Black Cohosh for Hot Flash Reduction
Black cohosh is the most-studied herbal for hot flashes, with meta-analyses showing modest benefit over placebo in perimenopausal women.
Overview
Verdict
How It Works
Dosing & Protocol
Typical dose
- Recommended dose
- 40–80 mg/day standardized extract (2.5% triterpene glycosides) for up to 6–12 months.
- Expected timeframe
- 4-12 weeks
Protocol
- form
- Extract standardised to 2.5% triterpene glycosides
- timing
- With food; if night sweats dominate, weight the dose toward the evening
- duration
- Up to 6-12 months, with a formal review at 12 weeks
- stop rule
- No meaningful reduction at 12 weeks means it is not working for you - stop rather than continuing indefinitely
- titration
- Increase to 40-80 mg/day, single or divided, if flushes persist
- measurement
- Log hot flush frequency and severity daily for a week before starting, and again at week 12
- starting dose
- 20-40 mg standardised extract daily with food for the first two weeks
Evidence
What the studies say
Complementary therapies for management of menopausal symptoms: a systematic review to inform the update of the International Menopause Society recommendations on women's midlife health
Maunder A, Mardon AK, Rao V +4 more
moderate-certainty evidence supports black cohosh (vasomotor/menopausal symptoms)
Vasomotor symptoms resulting from natural menopause: a systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause
Sarri G, Pedder H, Dias S +2 more
Isoflavones and black cohosh were more effective than placebo
Black cohosh extracts in women with menopausal symptoms: an updated pairwise meta-analysis
Sadahiro R, Matsuoka LN, Zeng BS +1 more
Black cohosh extracts were associated with significant improvements in overall menopausal symptoms (Hedges' g = 0.575, 95% CI = 0.283 to 0.867, P < 0.001), as well as in hot flashes (Hedges' g = 0.315, 95% CIs = 0.107 to 0.524, P = 0.003)
Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial
Newton KM, Reed SD, LaCroix AZ +3 more
Black cohosh, multibotanical preparations and soy did not reduce vasomotor symptom frequency or intensity more than placebo at any timepoint, whereas hormone therapy did.
Black cohosh and breast cancer: a systematic review
Fritz H, Seely D, McGowan J +4 more
Current evidence does not support an association between black cohosh and increased risk of breast cancer
Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1
Pockaj BA, Gallagher JG, Loprinzi CL +4 more
failed to provide any evidence that black cohosh reduced hot flashes more than the placebo
Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms
Osmers R, Friede M, Liske E +3 more
effective in relieving climacteric symptoms, especially in early climacteric women
Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer
Jacobson JS, Troxel AB, Evans J +4 more
Black cohosh was not significantly more efficacious than placebo against most menopausal symptoms
Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidence
Castelo-Branco C, Gambacciani M, Cano A +4 more
iCR was significantly superior for treating neurovegetative and psychological menopausal symptoms
Safety and Efficacy of Black Cohosh and Red Clover for the Management of Vasomotor Symptoms: A Randomized Controlled Trial
Geller SE, Shulman LP, van Breemen RB +10 more
Neither red clover nor black cohosh reduced vasomotor symptoms significantly more than placebo over 12 months, while hormone therapy did.
Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial
Frei-Kleiner S, Schaffner W, Rahlfs VW +2 more
showed no superiority of the tested black cohosh extract compared to placebo
Safety
Caveats
Avoid with liver disease; rare liver injury reported. Not for estrogen-sensitive conditions without clinician input. Less effective in surgical/early menopause.
Less likely to help if
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Individual results may vary. The statements on this website have not been evaluated by the Food and Drug Administration. Products and information are not intended to diagnose, treat, cure, or prevent any disease.