Black cohosh (Actaea racemosa, Cimicifuga racemosa [previous name], baneberry, black snake root, bugbane, squawroot) is a perennial herb and was an ingredient in Lydia Pinkham’s Vegetable Compound, marketed in the early 1900s. The rhizomes and roots are used medicinally. Black cohosh constituents contain alkaloids (N-methyl-cytisine and related unknown alkaloids), terpenoids (actein, deoxyactein, cimicifugoside, and neocimiside), isoflavones (formononetin, genistein, and keamferol), resins (cimicifugan), tannins (polyphenolic compounds), organic acids (acetic, butyric, formic, isoferulic, oleic, palmitic, and salicylic), and volatile oils.

Black cohosh is taken orally for the symptoms of menopause, premenstrual syndrome (PMS), dysmenorrhea, nervous tension, dyspepsia, rheumatism, fever, sore throat, and cough and is used to induce labor and as a mild sedative. The mechanism of action of cohosh is unknown. Available products include powder root-rhizome and extract of black cohosh. Combination formulas include Estroven, Avlimil, Black Cohosh Extra Plus, Menopause, Menopause Formula, and Menopause Support.

Black cohosh may be effective in reducing menopausal symptoms such as hot flashes. The differences seen were not statistically significant when compared with hormone replacement therapy (HRT). Most clinical studies have used a standardized formulation (Remifemin) that contains 1 mg triterpene glycosides, calculated as 27-deoxyacetin. There was no evidence that black cohosh affects the endometrium, which may negate the risk of endometrial cancer.

Adverse reactions seen with black cohosh include gastrointestinal upset, headache, dizziness, weight gain, feeling of heaviness in the legs, and cramping. An overdose of black cohosh can cause nausea, vomiting, nervous system and visual disturbances, reduced heart rate, and perspiration. There are no known drug interactions or herbal or dietary supplement interactions. Women with hormone-sensitive conditions, such as breast, uterine, and ovarian cancer, endometriosis, or uterine fibroids, should avoid the use of black cohosh due to its estrogenic effects. Therapy for longer than six months is not recommended, as there are no available data regarding long-term use. Black cohosh is not the same herb as blue or white cohosh and should not be confused with them.

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