4 Benefits of Black Cohosh: Dosage & Safety

Black cohosh is a prized herb with deep roots in traditional American medicine.  This therapeutic plant has a bitter root that is used medicinally for numerous health issues.  Traditionally, black …

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Written by: Siobhan Mendicino
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Medical Review by: Daniel Powers, MS
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Black cohosh is a prized herb with deep roots in traditional American medicine. 

This therapeutic plant has a bitter root that is used medicinally for numerous health issues. 

Traditionally, black cohosh was used for painful and inflamed joints, women’s gynecological issues, and menopause symptoms.

This article will look at the health benefits of black cohosh, its safety, and history.  

Health Benefits of Black Cohosh

What is Black Cohosh?

Black cohosh is the pungent, bitter rhizome of the bugbane plant. The plant is known for its characteristic black “roots” that set it apart from other species in the cohosh family.  

The scientific name for black cohosh is Actaea racemosa (formerly Cimicifuga racemosa). Black cohosh is a time-tested herb that was and is a medicinal staple for indigenous North Americans.

In traditional herbal medicine, black cohosh was used to support gynecological complications, induce perspiration, and manage inflammation of the joints. Traditional accounts also suggest that black cohosh was used to soothe intense coughs like whooping cough.

Modern research shows that black cohosh may help to support female reproductive organs and hormones, reduce arthritis symptoms, and relax the nervous system. Active constituents in black cohosh, like triterpenes, saponins, and phytoestrogen, may be responsible for some of these health-supporting properties. 

While black cohosh is the common name for the whole plant, the only medicinal part of the plant is the black rhizome. A rhizome is an underground part of the stem that provides both roots and stem with nutrients.

Due to its native location, black cohosh was essential to North America’s ancient medicinal systems as a treatment for internal complications or external trauma like bites from poisonous snakes.

Numerous scientific human trials, animal studies, and traditional accounts summarize the many benefits of black cohosh. 

Black cohosh health benefits

Health Benefits of Black Cohosh:

Traditional medicine systems and modern herbalists have observed various black cohosh benefits.

Below are the top expert accounts from traditional and professional herbalists describing the benefits of black cohosh and its active constituents. 

1. May Support the Female Reproductive System 

Traditional evidence describes black cohosh as having highly supportive effects on the female reproductive system, especially for women experiencing menopause symptoms (like hot flashes).

The female reproductive system consists of the ovaries, fallopian tubes, uterus, vagina, and vulva and is responsible for producing eggs, certain sex hormones, and supporting a fertilized egg until birth. Optimal functionality is required by all organs to provide reproductive functions and hormonal balance.

In particular, it appears that black cohosh supports women suffering from menopausal symptoms, including hot flashes, night sweats, and migraines. It’s also thought to potentially be used as a hormone replacement therapy for women.

In a comparative trial observing women with menopausal hot flashes, taking a black cohosh root supplement reduced the number and severity of hot flashes compared to evening primrose oil. While both supplements improved quality of life, black cohosh significantly decreased hot flashes and produced better results than evening primrose oil.

In an animal study involving rats undergoing hot flushes, Actaea racemosa effectively reduced the severity of hot flushes. The rats received 50mg or 100mg of the black cohosh supplement and both produced results. 

Another animal study found that black cohosh extract acts like estrogen in rats without ovaries. The estrogenic effects were observed in bones and fat tissue, but not in the uterus. Researchers believe that black cohosh extract could be an alternative to human hormone replacement therapy.

In a clinical trial observing menopausal women and rats without ovaries, researchers discovered that black cohosh significantly reduces levels of luteinizing hormone, which triggers ovulation and other reproductive functions. 

Traditional accounts mention that black cohosh was frequently used to promote menstruation, induce contractions, and support efficient labor. 

In their traditional herbal text, Dr. Felter and Dr. Lloyd mention that black cohosh “plays a very important part in the therapeutics of gynecology.” They describe the herb as “surpassed by no other drug” for painful menstruation and extremely helpful for “irritat[ed] and congest[ed] conditions of the uterus.” 

AHG Registered Herbalist, David Hoffmann, describes Actaea racemosa as helpful for managing menopausal symptoms. He states that it’s helpful for easing “the physical and mental changes associated with perimenopause and menopause, as well as hormonal deficits resulting from ovariectomy or hysterectomy in younger women.” 

He also mentions that a number of scientific studies claim the herb is supportive of “menopausal symptoms, such as hot flashes, headache, vertigo, heart palpitations, ringing in the ears, and a range of associated psychological symptoms.” He also states that black cohosh extract “has been used successfully in women younger than 40 years for the treatment of hormonal deficits resulting from ovariectomy or hysterectomy”.

Revered herbalist, Mauve Grieve, mentions in her text A Modern Herbal that black cohosh is an emmenagogue, meaning it will bring on absent or late menstruation.

