Written by Jianping Liu, Xun Li and the CAM-Cancer Consortium.
Updated March 9, 2017

Black cohosh (Actaea racemosa)

Abstract and key points

  • Black cohosh (Actaea racemosa) is a medicinal herb.
  • Current evidence does not support an association between black cohosh and increased risk of breast cancer.
  • There is a lack of evidence supporting the efficacy of black cohosh for reduction of hot flashes in breast cancer patients.
  • Black cohosh appears to be relatively safe; but pre-existing liver damage is a contraindication.

Black cohosh (Actaea racemosa, synonym: Cimicifuga racemosa) is a medicinal herb traditionally used by native American Indians for menstrual, menopausal, and other conditions. Extracts of black cohosh have been recommended as an alternative to hormone replacement therapy for the treatment of hot flushes in menopausal women.

The effects of black cohosh have been assessed in a systematic review including 14 randomized controlled trials, 7 uncontrolled trials and 5 observational studies. The evidence on efficacy forhot flushesis divided, with some benefits seen when compared with baseline, but not when compared with placebo. Two observational studies found no association between black cohosh and risk of breast cancer, whereas two studies reported significant reductions in risk of primary breast cancer among postmenopausal women and risk of recurrence, respectively. Seventeen trials showed no significant impact on circulating hormone levels or proliferation in oestrogen responsive tissues.

Reviews of preclinical and clinical studies suggest black cohosh to be safe but pre-existing liver damage is a contraindication.

Read about the regulation, supervision and reimbursement of herbal medicine at NAFKAMs website CAM Regulation.


Jianping Liu, Xun Li, CAM-Cancer Consortium. Black cohosh (Actaea racemosa) [online document]. http://cam-cancer.org/The-Summaries/Herbal-products/Black-cohosh-Actaea-racemosa. March 9, 2017.

Document history

Most recent update in March 2017 by Barbara Wider.
Assessed as up to date in September 2013 by Barbara Wider.
Update and revision in June 2012 by Jianping Liu, Xun Li and Guoyan Yang.
Fully revised and updated in August 2009 by Jianping Liu and Xun Li.
Summary first published in March 2006, authored by Jianping Liu. 


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