Black cohosh, a member of the buttercup family (Ranunculaceae), is native to North American woodlands. The clinical evidence points to a benefit in managing physical and psychological symptoms of menopause, but is inconclusive. Most modern research involves a proprietary product called Remifemin®, which is standardised to triterpene glycosides. Black cohosh roots and rhizomes have been used traditionally for a range of gynaecological conditions and numerous other complaints, including rheumatism, upper respiratory infections, kidney ailments, and fatigue. In the late nineteenth century, black cohosh, which had become a favourite in North American Eclectic medicine for rheumatic and gynaecological conditions, was introduced into Germany. Triterpene glycosides and caffeic acid derivatives are thought to be responsible for the herb's activity. The mechanism of action has not yet been fully determined. Contrary to popular reputation, black cohosh is not an oestrogenic substitute for hormone replacement therapy (HRT); however other hormone modulating effects are possible. Recently there have been a cluster of reports linking consumption of black cohosh to liver problems: evidence is emerging that a proportion of these reports relate to adulterated products. While the serious problems of adulteration of the market by other potentially poisonous species is unregulated this is likely to remain a quality issue as much as a challenge to the safety of real black cohosh. This is one case where choosing only products with externally verified quality standards is essential.