The European Medicines Agency, a government organization that evaluates and supervises medicinal products, suggests the use of black cohosh for “relief of menopausal [symptoms] such as hot flushes and profuse sweating.”


Both scientific evidence and registered herbalists confirm that black cohosh may work to benefit the female reproductive system and reduce symptoms of menopause. Additional human studies are needed for verification of these findings.

2. May Support the Nervous System

Scientific trials and traditional evidence show that black cohosh may support nervous system conditions and may be helpful for issues such as anxiety, depression, and insomnia.

Anxiety and depression are characterized as mental health disorders that affect the nervous system. Both conditions trigger symptoms like fatigue, low energy, and sleep disturbances which often affect mood and behavior.

A clinical trial observing early postmenopausal women with sleep complaints found that black cohosh supplements significantly improved sleep quality. The extract increased sleep efficiency and decreased the number of times women awoke after they fell asleep. Researchers also mentioned that these effects also improved overall quality of life.

A review of black cohosh extract in healthy adults describes the herb as having properties that reduce anxiety. Researchers reached this conclusion after the extract was found to have lowered a stress biomarker despite several flaws in the study.

Another review of anxiety and depression in menopausal and perimenopausal women found that black cohosh reduced these menopause symptoms; however, the results were non-significant. 

An animal trial studying rats with hot flushes suggests that black cohosh supplements may have an antidepressant effect. When the rats received the black cohosh extract it increased mobility after a behavioral test, suggesting that the rats recovered more quickly from their “depressed” reaction. 

Herbalist David Hoffmann writes that black cohosh is a relaxing nervine that may help with menopausal symptoms, such as “irritability, sleep disturbances, and depressive moods”. It’s also said to reduce night sweats, which can lower sleep quality.


Human clinical research indicates that black cohosh may aid the nervous system by working as an herbal remedy for anxiety, depression, and insomnia.

3. May Reduce Arthritis Symptoms

Animal studies, traditional accounts, and modern herbalists claim that black cohosh may help reduce arthritis symptoms. 

Arthritis is characterized by inflammation and the increasing loss of cartilage in the joints. Symptoms include joint pain, stiffness, limited range of motion, and joint deformities. Genetics, various environmental triggers, and lifestyle factors typically cause arthritis.

An animal study observing ovariectomized (removed ovaries) rats with deteriorating knee joint cartilage discovered that black cohosh supplements may prevent symptoms that lead to osteoarthritis. Researchers attributed this effect to the saponin content in black cohosh.   

In his text Medical Herbalism, David Hoffmann mentions that black cohosh extract is effective “against rheumatic pain, including that of rheumatoid arthritis, osteoarthritis, and muscle problems.” He suggests that the herb’s “contribution to the treatment of arthritic disorders should not be overlooked”.

In the King’s American Dispensatory, Dr. Felter & Lloyd suggest that black cohosh is one of the most valued herbs for rheumatism and has gained a highly respected reputation in this area of medicine. Some accounts suggest that a black cohosh herbal supplement may cure acute rheumatism.

Herbalist M. Grieve mentions that black cohosh “infusion and decoction have been given with success in rheumatism.”

The American Botanical Council writes that the Canadian Natural and Non-prescription Health Products Directorate recommends using black cohosh to “help relieve muscle and joint pain associated with rheumatic conditions (such as rheumatoid arthritis, osteoarthritis, and/or fibrositis)”.


Lab-based research and traditional herbalism have found that black cohosh may reduce symptoms of arthritis, however human trials are needed to confirm this finding.

4. Other Benefits 

Other purported black cohosh benefits include: 

  • May Prevent Cancer Growth: Several reviews suggest that menopausal women suffering from breast cancer may benefit from black cohosh supplements. The American Botanical Council writes that black cohosh supplements “may have positive effects on breast cancer cells.”
  • May Help with Poisonous Bites: Numerous traditional accounts suggest that black cohosh treats bites caused by poisonous animals like snakes and insects. 
  • May have Antioxidant Effects: A lab-based study suggests that black cohosh herbal supplements may protect cells against oxidative damage through antioxidant activity.  


Black cohosh has been tied to a wide variety of health benefits. Human clinical trials are needed to verify these findings.
Benefits of taking black cohosh

Black Cohosh Safety:

Safety Class: 2B (Not for use during pregnancy)

Interaction Class: A

Black cohosh is generally recognized as safe (GRAS) by the FDA. 

This herb is safe for most individuals when consumed appropriately.

Pregnancy & Lactation:

The Botanical Safety Handbook mentions that black cohosh is “contraindicated for use during pregnancy due to the reported emmenagogic effect”.  

Various traditional and contemporary herbalism accounts suggest using black cohosh for different stages of pregnancy; however, due to a lack of data on black cohosh during pregnancy and lactation, the Botanical Safety Handbook does not recommend it.

