Uses of Black Cohosh

By | April 30, 2014

The primary uses of Black Cohosh relate to menopausal symptoms. Black Cohosh has properties similar to estrogen but is not a hormone-replacement therapy. The herb is effective for many women, but should not be taken in the presence of certain medical conditions, such as liver disease, or when taking certain prescription drugs.

About Black Cohosh

Black Cohosh, Cimicfuga racemosa, is a perennial plant and member of the buttercup family. Common names include bugbane, bugwort, black snakeroot and squawroot, as well as the medication Remifemin.


Originally used by Native Americans as a remedy for women’s health conditions, it was also used to relieve muscle aches as well as joint pain associated arthritis. The Native Americans also made a salve and applied as a snakebite antidote and as a hallucinogenic, to bring about visions in ceremonies.

The fresh or dried roots and rhizomes or underground stems of the plant are used in herbal remedies; preparations include capsule or tablet form, liquid extract or tincture, powder or infused as a tea. Black cohosh is unrelated to blue and white cohosh, which can have toxic effects.


The uses of Black Cohosh primarily relate to symptoms of menopause. The estrogenic activity initiated after taking the herb lowers luteinizing hormone (LH), which decreases the amount of progesterone produced from the ovaries. This, in turn, causes the body to behave as if it were producing estrogen and decreases menopausal symptoms such as:

  • Hot Flashes
  • Mood Swings
  • Night Sweats
  • Vaginal Dryness
  • Heart Palpitations
  • Migraines

In addition, non-menopausal uses of Black Cohosh include the treatment of menstrual cramps and bloating, pain before, during and after childbirth and ovarian and uterine pain. Black Cohosh is believed to possess anti-inflammatory, anti-spasmodic, astringent, diaphoretic, diuretic, expectorant and hypnotic effects. Additional past and present uses of Black Cohosh include arthritis, rheumatoid and inflammatory conditions, muscle aches and pains, sore throat, cough and indigestion. In addition, it was found to be an effective insect repellent.

Adverse Effects

Black cohosh is generally well tolerated. Possible side effects include indigestion, headache, nausea, vomiting, diaphoresis, dizziness, stiffness, trembling, feelings of heaviness in the legs or extremities, low blood pressure and weight gain.

Excessive doses may lead to seizure, visual disturbances, irregular heartbeat, slow pulse and liver damage. Cases of liver damage have been associated with pre-dispositions, other conditions or when Black Cohosh is taken concurrently with a drug or herb known to have synergistic or interactive effects.


Black Cohosh is not recommended for use in women who are pregnant or breast-feeding, those with breast, ovarian or uterine cancer and those with hormone-sensitive conditions such as endometriosis or uterine fibroids. It may also interfere with oral contraceptives.

Although the estrogen-like action of Black Cohosh diminishes the effects of menopause in some women, it should not be considered a hormone or estrogen replacement. As such, it does not provide protection against conditions such as osteoporosis, which traditional hormone-replacement therapy is believed to provide.

Black Cohosh is contradicted in women who take the following medications:

    • Lipitor (atorvastatin), increases risk of liver damage
    • Plantinol -AQ (cisplatin), decreases efficacy in cancer treatment
    • Cytochrome P450 2D6 (CYP2D6) substrates: medications changed and broken down by the liver; decreases the time liver breaks down substances and potentially increases side effects and effects of medications such as:
      • Elavil (amitriptyline)
      • Clozaril (clozapine)
      • Norpramin (desipramine)
      • Aricept (donepezil)
      • Duragesic (fentanyl)
      • Tambocor (flecainide)
      • Prozac (fluoxtine)
      • Demerol (meperidine)
      • Dolophine (methadone)
      • Lopressor, Toprol XL (metoprolol)
      • Zyprexa (olanzapine)
      • Zofran (ondansetron)
      • Ultram (tramadol)
      • Desyrel (trazodone)
    • Hepatotoxic drugs: medications that can harm the liver; an increased risk of liver damage exists with the following drugs:
    • Tylenol (and other brand-names containing acetaminophen)
    • Cordarone (amiodarone)
    • Tegretol (carbamazepine)
    • INH (isoniazid)
    • Rheumatrex (methotrexate)
    • Aldomet (methyldopa)
    • Diflucan (fluconazole)
    • Sporanox (itraconazole)
    • Erythrocin, Ilosone and other brand antibiotic (erythromycin)
    • Dilatin (phyetoin)
    • Mevacor (lovastatin)
    • Pravachol (pravastatin)
    • Zocor (simvastatin)

This is not an exhaustive list and, as with any medication, you should consult your physician or qualified professional before taking Black Cohosh.

In addition, Black Cohosh is contradicted in persons with aspirin allergy as the herb contains small amounts of salicylic acid, the main compound in aspirin.

Individuals with a history of blood clots, stroke, seizures, hypertension or liver disease should avoid Black Cohosh.


Native Americans have used the root and rhizomes of the Black Cohosh plant for hormonal conditions affecting women, inflammatory and rheumatoid conditions and as an antidote to rattle snakebites. Today, due to its estrogen-like behavior, the most popular uses of Black Cohosh relate to symptoms of menopause. Black Cohosh is contradicted in persons with liver disease and is counter-intuitive when taken with a number of different medications; individuals should consult a physician before taking this herb.