Black Cohosh
SUPPLEMENT SAMPLER 2
University of Wisconsin Integrative Medicine
www.fammed.wisc.edu/integrative
Dose
2
The best-studied and most widely available formulation of black cohosh in the United States is
Remifemin.
Menopausal symptoms:
o In capsule, 40 mg twice daily for up to six months
o In tincture form, 2 mL twice daily of a 1:1 tincture in 90% alcohol
Osteoporosis: black cohosh extract CR BNO 1055 40 mg/day
Side Effects
Taken orally, black cohosh can cause gastrointestinal upset. Other adverse effects include rash,
headache, dizziness, weight gain, cramping, breast tenderness, and vaginal spotting. Liver toxicity,
leading to liver failure, has been described in women taking black cohosh alone and in combination with
other herbs; however, adverse effects on the liver have not been proven in clinical trials.
There is conflicting evidence with respect to black cohosh and breast cancer. There is some evidence in
animal models that there may be an increased risk of metastasis in existing breast cancer when taking
black cohosh.
7
Systematic review of current evidence does not support an association between black
cohosh and breast cancer.
8
In fact, there are studies suggesting that black cohosh increased disease-
free survival in breast cancer patients.
9
It is advised that women with breast cancer or a history of
breast cancer consult their physician before taking black cohosh. Patients with kidney transplant, liver
disease, and protein S deficiency should also use caution with black cohosh, as there may be an
increased risk of adverse reactions in these conditions.
Cost
$16 to $23 per month at the 20 mg, twice daily dose.
Comments
Black cohosh should not be confused with blue cohosh (Caulophyllum thalictroides) which has different
indications for use and a greater potential for toxicity.
Clinical Bottom Line
Black cohosh can be used for short-term (less than one year) relief of vasomotor symptoms of
menopause in most women. Caution should be used in women who have breast cancer, or a history of
breast cancer or liver disease. There is currently not enough evidence to recommend black cohosh for
the treatment or prevention of osteoporosis.
References
1. Klingler, B. Black Cohosh. Am Fam Physician. 2003;68(1):114-116.
2. M.R. Rhyu, J. Lu, D.E. Webster, D.S. Fabricant, N.R. Farnsworth, Z.J. Wang. Black cohosh (Actaea
racemosa, Cimicifuga racemosa) behaves as a mixed competitive ligand and partial agonist at the human
mu opiate receptor. J Agric Food Chem. 2006;54:9852–9857.
3. Therapeutic Research Faculty. Black Cohosh Full Monograph.
www.naturaldatabase.therapeuticresearch.com. Updated July 23, 2014.
4. Shams T, Setia MS, Hemmings R, McCusker J, Sewitch M, Ciampi A. Efficacy of black cohosh-containing
preparations on menopausal symptoms: a meta-analysis. Altern Ther Health Med. 2010;16(1):36-44.
5. Wuttke W, Gorkow C, Seidlová-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone
turnover, vaginal mucosa, and various blood parameters in postmenopausal women; a double blind,
placebo-controlled and conjugated estrogens-controlled study. Menopause. 2006;13(2):185-196.