Educational information, not medical advice — ask your doctor or midwife.
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Macrotys is the old Eclectic doctors' name for black cohosh. It is the root and rootstock of Actaea racemosa, once called Cimicifuga racemosa. The plant is a tall woodland herb from eastern North America.
Today it is sold almost entirely for menopause, the time when periods stop. People take it for hot flashes and night sweats. Older folk use covered period pain, joint aches and childbirth.
The honest verdict: human evidence is mixed and far from settled. Some trials show mild relief of hot flashes. Others show no gain over a dummy pill.
It also has a rare but real liver safety question, covered below. And long traditional use is not proof that a remedy works, nor proof that it is safe.
No one has pinned down how black cohosh works. That matters, because the claims get ahead of the facts.
For years it was described as a plant estrogen. Most laboratory work does not support that. Good products do not appear to act on estrogen receptors in cell tests.
In cell studies, parts of the root bind serotonin receptors. Those receptors help set body temperature. Whether this happens in a woman taking a capsule has not been shown.
Animal and cell work also hints at effects on pain signals and bone cells. None of that has been confirmed in people. Treat it as a lead, not a finding.
Most products on sale are standardised dry extracts in tablet or capsule form.
Common forms: - Standardised extract tablets, often an isopropanolic or ethanolic type - Capsules of plain powdered root - Liquid tincture in alcohol, the old Eclectic form - Dried root for tea, now uncommon - Combination menopause formulas with soy, red clover or St John's wort
Combination products make trouble hard to trace. If you react badly, you cannot tell which herb did it.
Species mix-ups are a known issue in this trade. Products that name the full botanical source and test for identity are the safer bet.
Native peoples of eastern North America used the root for women's complaints, joint pain and snakebite. Settlers copied the practice.
Nineteenth-century Eclectic physicians called it macrotys and ranked it highly. Their texts listed it for rheumatism, period pain, after-birth pain and nervous complaints. King's American Dispensatory gave it a long entry.
It was a main ingredient of Lydia Pinkham's Vegetable Compound, sold from 1876. That product made the root a household name in the United States.
German makers revived it in the 1950s as a menopause remedy. Most modern trials used those German extracts.
Stop taking it and see a doctor the same day if you notice signs of liver trouble: - Yellow skin or yellow eyes (jaundice) - Dark urine or pale stools - Pain or fullness in the upper right belly - Unusual tiredness, nausea or loss of appetite
Also see a doctor if you get vaginal bleeding after menopause, or bleeding between periods. That needs checking whatever the cause.
Book a review if hot flashes have not changed after about 12 weeks, or if you have used it for six months.
Tell your doctor you have been taking black cohosh. It is easy to miss on a medicines list.
In the United States it is sold as a dietary supplement. The FDA does not check it for effect before sale.
In the UK and the EU it is sold under traditional herbal registration, with a required liver warning. Australia requires a liver warning on the label too.
Evidence grades and traditional-use labels are explained in our methodology. Nothing here is medical advice.
Reviewed by the HealisticMD editorial team How we grade evidence →
What it is typically used for, usual dose, cautions, and the study behind it where real trial data exists.
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