[3] Most dietary supplements containing black cohosh are not well-studied or recommended for safe and effective use in treating menopause symptoms or any disease.

[3] In contrast, some herbal medicinal products containing black cohosh extract hold a marketing authorization in several states of the European Union and are well-studied and recommended for safe and effective use for the relief of menopausal symptoms, such as hot flashes and profuse sweating.

Nuttall's classification was based solely on the dry follicles produced by black cohosh, which are typical of species in Cimicifuga.

[2] Black cohosh is a smooth (glabrous) herbaceous perennial plant that produces large, compound leaves from an underground rhizome, reaching a height of 25–60 cm (9.8–23.6 in).

[9][10] The basal leaves are up to 1 m (3 ft 3 in) long and broad, forming repeated sets of three leaflets (tripinnately compound) having a coarsely toothed (serrated) margin.

It bears tall tapering racemes of white midsummer flowers on wiry black-purple stems, whose mildly unpleasant, medicinal smell at close range gives it the common name "Bugbane".

[4] In the U.S., India, and some other countries, black cohosh is used as a dietary supplement marketed mainly to women for treating menopausal symptoms and other gynecological problems.

Lack of proper authentication and adulteration of commercial preparations by other plant species are risk factors in dietary supplements[10][24] and a critical matter of quality control in herbal medicinal products holding a marketing authorization.

Very high doses of black cohosh may cause nausea, dizziness, visual effects, a lower heart rate, and increased perspiration.

[25] Package leaflets of phytomedicines made from black cohosh caution that people with liver problems should not take it,[2][26] although a 2011 meta-analysis of research evidence suggested this concern may be unfounded.