, fukinolic acid, and cimicifugic acids. These compounds have anti-inflammatory and antioxidant properties.
The first report on the isolation and full structural characterization of an alkaloid in black cohosh was published in 2005 by Fabricant et al., who reported on the identification of a new cyclic guanidine-type alkaloid named cimipronidine. This was an interesting discovery not only because of the novelty of the structure (a new chemical entity with seven carbon atoms), but also because guanidine alkaloids are relatively rare in higher plants. Furthermore, cimipronidine was the first reported guanidine alkaloid from the Ranunculaceae family. Black cohosh also contains N-methylcytisine, as well as guanidine alkaloids.
In addition to choline derivatives, several betaines have been identified in black cohosh.
The active constituent(s) and mechanism(s) of action remain unknown. Since serotonergic receptors and transporters are involved with thermoregulation, black cohosh and its phytoconstituents were evaluated for serotonergic activity using 5-HT7 receptor binding, cAMP induction, and serotonin selective reuptake inhibitor (SSRI) assays. Crude extracts displayed 5-HT7 receptor binding activity and induced cAMP production. Fractionation of the methanol extract led to isolation of phenolic acids and identification of Nω-methylserotonin by LC/MS-MS.
The mechanism by which black cohosh exerts its biological effects remains contested. Although the mechanism by which BCE relieves symptoms is unknown, several hypotheses have been proposed: it acts (1) as a selective estrogen receptor modulator, (2) through serotonergic pathways, (3) as an antioxidant, or (4) on inflammatory pathways.
The use of black cohosh by menopausal women makes the question of estrogenic activity particularly relevant. Molecular and physiological studies to determine if BCE has estrogen activity have yielded conflicting results. An early study indicated that BCE bound to estrogen receptors, while later studies found that it did not. Given that the clinically utilized hydrophilic extracts of black cohosh roots and rhizomes are not estrogenic, alternative mechanisms of menopausal symptom relief have been proposed. Studies show it has no effect on LH, FSH, prolactin, or estradiol levels.
BCE does not induce the proliferation (i.e., is not estrogenic) of hormone-dependent or independent breast or prostate cancer cell lines, but does inhibit proliferation (antiestrogenic) through the induction of apoptosis.
One proposed alternative mechanism suggests serotonergic activity by triterpenes to minimize episodes of hot flashes and bone loss. The triterpenes tested displayed no significant activity for binding to the 5-HT7 receptor. Instead, a more accepted theory states that a serotonin derivative (Nω-methylserotonin) found in black cohosh may activate serotonin receptors. Black cohosh relieves menopausal symptoms likely by mimicking neurotransmitters: dopaminergic, noradrenergic, serotonergic and GABAergic effects have been demonstrated.
The most prominent triterpene in BCE, 23-epi-26-deoxyactein, suppresses cytokine-induced nitric oxide production in brain microglial cells, although the whole BCE extract actually enhanced this pathway. A variety of activities have been reported for black cohosh and its compounds, but the absorption and tissue distribution of these compounds is unknown.
One component isolated from black cohosh, 25-acetylcimigenol xylopyranoside (ACCX), inhibited receptor activator of nuclear factor kappa B ligand (RANKL)-induced osteoclast differentiation of mouse bone marrow macrophages. Black cohosh extract has also been associated with decreased bone loss in the ovariectomized (OVX) rat model, as well as increased bone mineral density (BMD) and enhanced callus formation in a OVX rat tibia fracture healing model. These bone-related findings remain at the preclinical level.
This is the most extensively studied clinical application of black cohosh. Studies using various designs since the 1950s have attempted to determine whether black cohosh affects menopausal symptoms.
A 2012 Cochrane Review examined the totality of clinical trial evidence. The studies were highly heterogeneous with respect to such factors as design, duration, type and amount of black cohosh used, and main findings. The review's authors concluded that there was "insufficient evidence" from these trials "to either support or oppose the use of black cohosh for menopausal symptoms."
A 2016 systematic review and meta-analysis of randomized clinical trials examined four studies of herbal and plant-based therapies that included black cohosh (three of which were examined in the Cochrane Review) to treat menopausal symptoms. The trials randomized a total of 511 women to a daily dose of various formulations of 6.5 to 160 mg/day black cohosh extract or placebo.
