Black Cohosh

Different mechanisms for menopause support

Multi-target menopause symptom relief

⟡ Dong Quai

Traditional combination for menopausal support

Enhanced support for women's health symptoms

⟡ Red Clover

Different mechanisms for menopausal support

Enhanced relief from menopausal symptoms

⟡ Wild Yam

Often combined for menopausal support

Multi-herb approach to menopausal symptoms

⟡ Sage

Complementary phytoestrogenic herbs that together provide broader coverage of menopausal symptoms including hot flashes, mood disturbances, and sleep disruption.

Enhanced menopausal symptom relief targeting vasomotor, psychological, and cognitive domains

Top studies from 38+ peer-reviewed papers

📚meta-analysisn=2310

Sadahiro R et al. • Menopause (New York, N.Y.) (2023)

“This study provides updated evidence regarding the potentially beneficial effects of black cohosh extracts for relieving menopausal symptoms in menopausal women.”

Key Findings:

However, black cohosh did not significantly improve anxiety (Hedges' g = 0.194, 95% CI = -0.296 to 0.684, P = 0.438) or depressive symptoms (Hedges' g = 0.406, 95% CI = -0.121 to 0.932, P = 0.131).
The dropout rate for black cohosh products was similar to that for placebo (odds ratio = 0.911, 95% CI = 0.660 to 1.256, P = 0.568).
This study provides updated evidence regarding the potentially beneficial effects of black cohosh extracts for relieving menopausal symptoms in menopausal women.

📚systematic-review

Lopresti AL et al. • Nutritional neuroscience (2022)

“For most phytonutrients, the effects of supplementation on HPA-axis activity in humans is unclear.”

Key Findings:

For most phytonutrients, the effects of supplementation on HPA-axis activity in humans is unclear.
Before more definitive conclusions about the effects of phytonutrients on the HPA-axis can be made, further research is required.
Further research warranted to confirm findings

📚meta-analysisn=43759

Castelo-Branco C et al. • Climacteric : the journal of the International Menopause Society (2021)

“With its good safety profile in general and at estrogen-sensitive organs, iCR as a non-hormonal herbal therapy can also be used in patients with hormone-dependent diseases who suffer from iatrogenic climacteric symptoms.”

Key Findings:

Effect sizes were larger when higher dosages of iCR as monotherapy or in combination with St.
The clinical data did not reveal any evidence of hepatotoxicity.
Hormone levels remained unchanged and estrogen-sensitive tissues (e.g. breast, endometrium) were unaffected by iCR treatment.
As benefits clearly outweigh risks, iCR/iCR+HP should be recommended as an evidence-based treatment option for natural climacteric symptoms.

📚systematic-reviewn=745

Peng J et al. • Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences (2020)

“The limited evidence so far indicates that BCE could efficiently improve perimenopausal symptoms cause by low estrogen status of the patients recieved GnRHa treatment after surgery for endometriosis, but does not alter hormone levels of patients.”

Key Findings:

Meta-analysis results showed that the addition of BCE did not alter hormone levels of patients, including serum estradiol levels [ MD=1.24, 95% CI(-4.58, 7.08), P>0.05] and luteinizing hormone levels [ MD=-0.02, 95% CI(-0.15, 0.11), P>0.05].
BCE affected Kupperman's menopausal index (KMI) score 12 weeks after the surgery [ MD=-11.50, 95% CI(-20.09, -2.90), P < 0.01] and KMI score 24 weeks after the surgery [ MD=-23.68, 95% CI(-39.66, -7.69), P < 0.01].
The limited evidence so far indicates that BCE could efficiently improve perimenopausal symptoms cause by low estrogen status of the patients recieved GnRHa treatment after surgery for endometriosis, but does not alter hormone levels of patients.

📚systematic-review

Compare with Others Find Based on Your Goals

Yeung KS et al. • Phytotherapy research : PTR (2018)

“However, well-designed larger clinical trials are needed before these herbs can be recommended and to further assess their psycho-oncologic relevance.”

