# Black cohosh

Source: https://onco.cc/technologies/black-cohosh/  
OnCo record `black-cohosh` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Black cohosh is a root extract sold for menopausal hot flushes, and women on tamoxifen or aromatase inhibitors often try it. Placebo-controlled trials in women treated for breast cancer gave mixed results, and rare cases of serious liver injury have been reported.

## Summary

Black cohosh is used mainly for menopausal symptoms, and the NCI PDQ summary cites a market report placing it among the 15 top-selling herbal supplements in the United States in 2019. Memorial Sloan Kettering's About Herbs summary describes the trials of black cohosh for hot flushes caused by breast cancer treatment as mixed, while noting one report of benefit in menopausal symptoms caused by luteinising hormone-releasing hormone analogues; the NCI PDQ summary concludes that observational and open-label studies suggest benefit but that placebo-controlled trials have not confirmed it. Current laboratory and clinical work on the usual hydroalcoholic extracts does not support the old idea that it acts like oestrogen; serotonin-like activity is better supported. The safety concern is the liver: after reviewing 30 cases of liver injury, the United States Pharmacopeia's expert committee asked for a caution on product labels, and MSK lists case reports of hepatitis resembling autoimmune hepatitis. MSK also lists possible interference with tamoxifen and increased toxicity of doxorubicin and docetaxel in laboratory work, of unknown clinical relevance, and notes poor quality control in several products. Non-hormonal drugs, acupuncture and cognitive behavioural therapy have better evidence for treatment-related hot flushes.

## Fields

- Kind: Technology
- Status: phase-2
- Last checked: 2026-11-04
- Also known as: Actaea racemosa; Cimicifuga racemosa; Remifemin
- Tags: complementary; supportive-care; evidence:insufficient
- Principle: Triterpene glycosides and other constituents appear to act on serotonin, dopamine and GABA signalling rather than on the oestrogen receptor; hormone levels did not change in clinical studies.
- Strengths: Widely studied, generally well tolerated; Does not appear to act as an oestrogen in current studies
- Limitations: Placebo-controlled trials in breast cancer survivors mixed; Rare serious liver injury; Product quality and adulteration problems

## Sources

- MSK About Herbs: Black cohosh (page last updated 26 May 2022): https://www.mskcc.org/cancer-care/integrative-medicine/herbs/black-cohosh
- NCI PDQ: Black cohosh: https://www.cancer.gov/about-cancer/treatment/cam/hp/black-cohosh-pdq

## Connected records

- technologies: [Acupuncture for hot flushes on endocrine therapy](https://onco.cc/technologies/acupuncture-hot-flushes/), [Asian ginseng (Panax ginseng)](https://onco.cc/technologies/asian-ginseng/), [Endocrine therapy (SERMs, AIs, SERDs)](https://onco.cc/technologies/endocrine-therapy/), [Evidence-based integrative oncology](https://onco.cc/technologies/integrative-oncology/), [Milk thistle (silymarin)](https://onco.cc/technologies/milk-thistle-silymarin/)
- cancers: [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/)
- fronts: [Hormonal Therapy](https://onco.cc/fronts/hormonal/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- drugs: [Docetaxel](https://onco.cc/drugs/docetaxel/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Tamoxifen](https://onco.cc/drugs/tamoxifen/)
- terms: [Hepatotoxicity (liver enzyme elevation)](https://onco.cc/terms/hepatotoxicity/), [Hot flushes on hormone therapy](https://onco.cc/terms/hot-flushes-on-hormone-therapy/)
- bottlenecks: [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)

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