The range of dosages (8 to 160 mg daily) and wide range of intervention periods (four to 52 weeks) also made comparisons difficult. Furthermore, many of the studies reporting to have measured outcomes either did not report the data, or provided data that was insufficient for meta-analysis.
Major clinical bodies have weighed in cautiously. The American College of Obstetricians and Gynecologists, in its 2015 clinical guidelines for managing menopausal symptoms, concluded that "data do not show that" herbal dietary supplements like black cohosh "are efficacious for the treatment of vasomotor symptoms." The North American Menopause Society advises clinicians against recommending herbal therapies such as black cohosh because "they are unlikely to be beneficial" in alleviating vasomotor symptoms.
The Cochrane Review found adequate justification for conducting further studies on black cohosh's use to treat menopausal symptoms. Its authors recommended that researchers conduct higher quality trials with larger samples and provide more details about their experimental protocols.
While several clinical trials document the efficacy of BCE in alleviating menopausal symptoms, preclinical studies to determine how BCE works have yielded conflicting results. Part of this is because there is not a universally accepted method to standardize the dose of black cohosh triterpenes, the presumed active ingredients in the extract.
Despite the mixed picture from pooled analyses, some individual trials have shown positive signals. A more recent meta-analysis found that isopropanolic black cohosh extract, an herbal medicinal product widely used in the EU as nonhormonal therapy, is comparable to low-dose transdermal estradiol or tibolone with a better benefit-risk profile than tibolone. In other studies, black cohosh did not enhance bone density, improve menopausal symptoms, nor improve 10-year risk of coronary heart disease in early postmenopausal women, although it has been reported to improve sleep.
Overall evidence strength: Mixed to weak. Results are inconsistent across trials, heavily dependent on preparation type, dose, and study duration. No definitive conclusion of superiority over placebo has been established by major systematic reviews or clinical guidelines.
Observational and open-label studies have demonstrated reductions in the number and severity of hot flashes among breast cancer patients undergoing adjuvant endocrine therapy complemented with black cohosh; however, randomized, double-blind, placebo-controlled clinical trials have failed to demonstrate reductions greater than that seen with placebo. Significant declines in hot flash frequency and severity and other menopausal symptoms are reported in a review of observational studies of breast cancer patients and survivors taking Remifemin® (20–40 mg/d), with or without tamoxifen or raloxifene.
Prospective trials indicated reductions as high as 56% (95% CI = 40%–71%) in hot flash scores (daily frequency times average severity).
One randomized trial concluded that black cohosh was not significantly more efficacious than placebo against most menopausal symptoms, including number and intensity of hot flashes, in women with a history of breast cancer.
Investigations of black cohosh for hot flashes due to breast cancer treatment also yielded mixed results, but supplementation may be effective for menopausal syndrome induced by luteinizing hormone-releasing hormone (LHRH) analogue.
Overall evidence strength: Weak to preliminary. Open-label and observational studies suggest benefit, but blinded RCTs have not confirmed superiority over placebo in this population.
Many women use black cohosh as a natural treatment for menopausal symptoms. However, controversy exists around safety in breast cancer because of its purported estrogenic activity.
One prospective open drug safety study examined breast tissue effects directly. The aim of this study was to determine the effects of the isopropanolic extract of black cohosh (Remifemin) on mammographic breast density and breast epithelial proliferation in healthy, naturally postmenopausal women with climacteric symptoms. It was a prospective, open, uncontrolled drug safety study in which baseline status was compared with status after 6 months of treatment. A total of 74 women were treated with 40 mg black cohosh daily, and 65 women completed the study. Mammograms were performed, and breast cells were collected by percutaneous fine needle aspiration biopsies at baseline and after 6 months. The findings suggest that the isopropanolic extract of black cohosh does not cause adverse effects on breast tissue. Furthermore, the data did not indicate any endometrial or general safety concerns during 6 months of treatment.
Preclinical data suggest black cohosh may decrease proliferation of prostate cancer cells and induce an apoptotic response in liver cells, but it also increased incidence of metastatic disease in mice. Whether it has similar effects in breast cancer patients is not clear, and a retrospective observational study of breast cancer patients found that isopropanolic black cohosh extract enhanced disease-free survival.
