Native to eastern North America, black cohosh thrives in moist, shaded woodlands. Over time, it has also become a popular garden perennial that rarely goes unnoticed. Shortly after midsummer, black cohosh begins sending up tall flower stalks covered with tiny, pearl-shaped buds. As the buds open, the stalks take on the look of soft, white bottlebrushes towering above the dark green foliage. The fact that honeybees scorn the flowers but flies and beetles love them may be the source of at least two of black cohosh’s other common names, bugbane and bugwort, respectively. Another is black snakeroot. To understand this nickname’s source, dig around the base of the plant and expose its twisted rhizomes, which look like dark little snakes.

Therapeutic Uses

Premenstrual syndrome
Menstrual cramps
Mild depression (melancholy)
The primary use for black cohosh is to treat menopause-related symptoms. Germany’s health authorities recognize its use for menopausal symptoms (hot flashes, night sweats, and sleep disturbances), as well as for premenstrual syndrome and menstrual cramping. Early studies suggested that black cohosh acted like a natural estrogen, or phytoestrogen, gently reducing hot flashes and vaginal dryness. But newer research has found no hormonal effects of black cohosh in menopausal women.
More than 20 published clinical trials have evaluated the effectiveness of black cohosh for menopausal hot flashes. While some studies show a modest reduction in symptoms, not all clinical trials have been positive. There may be added benefit when black cohosh is combined with St. John’s wort. One clinical trial of 301 women reported a 50 percent reduction in symptoms with the combination, compared with 19 percent reduction in the placebo group. Current research has not yet determined the effectiveness of black cohosh for hot flashes.
Scientists at the University of Illinois at Chicago have demonstrated that compounds in black cohosh act as antidepressants and reduce pain sensitivity, lending support to the traditional use of black cohosh as a treatment for melancholy, or depressed mood, as well as its widespread use as a remedy for arthritis and menstrual pain. No clinical trials have evaluated its effectiveness for these conditions.

How to Use

Tea: Simmer 2 teaspoons of chopped root and rhizome in 2 cups water for 10 minutes. Strain. Drink ¼ cup, 2 to 3 times per day.
Capsules: 40 to 200 mg of dried rhizome taken daily, in divided doses.
Tincture: Generally, 1 to 2 ml, 3 times per day.
Standardized extract: 20 to 40 mg black cohosh extract twice daily.
Products are often standardized to provide 1 to 2 mg of 27-deoxy-actein.


Except for minor gastrointestinal upset, clinical trials have shown black cohosh to be free of side effects. A few reports have suggested black cohosh may, in rare cases, cause damage to the liver, prompting European, Australian, Canadian, and British health authorities to require product labels suggesting conferral with a health-care provider by anyone with any type of liver disease. Safety during pregnancy and breast-feeding is not known.

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