Overview

Black cohosh is a plant called Actaea racemosa. Dietary supplements that contain black cohosh are usually made from the root (rhizome) of the plant. People often take black cohosh for symptoms of menopause and for other reasons, although its benefits are not well defined. Common side effects may include nausea, joint pain, upset stomach, and rash. Before taking black cohosh, make sure to tell your health care provider about any health conditions you have or medicines you are taking.

Uses

What is black cohosh used for?

Black cohosh (Actaea racemosa) is used for various reasons. However, the benefits of black cohosh are not well defined. Some common reasons that people use black cohosh include the following.

• Menopause symptoms
• Premenstrual syndrome (PMS)

The Food and Drug Administration (FDA) has not reviewed black cohosh for safety and effectiveness, and it is not approved by the FDA. Learn more about dietary supplements here.

How does black cohosh work (mechanism of action)?

Black cohosh is a plant called Actaea racemosa. It is part of the buttercup family of plants. Black cohosh may be known by many other names, including black snakeroot, rattleroot, and bugbane. Dietary supplements containing black cohosh are made from the root (rhizome) of the plant.

Certain chemicals found in black cohosh, called triterpene glycosides, may have effects in the body. These chemicals may change the way that the body responds to certain hormones, such as estrogen, luteinizing hormone (LH), or follicle-stimulating hormone (FSH). But it is unclear if or how black cohosh may work to reduce symptoms of menopause or premenstrual syndrome (PMS).

Herbal products like black cohosh naturally contain many different chemicals, such as triterpene glycosides. The amounts of each chemical in a specific black cohosh product may vary. Different amounts of triterpene glycosides may change the effects of black cohosh on the body. Some black cohosh dietary supplements are made to contain a certain amount of these chemicals.

How should I store black cohosh?

You should store black cohosh according to the product label. Most dietary supplements should be kept in a cool, dry location that is out of the reach of children and pets and not in direct sunlight.

Side Effects

What are the most common side effects of black cohosh?

The most common side effects of black cohosh are listed below. These side effects may vary depending on the dose you are taking or the specific product you are using. Tell your health care provider if you have any of these side effects that bother you.

• Nausea
• Joint pain
• Upset stomach
• Rash

There may be other side effects of black cohosh that are not listed here. Contact your health care provider if you think you are having a side effect of a supplement. In the U.S., you can report side effects to the FDA at www.safetyreporting.hhs.gov or by calling 888-SAFEFOOD (888-723-3366). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of black cohosh?

While less common, the most serious side effects of black cohosh are described below, along with what to do if they happen.

Severe Allergic Reactions. Black cohosh may cause allergic reactions, which can be serious. Stop taking black cohosh and get help right away if you have any of the following symptoms of a serious allergic reaction.

• Breathing problems or wheezing
• Racing heart
• Fever or general ill feeling
• Swollen lymph nodes
• Swelling of the face, lips, mouth, tongue, or throat
• Trouble swallowing or throat tightness
• Itching or skin rash
• Bumps on the skin called hives that can be red, pink, white, or brown depending on your skin tone
• Nausea or vomiting
• Dizziness, feeling lightheaded, or fainting
• Stomach cramps
• Joint pain

Liver Damage.Liver damage, also called hepatotoxicity, has happened in some people taking black cohosh. It is not clear whether liver damage was caused by black cohosh or by other chemicals or plants found in products labeled as black cohosh. Call your health care provider right away if you have any of the following symptoms of liver damage.

• Nausea or vomiting
• Stomach or belly pain
• Fever
• Weakness or unusual tiredness
• Itching
• Loss of appetite
• Light-colored poop
• Dark-colored urine (pee)
• Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Precautions

Who should not use black cohosh?

Allergies to Ingredients. People who are allergic to any of the following should not take black cohosh.

• Actaea racemosa
• Black cohosh
• Cimicifuga racemosa
• Any of the ingredients in the specific product

Your pharmacist can tell you all of the ingredients in the specific black cohosh products they stock.

What should I know about black cohosh before using it?

Black cohosh is a dietary supplement. It cannot be marketed to treat or cure a disease.

Read and follow the directions on the specific product you are taking, or take it as recommended by your health care provider.

Keep black cohosh out of the reach of children.

Herbal products, such as black cohosh, naturally contain many different chemicals. The amount of each chemical in a specific black cohosh product can change for many reasons, including the area where the plant was grown, the weather during growth, the time of year when it was harvested, and the way that the plant was processed after it was harvested. If you switch to a new bottle or a different brand, you may not have the same effects or side effects because of this variability. Talk to your health care provider if you have questions or concerns.

Some black cohosh products have been found to contain a different plant, called blue cohosh (Caulophyllum thalictroides). Although black cohosh and blue cohosh have similar names, they are very different plants with different effects and safety concerns.

The FDA has not tested black cohosh products to confirm that they contain the ingredients stated on their labels. Some dietary supplements have been tested by third-party organizations to confirm that they contain the ingredients listed on their labels and do not contain any harmful chemicals. Learn more about how to choose a safe dietary supplement product here.

What should I tell my health care provider before using black cohosh?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if black cohosh is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions.Tell your health care provider if you have any of the following.

• Hormone-sensitive cancer, such as breast or ovarian cancer
• Liver problems

Other Medicines and Supplements.Black cohosh may interact with other medicines and supplements. Before taking black cohosh, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. It is not known if or how black cohosh could affect pregnancy or harm an unborn baby. Tell your health care provider if you are pregnant or plan to become pregnant.

Breastfeeding. It is not known if black cohosh passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed.

Interactions

Does black cohosh interact with foods or drinks?

There are no known interactions between black cohosh and foods or drinks.

It is unknown if drinking alcohol will affect black cohosh.

Does black cohosh interact with medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using hormone replacement therapy or any medicines that contain hormones, including certain types of birth control.

The interactions between black cohosh and medicines are not fully understood. As with most dietary supplements, the research on drug interactions with black cohosh is incomplete. Always check with your health care provider before using black cohosh with any medicines.

Dosing

What should I do if I accidentally use too much black cohosh?

If you or someone else has used too much black cohosh, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

Most studies of black cohosh have used products that contain a certain amount of triterpene glycosides, which are thought to have effects in the body.  But many black cohosh products have been found to contain other plants or harmful chemicals. Read the product label closely and speak with a health care provider about how to use black cohosh safely. Do not take double or extra doses, even if you miss a dose.