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Black Cohosh

Black Cohosh

Doesn't appear to help

Ease the full menopause symptom load

May have slight negative effect · 13–128 mg/day for 8–52 weeks · 1 meta-analysis , n=385

7 papers · 2 claims · 20 outcomes scored

Outcomes

What black cohosh actually does, by outcome

Each row is one outcome with effect size, evidence base, the dose that worked in trials, and time to first effect. Magnitude tiers come from native-unit MCID where available, Cohen's d otherwise.

Outcome Effect Evidence Dose Weeks Rank
Reduce hot flashes and night sweats Probably doesn't help
trivial 		3 meta-analyses n=393 Meta-analyzed 40–128 mg 8–52 wk —
Ease the full menopause symptom load May have slight negative effect
trivial 		4 meta-analyses n=385 Meta-analyzed 13–128 mg 8–52 wk —
Buy well

Recommended Black Cohosh products

Real products that dose Black Cohosh where the research does, in a clean formulation, from brands we've audited. We only list ones we'd stand behind.

Chosen for adequate Black Cohosh dosing vs. the studied range, a clean formulation (grade A–C), and independent brand-quality audits. Not sponsored.

Risk profile

Adverse events and known drug interactions

Safety events

Hepatotoxicity severe
Autoimmune hepatitis severe
hepatotoxicity severe
Uterine dilation moderate
Uterine hemorrhage moderate
Uterine thrombus moderate
Uterine ulceration moderate
Ineffective erythropoiesis / megaloblastic anemia (macrocytic anemia) moderate

Drug interactions

Nifedipine major increases concentration
Cyclosporine major increases concentration
Midazolam major increases concentration
Triazolam major increases concentration
other major increases concentration
other moderate increases toxicity
Digoxin minor unknown

Sources

  1. 1. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. (2009) ↑
  2. 2. Randomized, double-blind, placebo-controlled trial of Cimicifuga racemosa (black cohosh) in women with anxiety disorder due to menopause. (2009) ↑
  3. 3. Black cohosh (Cimicifuga spp.) for menopausal symptoms. (2012) ↑
  4. 4. Effects of botanicals and combined hormone therapy on cognition in postmenopausal women. (2009) ↑
  5. 5. Dose-Dependent Effects of the Cimicifuga racemosa Extract Ze 450 in the Treatment of Climacteric Complaints: A Randomized, Placebo-Controlled Study. (2012) ↑
  6. 6. The effect of phytoestrogens (Cimicifuga racemosa) in combination with clomiphene in ovulation induction in women with polycystic ovarian syndrome: A clinical trial study. (2022) ↑
  7. 7. Efficacy of black cohosh (Cimicifuga racemosa L.) in treating early symptoms of menopause: a randomized clinical trial. (2013) ↑

Generated August 14, 2026

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