Overall evidence strength: Preclinical data are conflicting (some antitumor, some pro-metastatic findings in animal models). The single prospective human tissue safety study was uncontrolled. No definitive human RCT evidence on breast cancer risk is available.
Preliminary data suggest black cohosh has antiosteoporotic effects and enhances bone formation. In addition to providing relief from the vasomotor symptoms of menopause, extracts of black cohosh have also been reported to protect against postmenopausal bone loss.
However, human clinical evidence is limited. In a controlled animal study, a high dose of risedronate significantly increased bone mineral density (BMD) of the femur and vertebrae, while black cohosh extract had no significant effect on BMD individually and minimal effects upon coadministration with risedronate.
Overall evidence strength: Preliminary. Preclinical data and animal models show some potential for bone protection; controlled human clinical trial evidence is lacking and one human study found no benefit on BMD.
Black cohosh has also been promoted for other conditions, including menstrual cramps and premenstrual syndrome, and to induce labor. A substantial number of studies in people have evaluated black cohosh for menopause symptoms. Much less research has been done on black cohosh for other conditions.
Overall evidence strength: Insufficient clinical evidence. These remain largely traditional-use claims with very limited rigorous human study data.
The following dosages are reported from clinical studies and regulatory/pharmacopeial sources; they are not recommendations.
Clinical trials using various black cohosh preparations to treat menopausal symptoms have shown that its use is associated with a low incidence of adverse effects. The most commonly reported side effects are gastrointestinal upset and rashes, both of which are mild and transient. In clinical trials using black cohosh to treat menopausal symptoms, it was found that it was associated with a low incidence of adverse effects. Those reported were musculoskeletal complaints, uterine bleeding, and breast pain.
In recent years, products labeled as black cohosh have been implicated in many instances of clinically apparent, acute liver injury, some cases of which have been severe and led to emergency liver transplantation or death.
Black cohosh does not appear to be inherently hepatotoxic, and the clinical features of cases suggest that the liver injury is an idiosyncratic reaction which may be immunologically mediated. The specific component of black cohosh responsible for the hepatic injury is not known. The NIH LiverTox database assigns a Likelihood Score of A: products sold as black cohosh are well-established causes of clinically apparent liver injury, but the specific ingredient or component that accounts for the injury is unclear.
As with many herbal dietary supplement products, unknown adulterants or herbals mislabeled as black cohosh may be the actual cause of hepatic injury. The severity of liver injury ranges from moderate elevations in liver enzymes to acute hepatic failure and death. However, mild disease with spontaneous resolution with stopping the herbal is more common.
To date, over 50 case reports have been published linking black cohosh to clinically apparent liver injury ranging from self-limited hepatitis, prolonged hepatitis with cholestasis, autoimmune hepatitis and acute liver failure requiring transplant. The reported latency to onset of liver injury ranges from 1 to 48 weeks, but is usually within 2 to 12 weeks of starting the medication.
A clear causal relationship between black cohosh and hepatotoxicity is controversial. The reason for this is multifactorial but is largely due to the fact that products labeled as black cohosh usually contain other compounds and multiple ingredients.
The American Herbal Products Association recommends that pregnant women not take black cohosh except under the supervision of their health care provider because studies have not rigorously evaluated its use during pregnancy. Avoid use in pregnancy and lactation. Black cohosh has been used to improve pregnancy rates following in vitro fertilization and in women with polycystic ovarian syndrome (PCOS). Premature birth may occur with large doses.
Black cohosh supplementation does not significantly alter the expression or activity of metabolic enzymes CYP3A4, CYP1A2, or CYP2E1. While a statistically significant decrease in the CYP2D6 phenotype (approximately 7%; P = .02) has been observed in a human study, the clinical relevancy of this finding is questionable — especially since a very high dose was used for this particular investigation (1,090 mg bid).
Black cohosh may interact with drugs metabolized by the CYP3A4 enzyme. Clinical significance has yet to be determined.
