Black Cohosh

“Black Cohosh”


A powerful herb for both woman and men – although it can be seen primarily for it’s use in women hormonal regulation. It has a ‘normalising’ action for both sexes.

Reduces pain, eases discomfort and regulates hormones. Herbalists have used this herb for nervous conditions, such as anxiety, with concomitant muscle pain.

It’s primary use is for stimulating labour and regulating contractions & as a tonic for menopause.


Botanical Name: Actaea racemosa

Common name: Black Cohosh, Cimicifuga, Black Bugbane, Snake Root

Family: Ranunculaceae

Parts Used: Root, Rhizome

Active Constituents:

  • Oleic, palmitic, salicylic acids
  • Tannins
  • Volatile oil (Blumenthal et al 2000 p25)
  • Steroidal Saponin
  • Triterpene glycosides — i.e. cimicifugoside and actein



  • Anti-rheumatic
  • Spasmolytic
  • Oestrogen modulating
  • HPO Axis Regulator
  • Uterine tonic (Bone 2003 p96)
  • Anti-tussive
  • Anti inflammatory
  • Tonic/Nervous System restorative
  • Serotonergic – partial antagonist of 5-HT(7) receptor
  • Dopaminergic – reduce some Sx menopause e.g. hot flushes
  • Emmenagogue (traditionally)
  • Modulate Oestrogen (steroidal saponin)
  • Reduce LH secretion
  • Labour-inducing aid – uterine stimulant
  • Phyto-SERMS — compounds that act as selective oestrogen-receptor modulators
Theorised that it may act through:
1) serotonergic pathways
2) as a SERM (see above) or
3) as an antioxidant
4) on inflammatory pathways


  • Symptoms associated with menopause
  • Dysmenorrhoea
  • Premenstrual Syndrome
  • Period Cramping
  • Ovarian dysfunction, ovarian insufficiency
  • Amenorrhoea
  • Ovarian pain
  • Female infertility (primary & secondary)
  • Arthritis
  • Rheumatism
  • Neuralgia
  • Myalgia
  • Sciatica
  • Tinnitus
  • Whooping cough
  • Reducing vasomotor symptoms associated with menopause
  • Hormonal ‘normaliser’ for both MEN & WOMEN
  • Nervous system conditions with concomitant muscle pain/tension & tremors 



Pregnancy, lactation

Oestrogen-dependent tumours such as breast cancer.


Possible interaction with Tamoxifen (Bone 2003 p96). Avoid in chemotherapy (Braun & Cohen).

Statin drugs e.g. atorvastatin
May potentiate increase in liver enzymes, specifically ALT.
Monitor (low level of risk). 

Not to be used in pregnancy – except as a partus prep (in last month).

# May cause CYP3A4 inhibition although one 2006 study found no effect on this – Still,  Check interaction with CYP3A4 substrate drugs #

BEWARE WITH LIVER — check enzymes. Avoid combining with any medication that could be hepatotoxic



  • Overdose has caused nausea and vomiting and may produce vertigo as well as visual and nervous disturbance (Bone 2003 p96).
  • High doses cause frontal headache.
  • Stomach complaints have been observed with a low frequency in clinical trials



1.5-3.0 ml of 1:2 liquid extract per day

10-20 ml of 1:2 liquid extract per week

Powdered root – 0.3 – 2 grams three times daily (Braun & Cohen)
TIME FRAME – results in 4 to 12 weeks
Limited 6  months dosing recommended due to lack of longer term studies of safety


When combined with St. John’s Wort, there may be increase in efficiency (based on 2 RCTs, as reviewed in EFFICACY OF BLACK COHOSH-CONTAINING PREPARATIONS ON MENOPAUSAL SYMPTOMS: A META-ANALYSIS (2010). Taghreed S. et al.).



Bone, K. (2002). A clinical guide to Blending Liquid Herbs
Braun, L. & Cohen, M. (2010). Herbs and Natural Supplements

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