Black Cohosh for Night Sweats

Black cohosh is the most-studied herbal option for menopausal vasomotor symptoms. Trial results are genuinely mixed — some show meaningful reductions in night sweats and flushes, others show no separation from placebo — and it does nothing for night sweats from non-menopausal causes.

Overview

Verdict

Mixed evidence

Mixed trial evidence for menopausal night sweats only; irrelevant to other causes, which must be ruled out first.

How It Works

Black cohosh triterpene glycosides appear to act on serotonergic thermoregulatory pathways rather than oestrogen receptors, modestly stabilising the narrowed thermoneutral zone of menopause.

Dosing & Protocol

Typical dose

Recommended dose: 20-40 mg standardised extract twice daily, for up to six months, only after menopause is established as the cause.
Expected timeframe: 4-8 weeks to judge response; discontinue if no benefit by 12 weeks.

Protocol

form: Extract standardised to 2.5% triterpene glycosides
step 1: Establish menopause as the cause first - night sweats also occur with thyroid disease, infection, lymphoma, sleep apnoea and several medications, and those need excluding
timing: With food, with the second dose in the early evening
duration: Up to six months, reviewed at 12 weeks
titration: Stay at 40 mg/day; increase toward 80 mg/day only if there is partial response at 6 weeks
measurement: Count nights disturbed by sweats per week, before and at week 12
starting dose: 20 mg standardised extract twice daily with food

Evidence

What the studies say

Meta-analyses report small-to-moderate reductions in vasomotor symptom frequency over placebo, with high heterogeneity between trials and preparations. German standardised extracts account for most positive results. Hormone therapy outperforms it substantially. Persistent drenching night sweats require exclusion of infection, malignancy and medication causes before any supplement trial.

Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial

Score: 9/10

2006

rct

n=351

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.

View source

Black cohosh (Cimicifuga racemosa) for menopausal symptoms

Score: 8/10

2012

systematic_review

n=1164

Leach MJ, Moore V

There was insufficient evidence that black cohosh reduced hot flushes or night sweats compared with placebo

View source

Safety

Caveats

Rare reports of liver injury — stop with jaundice, dark urine or upper abdominal pain. Avoid with liver disease. Not for pregnancy or breast cancer history without specialist advice.

Less likely to help if

Anyone whose night sweats are not menopausal — thyroid, infection, malignancy, sleep apnoea or medication causes will not respond.

Medical Disclaimer

The information provided on this website is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any supplement regimen.

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.