Since pharmacological activity of tamoxifen is dependent on the metabolic conversion into active metabolites by the action of cytochromes P450 2D6 and 3A4, a study evaluated whether black cohosh extracts can inhibit formation of active tamoxifen metabolites. At 50 µg/ml, a 75% ethanolic extract of black cohosh inhibited formation of 4-hydroxy-tamoxifen by 66.3%, N-desmethyl tamoxifen by 74.6% and α-hydroxy tamoxifen by 80.3%. This extract also inhibited CYP3A4 and CYP2D6 with IC50 values of 16.5 and 50.1 µg/ml, respectively. These findings were obtained in vitro; given that tamoxifen is a selective estrogen receptor modulator and is primarily metabolized by CYP2D6, even mild inhibition of the enzyme by black cohosh warrants further study.
Chemotherapy drugs: Black cohosh may increase toxicity of doxorubicin and docetaxel. Clinical significance has yet to be determined. Simvastatin: Black cohosh and the isolated compound actein have synergistic effects with simvastatin that may enhance activity but also increase side effects.
In recent years, adulteration of black cohosh roots and rhizomes (Actaea racemosa, Ranunculaceae) has become more apparent. Adulteration predominantly occurs with Chinese species of Actaea such as A. heracleifolia, A. dahurica, and A. cimicifuga (all known by the common name Chinese cimicifuga and by the Chinese name of sheng ma).
In an analysis of 11 commercial black cohosh products, three were found to contain the marker compound cimifugin and not cimiracemoside C, thereby indicating that these plants contain Asian Actaea instead of black cohosh. One product contained both black cohosh and an Asian Actaea species.
The European Pharmacopoeia (EP) Monograph Cimicifugae rhizoma includes a high-performance thin layer chromatography (HPTLC) test to detect possible substitution with A. cimicifuga, A. dahurica, A. heracleifolia, and A. podocarpa. The HPLC-ELSD methods in the EP and United States Pharmacopeia (USP) reportedly also provide a suitable way to distinguish black cohosh from adulterating species.
The inconsistent reports on the efficacy of black cohosh products may be due to the variability of the test article used, as few include characterization or standardization.
Health conditions that Black cohosh may help support.
Black cohosh (Actaea racemosa) has clinical evidence primarily for anxiety and mood symptoms associated with menopause, where multiple RCTs show significant reduction in anxiety, hot flashes, and depression. It is listed among promising herbs for anxiety in systematic reviews of herbal medicine. Mechanisms include serotonergic and dopaminergic modulation rather than phytoestrogenic effects.
Black cohosh (Actaea racemosa) has been used by Native Americans for musculoskeletal and menopausal symptoms. Clinical research suggests the extract increases bone-specific alkaline phosphatase, a marker of bone formation, and a double-blind placebo-controlled study found measurable effects on bone turnover markers in postmenopausal women.
Black cohosh has been evaluated for perimenopausal depression and anxiety-related mood symptoms, with effects attributed to serotonergic and dopaminergic activity. A 2023 meta-analysis found improvements in overall menopausal symptoms but not specifically in depressive symptoms. Evidence in non-menopausal depression is lacking.
Black cohosh (Actaea racemosa) is one of the most studied botanicals for menopausal symptoms. It acts primarily through serotonergic and dopaminergic pathways rather than as a classical phytoestrogen. Multiple RCTs and a 2012 meta-analysis support its use for hot flash reduction; however, it does not act through direct estrogen receptor binding in typical clinical use.
Black cohosh (Actaea/Cimicifuga racemosa) has demonstrated fertility-relevant effects in women with PCOS: a systematic review of 15 clinical studies including 8 RCTs found evidence for ovulation regulation and improved fertility outcomes. Combined with clomiphene, it improved pregnancy rates (43.3% vs. 20.3%) versus clomiphene alone in PCOS.
Black cohosh (Cimicifuga racemosa) is the most extensively studied botanical for menopausal hot flashes. Multiple RCTs are documented in the NIH ODS fact sheet; it appears to act via serotonergic rather than estrogenic pathways. Evidence is mixed across trials but overall supports modest reductions in hot flash frequency and severity.
Clinical evidence supports black cohosh improving objective sleep parameters in postmenopausal women. A randomized, double-blind, placebo-controlled trial using polysomnography found significant improvements in sleep efficiency and reduced wake-after-sleep-onset duration. Effect sizes were modest and evidence is largely confined to the menopausal population.
Black cohosh (Actaea/Cimicifuga racemosa) has clinical trial evidence for menstrual cycle regulation, particularly in PCOS. A 2014 BMC systematic review of 8 RCTs (762 women) found Cimicifuga racemosa equivalent to clomiphene citrate for ovulation induction and menstrual regulation. Its triterpene glycosides interact with hypothalamic-pituitary estrogen receptors to reduce LH and regulate the cycle.
