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Black cohosh supplement: what it may do for menopause and how to buy safely

By the Life in Good Form editors. Updated 2026-10-15.

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What black cohosh is

Black cohosh (Actaea racemosa, also called Cimicifuga racemosa) is a member of the buttercup family that grows in North America. The National Center for Complementary and Integrative Health (NCCIH) says Native Americans used it for kidney ailments, malaria, sore throat and menstrual cramps, and it has been used medicinally in Germany since the late 19th century.

Herbal preparations use the root or rhizome (underground stem). Today it is promoted mainly for menopause symptoms, and also for menstrual cramps, premenstrual syndrome and to induce labor.

What the research shows

NCCIH says a substantial number of human studies have tested black cohosh for menopause, with much less research for other conditions. The 2023 review covered products with black cohosh extracts, alone or combined with other herbs.

Results are not uniform. The NIH Office of Dietary Supplements (ODS) describes a 12-month trial in which women taking 128 mg a day of a standardized black cohosh extract did not do significantly better than placebo for hot flashes and night sweats. ODS adds that the wide variation in product makeup makes black cohosh hard to study, because the compounds behind any relief are not known.

Liver safety: the key warning

ODS reports at least 83 cases worldwide of liver damage, including hepatitis and liver failure, associated with black cohosh use. There is no evidence that black cohosh caused them, and some cases may have come from impurities, adulterants or the wrong Actaea species. NCCIH notes some products have contained the wrong herb or unlisted herbs.

• Australia has required a liver warning on black cohosh products since 2007.
• The U.S. Pharmacopeia recommended in 2008 that labels advise stopping and seeing a practitioner if you have a liver disorder or develop abdominal pain, dark urine or jaundice.
• The FDA does not require that warning, so a label may not mention it.
• Liver disorders. The U.S. Pharmacopeia advises people with liver disorders to avoid black cohosh.

Other safety points

• Side effects. ODS says the most common are mild, short-lived stomach upset and rashes.
• Short studies. Most studies lasted 6 months or less, and no published studies have assessed long-term safety.
• Breast or uterine cancer. NCCIH says it is uncertain whether black cohosh is safe after hormone-sensitive conditions such as breast or uterine cancer.
• Pregnancy and breastfeeding. It may not be safe. The American Herbal Products Association advises pregnant women not to take it except under a provider's supervision.
• Medicines. Talk with your provider before using it with any medicine.
• Not blue cohosh. Blue cohosh is a different herb that may cause high blood pressure, high blood sugar and chest pain, and its use to induce labor has been linked to life-threatening problems in infants.

Reading a black cohosh label

• Latin name. Look for Actaea racemosa or Cimicifuga racemosa, root or rhizome, so you know it is black cohosh and not blue cohosh or another species.
• Standardized extract. ODS says extracts are frequently standardized to provide at least 1 mg of triterpene glycosides per daily dose.
• Studied extract. Remifemin, used in several studies in a 2012 Cochrane review, is standardized to the equivalent of 40 mg of root or rhizome per daily dose of two tablets.
• Single herb vs blends. Menopause blends add other herbs, which makes it harder to know what you are taking and adds cautions.
• Quality testing. Because of adulteration concerns, prefer brands that state identity testing or third-party verification.

When to see a provider

NCCIH encourages talking with your health care providers about any complementary approach you use so you can make shared, well-informed decisions. Talk with your provider about menopause symptoms that bother you, tell them about every supplement you take, and ask before combining black cohosh with any medicine. Because the FDA does not approve dietary supplements before they are sold, the maker, not the government, is responsible for checking safety and labeling.

What to look for when you buy

Questions people ask

Does black cohosh work for hot flashes?

A 2023 review of 22 studies found improvements in hot flashes, but some individual trials found no benefit over placebo. Results vary by product.

Is black cohosh bad for the liver?

Rare cases of liver damage have been reported, though it is not proven black cohosh caused them. Avoid it if you have a liver disorder and stop if liver symptoms appear.

How long can you take black cohosh?

Research studies have used it for up to a year, but most lasted 6 months or less, and long-term safety has not been studied.

Is black cohosh the same as blue cohosh?

No. They are different herbs, and blue cohosh carries serious risks.

Can I take black cohosh after breast cancer?

It is uncertain whether it is safe after breast or uterine cancer. Talk with your oncologist first.

What are the side effects of black cohosh?

The most common are mild stomach upset and rashes.

Sources

• Black Cohosh: Usefulness and Safety (nccih.nih.gov), National Center for Complementary and Integrative Health
• Black Cohosh: Fact Sheet for Health Professionals (ods.od.nih.gov), NIH Office of Dietary Supplements

Sources checked 2026-10-15.