About Black Cohosh
Black cohosh is used primarily for menopausal vasomotor symptoms. Meta-analysis of 22 RCTs (2,310 women) found 26% improvement in vasomotor symptoms vs placebo. Results are mixed — some trials show significant benefit, others no difference from placebo. Most positive evidence comes from the isopropanolic extract (Remifemin) at 40 mg/day. Not effective for anxiety or depressive symptoms per meta-analysis. Safety profile is favorable in clinical trials. Rare hepatotoxicity reports exist but causal link is unestablished. No established RDA/UL.
What Black Cohosh supports
- May reduce hot flash frequency and severity (meta-analysis of 22 RCTs, 2,310 women)
- 26% improvement in vasomotor symptoms vs placebo (95% CI: 11–40%)
How much Black Cohosh to take
The RDA prevents deficiency. The effective range is what clinical trials used to actually move the outcome.
Effective
20–160
mg
RCTs predominantly use 20–40 mg/day of standardized extract (2.5% triterpene glycosides). Cochrane review median dose: 40 mg/day across 22 trials. Raw root powder (300–540 mg) is common in commercial products but less studied; unstandardized root powder and standardized extract are not directly bioequivalent.
Clinical evidence
Moderate clinical evidence. Meta-analysis of 22 trials (2,310 women) showed 26% improvement in menopausal hot flashes
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