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Blue Cohosh

Botanical name: Caulophyllum thalictroides


© Steven Foster

Parts used and where grown

Blue cohosh grows throughout North America. The roots of this flower are used medicinally. Blue cohosh is not related to black cohosh (Cimicifuga racemosa). However, both herbs are primarily used to treat women’s health problems.

Blue cohosh has been used in connection with the following conditions (refer to the individual health concern for complete information):

Science Ratings Health Concerns

Amenorrhea (lack of menstruation)

Dysmenorrhea (painful menstruation)

3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Historical or traditional use (may or may not be supported by scientific studies)

Native Americans are believed to have used blue cohosh flowers to induce labor and menstruation.1 Blue cohosh is a traditional remedy for lack of menstruation. It is considered an emmenagogue (agent that stimulates menstrual flow) and a uterine tonic. No clinical trials have validated this traditional use. It has also been used traditionally to treat painful periods (dysmenorrhea). Early 20th century physicians in the United States who treated with natural remedies (known as Eclectic physicians) used blue cohosh for these same purposes and also to treat kidney infections, arthritis, and other ailments.

Active constituents

A saponin from blue cohosh called caulosaponin is believed to stimulate uterine contractions.2 Several other alkaloids may be active in this herb. However, current research about the active constituents of blue cohosh is insufficient.

How much is usually taken?

Blue cohosh is generally taken as a tincture and should be limited to no more than 1–2 ml taken three times per day. The whole herb (300–1,000 mg per day) is sometimes used. Blue cohosh is generally used in combination with other herbs.

Are there any side effects or interactions?

Large amounts of blue cohosh can cause nausea, headaches, and high blood pressure. Blue cohosh should only be used under medical supervision and in limited amounts. Using blue cohosh during pregnancy has been brought into question by reports of an infant developing a stroke and another infant being born with congestive heart failure.3 4 Safety studies need to be completed to determine whether blue cohosh is safe to use during pregnancy.

At the time of writing, there were no well-known drug interactions with blue cohosh.


1. Castleman M. The Healing Herbs. New York: Bantam Books, 1991, 120–3.

2. Foster S. Herbal Renaissance. Salt Lake City: Gibbs-Smith Publisher, 1993, 48–50.

3. Finkel RS, Zarlengo KM. Blue cohosh and perinatal stroke. N Engl J Med 2004 351:302–3.

4. Jones TK, Lawson BM. Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication. J Pediatr 1998;132:550–2.

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