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Obtained from root of the plant, black cohosh is used as a dietary supplement to relieve the symptoms of menopause and dysmenorrhea. Black cohosh has antiosteoporotic effects and has been shown to enhance bone formation. Black cohosh alone or in combination with other herbs has been shown in clinical studies to be effective in the treatment of menopausal symptoms, but data are conflicting. Studies evaluating black cohosh to treat hot flashes from breast cancer treatment also yielded mixed results. Further supplementation with black cohosh did not enhance bone density, menopausal symptoms, or 10-year risk of coronary heart disease in early postmenopausal women.

In vitro studies show black cohosh decreases prostate cancer cell proliferation and induces an apoptotic response in liver cells. However, it also increased the incidence of metastatic disease in mice. Whether it has similar effects in breast cancer patients is not well studied, although a retrospective observational study of breast cancer patients found that black cohosh enhanced disease-free survival.

Some studies indiate that black cohosh does not possess estrogenic activity. Until this is confirmed, patients with estrogen receptor-positive cancers should use caution when considering the use of black cohosh dietary supplements.
Hepatoxicity has been assoicated with use of black cohosh, but conclusions from a meta analysis contradict such reports. Patients should consult their physicians before using black cohosh supplements.