Black cohosh (Cimicifuga/Actaea racemosa) is one of the most extensively studied botanicals for menopause. A 2023 meta-analysis of 22 studies found it potentially beneficial for overall menopausal symptoms, particularly hot flashes. A 2017 systematic review of 47 RCTs (n=8,326) found it more effective than placebo for vasomotor symptoms, though not significantly better than transdermal estradiol.
Black cohosh has been clinically evaluated for effects on bone metabolism in postmenopausal women. Studies show improvements in bone turnover markers, with one trial demonstrating stimulation of osteoblast activity. However, evidence on direct improvement in bone mineral density is conflicting and fracture prevention is unestablished.
Black cohosh (Actaea racemosa) is the most extensively studied botanical for perimenopausal symptoms. Multiple RCTs and reviews report reductions in hot flash frequency and improvements in overall menopausal symptom scores. It appears to act via serotonergic rather than estrogenic pathways. Evidence is mixed but a 2023 clinical trial found significant improvement versus placebo.
Black cohosh has demonstrated improvements in subjective and objective sleep quality in perimenopausal and postmenopausal women. Polysomnographic studies have shown increased sleep efficiency and reduced wakefulness. Evidence outside the menopausal context is absent.
Black cohosh has documented scientific evidence for reducing uterine fibroid size in postmenopausal women. A randomized double-blind parallel-controlled study in 62 Chinese women found that 40 mg/day isopropanolic Cimicifuga racemosa extract reduced total myoma volume by 30.3% over 12 weeks, compared to a slight increase in the tibolone group. It has a long traditional history as a uterine stimulant used by Native American herbalists and midwives.
Black cohosh has been studied for effects on vaginal mucosa in postmenopausal women. A clinical trial found beneficial changes including increased superficial cells and improvement in vaginal atrophy-related symptoms. However, the HALT Study RCT found no effect on vaginal epithelium or reproductive hormones.
Vertigo and dizziness are listed in the NIH ODS Black Cohosh Health Professional Fact Sheet as menopausal symptoms for which black cohosh is commonly used and studied. Clinical trials of black cohosh for the broad menopausal symptom cluster include vertigo as a subscale item on validated rating tools.
Black cohosh has a long traditional use for arthritis and rheumatic conditions documented by Native Americans and 19th-century American physicians. Some limited clinical evidence exists from a combination-herb product. The herb is attributed anti-inflammatory properties partly due to salicylic acid content.
Black cohosh has a long ethnobotanical record as a pain-relieving herb used by Native Americans and eclectic physicians for musculoskeletal and neuralgic pain. Recent mechanistic research implicates μ-opioid receptor partial agonism as a plausible antinociceptive pathway, though no RCTs have used chronic pain as a primary endpoint.
Headache relief is listed as a traditional use of black cohosh documented in 19th-century American practice and in the MHRA UK public assessment report on the herb. Black cohosh is also noted to commonly cause headache as a mild side effect. No dedicated clinical trials establish it as an effective headache treatment.
Black cohosh has a well-documented traditional use for menstrual cramps dating from Native American practice through 19th-century American eclectic medicine. The NCCIH confirms this historical use. Direct clinical trial evidence for dysmenorrhea as a primary endpoint is very limited.
Black cohosh has a documented traditional use for PMS and premenstrual mood and physical symptoms spanning Native American and 19th-century American practice. The NCCIH lists PMS as a promoted indication. Modern clinical trials targeting PMS specifically are very sparse, small, and inconclusive.
Black cohosh has traditional documentation for rheumatism including rheumatoid arthritis from both Native American practice and 19th-century eclectic medicine. The NIH StatPearls and MHRA list RA as a traditional indication. Modern scientific evidence is limited to proposed anti-inflammatory mechanisms without dedicated RCTs.
Tinnitus is listed in the MHRA UK Public Assessment Report as a traditional use of black cohosh, and the NIH ODS notes it as a menopausal symptom for which black cohosh is promoted. No dedicated clinical trials exist for black cohosh as a tinnitus treatment.
Body systems that Black cohosh may help support.
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