Key Findings:

Overall, 45% of studies reported positive findings with fewer adverse effects compared with conventional medications.
Based on available data, black cohosh, chamomile, chasteberry, lavender, passionflower, and saffron appear useful in mitigating anxiety or depression with favorable risk-benefit profiles compared to standard treatments.
These may benefit cancer patients by minimizing medication load and accompanying side effects.
However, well-designed larger clinical trials are needed before these herbs can be recommended and to further assess their psycho-oncologic relevance.

View all 38+ studies

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Black Cohosh

botanical

Actaea racemosa (Black Cohosh)

Leading herb for menopause symptoms, particularly hot flashes, with evidence comparable to low-dose estrogen for some women.

longevitymenopausehot flasheswomen's healthhormone-free

38+ studies

Evidence

Reviewed 19 days ago

moderate

Safety

20-40mg standardized extract (1mg triterpene glycosides)

Dose

8-12 weeks

Time to Effect

Standardized extract (2.5% triterpene glycosides)

Best Form

Mechanisms of Action

🧠

Central Thermoregulation

Affects brain temperature control centers

⚖️

Non-Estrogenic Action

Does not act like estrogen on tissues

Biological PathwayBeta

How Black Cohosh works — from molecular targets to health outcomes. Click an edge to see supporting research.This visualization is in beta — pathways are being refined and expanded.

Supplement

Molecular Target

Biological Process

Health Outcome

Strong

Moderate

Emerging

strong

moderate

emerging

Tap node to isolate • Pinch to zoom • Tap edge for research

Recommended Dose

20-40mg standardized extract (1mg triterpene glycosides)

20mg80mg

Optimal Timing

Morning and evening
With or without food

Can be taken without food

Available Forms

Form	Type
💊Standardized extract (2.5% triterpene glycosides)	Recommended
💊Remifemin (most studied brand)	Alternative
💊Dried root	Alternative

Remifemin is the most clinically studied preparation. Look for standardized extracts.

Duration

Minimum: 8 weeks

Optimal: 12 weeks

Cycling: German Commission E recommends limiting to 6 months. Take breaks or use under supervision long-term.

Note: Can be taken any time. Split dosing (twice daily) may provide more consistent effects.

🌡️

Hot Flash Reduction

Fewer and less severe hot flashes

⏱️ 4-8 weeks

60% of users notice thispositive

😴

Sleep Improvement

Fewer night sweats, better sleep

⏱️ 4-8 weeks

55% of users notice thispositive

😊

Mood Support

Reduced mood swings and irritability

⏱️ 4-8 weeks

50% of users notice thispositive

ModerateMax safe dose: 160mg/day used in studies; most use 40-80mg

🔴

Pregnant/nursing

Avoid — Uterine stimulant effects and potential hepatotoxicity

🟢

Breast cancer history

Likely safe (non-estrogenic), but consult oncologist

Who Should NOT Take This

Liver disease
Pregnancy
Hormone-sensitive conditions (controversial — may be safer than thought)
Breast Cancer History - use with caution

Drug Interactions

Hepatotoxic drugsmoderate

May add to liver stress

Hormone therapiesmild

May have unclear interactions

Tamoxifenmild

May theoretically interact; limited data

Possible Side Effects

GI upset

milduncommon

Tip: Take with food

Headache

milduncommon

Tip: Usually resolves

Liver problems (rare)

severerare

Tip: Monitor liver function; stop if symptoms occur

Warnings

Rare liver toxicity reported — monitor for symptoms
Limit continuous use to 6 months as precaution
Stop and seek care if jaundice or abdominal pain occurs

⟡ Soy Isoflavones

Different mechanisms for menopause support

Multi-target menopause symptom relief

⟡ Dong Quai

Traditional combination for menopausal support

Enhanced support for women's health symptoms

⟡ Red Clover

Different mechanisms for menopausal support

Enhanced relief from menopausal symptoms

⟡ Wild Yam

Often combined for menopausal support

Multi-herb approach to menopausal symptoms

⟡ Sage

Complementary phytoestrogenic herbs that together provide broader coverage of menopausal symptoms including hot flashes, mood disturbances, and sleep disruption.

