Black Cohosh (Actaea racemosa)

Evidence-based guide to Black Cohosh: benefits, dosage, safety and interactions.

Evidence

Mixed: Dozens of RCTs (mostly Remifemin) show benefit; the large HALT trial (2006) found no effect, but used a non-standardized preparation. 2016 meta-analysis of 16 RCTs found standardized extracts significant.

Traditional use and mechanism

Menopausal hot flushes, night sweats, mood disturbance. Native American use for menstrual regulation and menopause symptoms (Algonquin, Cherokee, Iroquois). German Remifemin registered 1956. One of the most studied herbs in women's health.

Safety

LIVER SAFETY: Unresolved question. Case reports of hepatotoxicity exist but causal relationship not confirmed in controlled trials (many were confounded by other hepatotoxic agents or product adulteration with Asian Cimicifuga species). USP safety review: no proven causal link for pure Actaea racemosa. Monitor for: unusual fatigue, dark urine, jaundice, RUQ abdominal pain. Discontinue immediately if any of these appear.