SupplementModerate evidenceImmunity

Black cohosh

EMA-monograph herb for menopausal hot flushes, the most-studied non-hormonal botanical option, with a rare hepatotoxicity signal.

Why

Black cohosh (Cimicifuga racemosa, syn. Actaea racemosa) holds an EMA HMPC monograph for relief of menopausal complaints such as hot flushes and excessive sweating. RCTs and meta-analyses report reductions in vasomotor symptom frequency and severity comparable to low-dose oestrogen-based options, with effect concentrated on the standardised extracts iCR/BNO 1055 (Klimadynon, Remifemin). The HALT trial in the US was null, contributing to mixed assessments; European trials of standardised extracts remain more consistently positive.

How it works

Originally thought to be oestrogenic, now better understood as having dopaminergic and serotonergic central activity that modulates the thermoregulatory threshold disturbance underlying hot flushes. Does not bind oestrogen receptors at clinical doses, supports use in oestrogen-sensitive contexts.

Expected onset · Symptom reduction often within 4 weeks; full effect at 8–12 weeks

How to take

Dosage

Standardised extract: 40 mg/day (Remifemin) or 6.5 mg of an ethanolic extract iCR. Higher doses up to 160 mg/day have been used.

Timing

Once or twice daily with food

On the label

Look for named standardised extracts, Remifemin (BNO 1055), iCR (ethanolic extract), or CR BNO 1055, with stated milligrams.

Ideal for

Perimenopausal and postmenopausal women with troublesome hot flushes and night sweats, seeking a non-hormonal botanical option.

Safety

Rare hepatotoxicity reports. Discontinue and seek medical advice for unexplained jaundice, dark urine, or right-upper-quadrant pain. Limit duration to 6 months without medical review. Not for use in pregnancy, breastfeeding, oestrogen-dependent malignancy, or active liver disease. Theoretical interaction with tamoxifen. Caution in breast cancer survivors.

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Evidence

At a glance

Schellenberg 2012 Phytomedicine RCT (n=304): isopropanolic extract iCR significantly reduced Menopause Rating Scale scores vs placebo over 12 weeks. Cochrane 2012 SR was inconclusive overall due to heterogeneous trials and the null HALT US trial; standardised European extracts have more consistent positive signal. EMA classifies the rhizome as Traditional Use for menopausal complaints.

Where to get it

Shop Black cohosh on Amazon

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