How Much Black Cohosh Should I Take?:

Standard dosing for black cohosh is as follows:

•Decoction (tea): Add 1 cup of water to ½ – 1 teaspoon of dried root and bring to a boil. Reduce to a simmer and allow to infuse for 10-15 minutes in a cup. Drink 1 cup, 3x per/day.

•Tincture (1:5): 2 to 4 ml, 3x/day.

•Fluid Extract (1:1): 0.3 to 1.8 ml, 3x/day.

•Remifemin® (a black cohosh pharmaceutical for menopause): 2.5mg, 2x/day.

The United States Pharmacopeia suggests using 1g of dried root daily.


Black cohosh is on the United Plant Saver’s “at-risk” list and is considered highly impacted by human activities.

Since the entire plant needs to be uprooted to gather the medicinal rhizomes, wild harvesting often causes plant death. Along with over-harvesting, black cohosh colonies are also threatened by logging and development projects. 

In Illinois and Massachusetts, black cohosh is listed as “endangered.” 

Thankfully, in recent years, there has been a significant increase in black cohosh cultivation due to the significant over-harvesting threat to the wild species.

Naming & Taxonomy:

Black cohosh’s scientific name is Actaea or Cimicifuga racemosa.

Cimicifuga” stems from the Latin words “cimex” and “fuga” meaning “bug flight,” and “actea” which originates from the Greek word for “elder tree.” These reference the Cimicifuga species’ ability to repel bugs and the similarity between black cohosh leaves and elder tree leaves. 

The term “cohosh” comes from the Algonquin Indian word for “rough”.

Various Native American tribes used others forms of this plant, including blue cohosh and white cohosh.

Actaea racemosa is a member of the buttercup family (i.e. the Ranunculaceae family) and is considered a perennial plant. The common name “black cohosh” refers to the color of the plant’s rhizome. Traditional accounts mention that it has a “faint, disagreeable odor” with a “bitter and acrid taste.” 

Black cohosh is native to North America and is a traditional perennial herb used by Native Americans. This herb has a tall stem surrounded by small white flowers and large leaves. It can be found in shady forested areas where it blooms in late June or early July.

It is found growing where the soil is dense and rich. The roots are medicinally ready for harvesting after three to five years.

Common names of black cohosh include Black Snake Root, Rattle Root, Squaw Root, Bugbane, Black Bugbane, Rattleweed, Rattle Snakeroot, Rattlesnake Root, Squawroot, Rattleweed, Rattletop, Macrotys, Baneberry, and Bugroot. 

Other plants in the cohosh species include: 

  • Actaea arizonica
  • Actaea bifida 
  • Actaea biternata
  • Actaea brachycarpa
  • Actaea cimicifuga
  • Actaea cordifolia 
  • Actaea dahurica
  • Actaea elata
  • and Caulophyllum thalictroides (blue cohosh).

History & Traditional Use:

Actaea racemosa’s history is deeply rooted in Native American medicinal traditions. Many traditional accounts suggest the herb was an essential medicine for Cherokee, Northeastern Algonquian, and Delaware tribes. 

Native American tribes use a black cohosh decoction for “diseases of women, for debility, to promote perspiration, as a gargle for sore throat, and especially for rheumatism.” These traditional accounts and knowledge were shared in medicinal texts written by Eclectic physicians. 

Early plant uses suggest that it was an “antidote” against rattlesnake bites and other poisonous bites. 

Black cohosh was first recommended in 1743 by a German man named Colden, who suggested its use to induce uterine contractions. In 1801, black cohosh debuted in a medical text describing it as “of high value” to the Native Americans, and useful for “putrid sore throat, itch, and in diseases of women.” Although Native American tribes are responsible for its historic first uses, Professor John King brought it to the attention of the medical community in 1832. 

Professor John King continually suggested black cohosh medicine for years; however, it didn’t get any attention from other Eclectic Physicians until 1852. 

Numerous modern clinical trials involving black cohosh mention that it is effective at treating gynecological issues, menopause-related symptoms, arthritis symptoms, and muscle issues. Both modern herbalists and medical professionals confirm these accounts.


Black cohosh is a highly supportive plant that has been time-tested by Native Americans, accredited herbalists, and modern medical physicians. In particular, it’s helpful for managing menopause symptoms, including hot flashes and night sweats.

While wild black cohosh is still used commercially, it is “at-risk” of becoming endangered. Therefore, only cultivated black cohosh should be used. 

Using black cohosh herbal supplements can be helpful for many different areas of health.

As always, make sure to talk with your doctor before adding a new herbal supplement to your routine.

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About Siobhan Mendicino

Siobhan is a herbal researcher and writer. She has a bachelor of science in communications as well as having completed a post-baccalaureate certificate in herbal studies.