Written by Jianping Liu, Xun Li and the CAM-Cancer Consortium.
Updated September 24, 2013

Black cohosh (Actaea racemosa)

Abstract and key points

  • Black cohosh (Actaea racemosa) is a medicinal herb.
  • Evidence from three randomised clinical trials is not sufficient to support the use of black cohosh extracts for treatment of hot flushes in breast cancer patients undergoing chemotherapy or receiving tamoxifen.
  • Black cohosh appears to be relatively safe; but pre-existing liver damage is a contraindication.

This summary is currently (April 2016) being updated, the version published here was last updated in September 2013. 

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.

Current evidence from one systematic review (including five randomised clinical trials and 21 pre-clinical studies) and two prospective observational studies is not sufficient to support the use of black cohosh extracts for the treatment of hot flushes in breast cancer patients undergoing chemotherapy or receiving tamoxifen. In all but one trial black cohosh extracts were not superior to placebo.

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. September 24, 2013.

Document history

Assessed as up to date in September 2013 by Barbara Wider.

Most recent 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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