Black Cohosh for Menopause
Black cohosh may modestly reduce hot flushes, but trial results conflict and liver safety signals require attention.
Overview
Verdict
How It Works
Dosing & Protocol
Typical dose
- Recommended dose
- 40-80mg standardized extract daily
- Expected timeframe
- 4-12 weeks
Protocol
- form
- Extract standardised to 2.5% triterpene glycosides, third-party tested
- step 1
- Decide what you are treating - black cohosh has data only for vasomotor symptoms, not for bone loss, genitourinary symptoms or cardiovascular risk, all of which need separate management
- timing
- With food
- duration
- Review at 12 weeks; do not continue beyond 6-12 months without medical review
- titration
- Increase to 40-80 mg/day after two weeks if flushes persist
- measurement
- A symptom diary of flush frequency and severity across a full week, before and at week 12
- starting dose
- 20-40 mg standardised extract daily with food
Evidence
What the studies say
Black cohosh (Cimicifuga spp.) for menopausal symptoms
Leach MJ, Moore V
There was no significant difference between black cohosh and placebo in the frequency of hot flushes or in menopausal symptom scores across the pooled trials.
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.
Safety
Caveats
A Cochrane review found insufficient evidence for a consistent effect on vasomotor symptoms, though some standardised-extract trials are positive - expect a modest and uncertain benefit. It does nothing for the bone loss that accelerates at menopause, so do not let it substitute for that conversation. Rare but serious hepatotoxicity including liver failure has been reported: stop at once with jaundice, dark urine, abdominal pain or unusual fatigue, and avoid in liver disease. Contraindicated in pregnancy and breastfeeding. Discuss with your oncologist in breast or hormone-sensitive cancer, and note possible tamoxifen interaction. Menopausal hormone therapy is more effective for moderate to severe symptoms.
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.