Black Cohosh

Herbal relief for menopause and menstrual problems

Menopausal symptoms such as hot flashes, insomnia, depression, and emotional lability commonly strike women in their 40s and early 50s. Such women look for help to cope with the discomfort and frustration associated with their change of life. Many postmenopausal women are uncomfortable with using hormone replacement therapy (HRT) to help diminish menopausal symptoms, because of the unpleasant side effects and fear of cancer associated with HRT.

A number of herbs have been suggested for the relief of menopausal symptoms, including black cohosh (Cimicifuga racemosa). Black cohosh has a longstanding reputation as a remedy for the treatment of “female complaints,” and was an official drug in the United States from 1820 until 1926.

Historical Uses

In the nineteenth century black cohosh had a reputation as an antiinflammatory for arthritis and rheumatism, for relieving painful menses, and for the treatment of nervous disorders. Root
extracts were used by Cherokee and Iroquois Indians to relieve pain; treat rheumatism, coughs, and colds; as a gargle for sore throat; and to treat menstrual irregularities.

Black cohosh is a large bushy perennial plant growing from four to eight feet in height in the deciduous forests of eastern North America. It has also been cultivated in Europe for medicinal use. The dried rhizomes and attached roots are regarded as the medicinally useful parts of the plant.

Black cohosh, which is also commonly known as black snakeroot or rattleweed, is a member of the buttercup family and thrives in moderately rich, moist, and lightly shaded conditions. Its tall, slender, white flowers are very conspicuous in the woods.

Clinical Studies

Early experiments with research animals showed that an extract of black cohosh induced an increase in the weight of the uterus. This was interpreted to mean that black cohosh had estrogenic activity.

Follow-up experiments with middle-age women showed that consumption of black cohosh extract was associated with a marked reduction in menopausal symptoms such as hot flashes, mood swings, depression, headache, and nervousness. Menstrual difficulties were also reduced in the women. Young women suffering from dysmenorrhea (difficult and painful menstruation) and premenstrual syndrome (PMS) have also derived benefit from using black cohosh preparations.

A clinical study of more than 700 women found that the use of a black cohosh preparation (Remifemin) produced a significant improvement in menopausal complaints. After two months more than 80 percent reported an improvement in symptoms such as hot flashes, sweating, headache, irritability, sleep disturbances, and depressive moods. In 93 percent of the women no side effects were reported from the use of black cohosh.

In a study of 80 women it was observed that hot flashes, profuse perspiration, headache and vertigo, and psychological disturbances such as nervousness, irritability, sleep disturbances, and depressive moods were significantly improved when women consumed eight milligrams per day of black cohosh extract (Remifemin) over a period of three months.

German researchers investigated the effect of black cohosh on 60 women under 40 years of age who had a hysterectomy in which at least one ovary was intact. They found that the daily use of eight milligrams of black cohosh extract was equally as effective as estrogen hormone therapy for the relief of hot flashes, sweating, sleep disturbances, depressive moods, and other related menopausal symptoms.

Activity Confirmed

Clinical studies during the past 40 years have continually confirmed that black cohosh is a safe and effective alternative for hormone replacement therapy in the treatment of hot flashes, mood swings, and other menopausal symptoms. In many experiments the use of black cohosh produced a mild mood-enhancing effect. At the present time, black cohosh is approved in Germany for the treatment of premenstrual syndrome, painful menstruation, and menopausal symptoms.

Safe Use

Black cohosh preparations have been used for many decades in Europe and are typically well tolerated by most persons. There is a fairly low risk of adverse side effects, although transient stomach discomfort has been observed in a few patients.

Clinical studies have shown that it is safe to use black cohosh for up to six months. Furthermore, there is no evidence that black cohosh causes cancer or produces any mutagenic effects. Nevertheless, black cohosh is not recommended for women who are either pregnant or breast-feeding.

The typical dose of black cohosh for effective results is either one 500-milligram tablet three times a day, or 20 to 30 drops of an extract of black cohosh (Remifemin) three times a day. Favorable results are usually observed within six to eight weeks of treatment. For maximum absorption of the active components, it is suggested that the tablets be sucked rather than swallowed.


Black cohosh extract appears to be a safe and effective treatment for PMS and menopausal complaints such as hot flashes, profuse sweating, mood swings, and sleep disturbances. It is useful where estrogen replacement therapy is contraindicated.

While black cohosh provides relief of menopausal symptoms similar to that seen with estrogen therapy, there is no indication that the herb provides any protection against bone loss or heart disease such as that associated with the use of estrogen.

Remember: Herbal products and dietary supplements can have pharmacological effects, may produce adverse reactions in some people, and could interact with over-the-counter and prescription medications you may take. Discuss with your physician your decision to use any herbal product. Anything mentioned in this article is not intended to diagnose, prescribe, or treat any ailment.

Winston J. Craig, Ph.D., R.D., is a professor of nutrition at Andrews University, Berrien Springs, Michigan.

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