Natural Standard® Patient Monograph, Copyright © 2017 ( All Rights Reserved. Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.


Black cohosh is popular as an alternative to hormonal therapy in the treatment of menopausal symptoms such as hot flashes, mood disturbances, excessive sweating, palpitations, and vaginal dryness. Several studies have reported black cohosh may improve menopausal symptoms for up to one year, although the evidence is mixed.

The mechanism of action of black cohosh remains unclear. Research suggests that there may be no direct effects on estrogen receptors, although this is an area of active controversy.

Safety and efficacy beyond one year have not been proven. Reports suggest the safety of short-term use, including in women with menopausal symptoms for whom estrogen replacement therapy is not suggested. Nonetheless, caution is advised until better-quality safety data are available. There have been reports of liver damage and higher lead levels in the blood from black cohosh. Use of black cohosh in high-risk populations (such as in women with a history of breast cancer) should be under the supervision of a licensed healthcare professional.

This evidence-based monograph was prepared by The Natural Standard Research Collaboration