Enhanced menopausal symptom relief targeting vasomotor, psychological, and cognitive domains

Top studies from 38+ peer-reviewed papers

📚meta-analysisn=2310

Sadahiro R et al. • Menopause (New York, N.Y.) (2023)

“This study provides updated evidence regarding the potentially beneficial effects of black cohosh extracts for relieving menopausal symptoms in menopausal women.”

Key Findings:

However, black cohosh did not significantly improve anxiety (Hedges' g = 0.194, 95% CI = -0.296 to 0.684, P = 0.438) or depressive symptoms (Hedges' g = 0.406, 95% CI = -0.121 to 0.932, P = 0.131).
The dropout rate for black cohosh products was similar to that for placebo (odds ratio = 0.911, 95% CI = 0.660 to 1.256, P = 0.568).
This study provides updated evidence regarding the potentially beneficial effects of black cohosh extracts for relieving menopausal symptoms in menopausal women.

📚systematic-review

Lopresti AL et al. • Nutritional neuroscience (2022)

“For most phytonutrients, the effects of supplementation on HPA-axis activity in humans is unclear.”

Key Findings:

For most phytonutrients, the effects of supplementation on HPA-axis activity in humans is unclear.
Before more definitive conclusions about the effects of phytonutrients on the HPA-axis can be made, further research is required.
Further research warranted to confirm findings

📚meta-analysisn=43759

Castelo-Branco C et al. • Climacteric : the journal of the International Menopause Society (2021)

“With its good safety profile in general and at estrogen-sensitive organs, iCR as a non-hormonal herbal therapy can also be used in patients with hormone-dependent diseases who suffer from iatrogenic climacteric symptoms.”

Key Findings:

Effect sizes were larger when higher dosages of iCR as monotherapy or in combination with St.
The clinical data did not reveal any evidence of hepatotoxicity.
Hormone levels remained unchanged and estrogen-sensitive tissues (e.g. breast, endometrium) were unaffected by iCR treatment.
As benefits clearly outweigh risks, iCR/iCR+HP should be recommended as an evidence-based treatment option for natural climacteric symptoms.

📚systematic-reviewn=745

Peng J et al. • Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences (2020)

“The limited evidence so far indicates that BCE could efficiently improve perimenopausal symptoms cause by low estrogen status of the patients recieved GnRHa treatment after surgery for endometriosis, but does not alter hormone levels of patients.”

Key Findings:

Meta-analysis results showed that the addition of BCE did not alter hormone levels of patients, including serum estradiol levels [ MD=1.24, 95% CI(-4.58, 7.08), P>0.05] and luteinizing hormone levels [ MD=-0.02, 95% CI(-0.15, 0.11), P>0.05].
BCE affected Kupperman's menopausal index (KMI) score 12 weeks after the surgery [ MD=-11.50, 95% CI(-20.09, -2.90), P < 0.01] and KMI score 24 weeks after the surgery [ MD=-23.68, 95% CI(-39.66, -7.69), P < 0.01].
The limited evidence so far indicates that BCE could efficiently improve perimenopausal symptoms cause by low estrogen status of the patients recieved GnRHa treatment after surgery for endometriosis, but does not alter hormone levels of patients.

📚systematic-review

Compare with Others Find Based on Your Goals

Yeung KS et al. • Phytotherapy research : PTR (2018)

“However, well-designed larger clinical trials are needed before these herbs can be recommended and to further assess their psycho-oncologic relevance.”

Key Findings:

Overall, 45% of studies reported positive findings with fewer adverse effects compared with conventional medications.
Based on available data, black cohosh, chamomile, chasteberry, lavender, passionflower, and saffron appear useful in mitigating anxiety or depression with favorable risk-benefit profiles compared to standard treatments.
These may benefit cancer patients by minimizing medication load and accompanying side effects.
However, well-designed larger clinical trials are needed before these herbs can be recommended and to further assess their psycho-oncologic relevance.

View all 38+ studies

What would you like to do next?

Related Supplements

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Ashwagandha

Reduces cortisol and anxiety while improving sleep quality and physical recovery in stressed adults.

Shv7.5

Shatavari

Premier women's tonic in Ayurveda that supports reproductive hormones, fertility, and lactation — the female counterpart to ashwagandha.

Vtx7.5

Vitex