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Black Cohosh

by Ara DerMarderosian, PhD

Black cohosh is the underground stem of a plant that can be ingested directly in powdered form or extracted into tablet or liquid form. It should be standardized to contain certain triterpenes. Black cohosh contains no phytoestrogens that can account for its purported estrogen -like effects, but it contains small amounts of anti-inflammatory compounds, including salicylic acid.


Black cohosh is said to be useful for menopausal symptoms (eg, hot flushes, mood lability, tachycardia, vaginal dryness), for menstrual symptoms, and for arthralgias in RA or osteoarthritis.

Scientific evidence regarding benefit in relieving menstrual symptoms is conflicting. There are few reliable data on its effectiveness for other disorders and symptoms.

Adverse effects

Adverse effects are uncommon. The most likely are headache and GI distress. Dizziness, diaphoresis, and hypotension (if high doses are taken) may occur.

There is no evidence that black cohosh interferes with any drugs. Theoretically, black cohosh is contraindicated in patients with aspirin sensitivity, liver disease, hormone-sensitive cancers (eg, certain kinds of breast cancer), stroke, or high BP. The US Pharmacopeia (USP) has recommended that black cohosh products be labeled with a warning declaring that they may be hepatotoxic.

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