Black Cohosh
Herb ·Exploratory record · not publication-reviewed ·Updated July 13, 2026
North American herb used for menopause symptom relief, especially hot flashes.
Exploratory record, not a reviewed medical publication.
See the editorial and medical-review policies for the publication gate.
This generated database record has not completed a claim-level review by a qualified human medical reviewer. Bibliography links and evidence labels are not approval. The page remains available for reference and is excluded from search indexing.
What the research says.
A quick, data-only summary. The full evidence, dosing, and sources are below.
Black Cohosh is a herb most often used for hot flash relief, menopause support, mood during menopause. NutriStack rates the overall evidence as moderate. A typical adult dose is 20-40 mg daily (standardized to 2.5% triterpene glycosides), commonly taken as remifemin is best-studied brand. This profile indexes 17 sources.
The bottom line
Evidence rating moderate. Most-documented uses: hot flash relief, menopause support, mood during menopause. 17 sources indexed (2008–2026), with 0 interaction records on file.
How it works, mechanistically.
Core mechanism
Triterpene glycosides (actein, cimicifugoside) modulate serotonin receptors and opioid receptors. Does NOT directly affect estrogen levels despite common belief. Reduces LH surges.12
Dosing & protocol.
Take with food; effects seen in 4-8 weeks13
What it actually costs.
Real-world pricing across three quality tiers. Assumes Standardized Black Cohosh Extract.
Assumes 20-40 mg/day. Vendor basis: NOW/iHerb, Vitacost, Life Extension, and Amazon marketplace; branded Remifemin-style extracts sit higher. Updated 2026-05-28.
The same dose, as food.
How much you'd eat to match a supplemental dose.
Black cohosh is a medicinal root extract and is not a culinary food with comparable triterpene glycoside dosing.
Full safety detail.
Side effects
- GI upset
- Headache
- Dizziness
- Liver toxicity (rare, monitor)
Contraindications
- Liver disease6
- Hormone-sensitive cancers
- Pregnancy
Sources, by evidence tier.
Numbered references. Citations throughout the page link here.
Meta-analyses & systematic reviews
10- 1Efficacy and safety of Actaea racemosa for relieving climacteric complaintsPMIDCurtis S, Moore A, Breakspear I · Menopause (New York, N.Y.) · 2026
Curtis S, Moore A, Breakspear I. Efficacy and safety of Actaea racemosa for relieving climacteric complaints. Menopause (New York, N.Y.). 2026
- 2Black cohosh extracts in women with menopausal symptoms: an updated pairwise meta-analysisPMIDCastelo-Branco C et al. · Climacteric · 2023
Black cohosh extracts significantly improved overall menopausal symptoms and hot flashes versus placebo across 22 articles including 2,310 women.
- 3Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidencePMIDBeer AM et al. · Climacteric · 2020
Isopropanolic black cohosh extract produced significant reduction in hot flushes, particularly in women with intense hot flushes, at 40 mg/day with improvement in mood.
- 4The efficacy of herbal medicines on anxiety and depression in peri- and postmenopausal women: A systematic review and meta-analysis.PMIDShahmohammadi A, Ramezanpour N, Mahdavi Siuki M, Dizavandi F, Ghazanfarpour M, Rahmani Y et al. · Post Reproductive Health · 2019
Black cohosh (Cimicifuga racemosa) was among the herbal medicines that showed significant improvements in anxiety and depression scores in peri- and postmenopausal women.
- 5Efficacy and safety of black cohosh (Actaea/Cimicifuga racemosa) for menopausal symptomsSource linkedPMIDLeach MJ, Moore V · Cochrane Database Syst Rev · 2012
- 6Suspected black cohosh hepatotoxicity: no evidence by meta-analysis of randomized controlled clinical trials for isopropanolic black cohosh extractPMIDNaser B et al. · Menopause · 2011
Meta-analysis of five RCTs showed no evidence that isopropanolic black cohosh extract has any adverse effect on liver function.
- 7Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysisPMIDShams T et al. · Altern Ther Health Med · 2010
Preparations containing black cohosh improved menopausal vasomotor symptoms by 26% overall, though with significant heterogeneity between trials.
