Black Cohosh has traditionally been used by Native Americans to relieve menstrual cramps and "female complaints" and was used later by American colonists to treat amenorrhea (lack of menstruation). It primary use in modern alternative medicine is for relief of symptoms associated with menopause, including hot flashes and depression.

Black cohosh has been used by Native North American Indians in their traditional medicine practices for various purposes, including amenorrhea and menopause. In the United States, there is evidence of the use of this herbal preparation for more than 100 years for gynecological complaints. Several studies in humans suggest that black cohosh may be safe and effective for improving symptoms of menopause, such as hot flashes, migraine headache and sleep disturbances. . However, only short-term use of black cohosh for menopausal symptoms has been evaluated. It is not clear if there are benefits in people with hot flashes caused by medications such as tamoxifen. Relief of certain menopausal symptoms may possibly be enhanced by concurrent use with hormone replacement therapy, although this is controversial. The North American Menopausal Society recommends the use of black cohosh in conjunction with lifestyle changes as an option for management of mild vasomotor symptoms. Many studies have been small and have flaws in their designs. Therefore, although this early evidence is quite promising, better studies are necessary before a strong overall recommendation can be made.