- 8Black cohosh (Cimicifuga racemosa) for menopausal symptoms: a systematic review and meta-analysisSource linkedPMIDShams T, Setia MS, Hemmings R et al. · J Womens Health · 2010
- 9Black cohosh for the management of menopausal symptoms : a systematic review of clinical trialsPMIDPalacio C, Masri G, Mooradian AD · Drugs & aging · 2009
Palacio C, Masri G, Mooradian AD. Black cohosh for the management of menopausal symptoms : a systematic review of clinical trials. Drugs & aging. 2009
- 10Black cohosh (Cimicifuga racemosa) for menopausal symptoms: a systematic review of its efficacyPMIDBorrelli F, Ernst E · Pharmacological research · 2008
Borrelli F, Ernst E. Black cohosh (Cimicifuga racemosa) for menopausal symptoms: a systematic review of its efficacy. Pharmacological research. 2008
Randomized controlled trials
1- 11Assessing the combined effects of Black Cohosh, Soy Isoflavones, and SDG Lignans on menopausal symptoms: a randomized, double-blind, placebo-controlled clinical trialPMIDPokushalov E, Ponomarenko A, Garcia C et al. · European journal of nutrition · 2025
Pokushalov E, Ponomarenko A, Garcia C et al.. Assessing the combined effects of Black Cohosh, Soy Isoflavones, and SDG Lignans on menopausal symptoms: a randomized, double-blind, placebo-controlled clinical trial. European journal of nutrition. 2025
Reviews & position papers
4- 12Black Cohosh Interactions with Prescription Medications Associated with Serotonin Toxicity and Rhabdomyolysis: A Case ReportPMIDDernbach MR, Carpenter JE, Shah N et al. · The Journal of emergency medicine · 2024
Dernbach MR, Carpenter JE, Shah N et al.. Black Cohosh Interactions with Prescription Medications Associated with Serotonin Toxicity and Rhabdomyolysis: A Case Report. The Journal of emergency medicine. 2024
- 13Black cohosh efficacy and safety for menopausal symptoms. The Spanish Menopause Society statementPMIDChedraui P et al. · Gynecol Endocrinol · 2022
Black cohosh is effective for menopausal symptoms; most common dose is 40 mg/day achieving significant reduction in hot flushes with effects seen in 4-8 weeks.
- 14Black cohosh and suspected hepatotoxicity: inconsistencies, confounding variables, and prospective use of a diagnostic causality algorithm. A critical reviewPMIDTeschke R et al. · Maturitas · 2010
Data do not support hepatotoxicity as causally related to black cohosh use; all case reports assigned only possible causality, none were probable or certain.
- 15United States Pharmacopeia review of the black cohosh case reports of hepatotoxicityPMIDMahady GB, Low Dog T, Barrett ML et al. · Menopause (New York, N.Y.) · 2008
Mahady GB, Low Dog T, Barrett ML et al.. United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause (New York, N.Y.). 2008
Reference material
2- 16Hedaoo K, Badge AK, Tiwade YR et al.. Exploring the Efficacy and Safety of Black Cohosh (Cimicifuga racemosa) in Menopausal Symptom Management. Journal of mid-life health. 2024Source linkedPMID
- 17Mohapatra S, Iqubal A, Ansari MJ et al.. Benefits of Black Cohosh (Cimicifuga racemosa) for Women Health: An Up-Close and In-Depth Review. Pharmaceuticals (Basel, Switzerland). 2022Source linkedPMID
Common questions.
Quick answers about Black Cohosh, drawn from the data on this page.
What is Black Cohosh?
North American herb used for menopause symptom relief, especially hot flashes.
What is Black Cohosh used for?
Commonly cited benefits of Black Cohosh include: Hot flash relief; Menopause support; Mood during menopause. NutriStack rates the overall evidence as moderate.
What is a typical dose of Black Cohosh?
A typical adult dose of Black Cohosh is 20-40 mg daily (standardized to 2.5% triterpene glycosides). The commonly recommended form is Remifemin is best-studied brand. These are general ranges, not personalized advice; confirm the right dose with a clinician.
What are the side effects of Black Cohosh?
Reported side effects include gi upset, headache, dizziness, liver toxicity (rare, monitor). This is educational information; check with a healthcare professional before use.
How strong is the evidence for Black Cohosh?
NutriStack rates this as Moderate, meaning several aligned RCTs or one large RCT plus supporting reviews. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.
Use this with your stack
Black Cohosh in NutriStack.
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