Subscribe to Dr. Meschino’s Free Newsletter

Subscribe Now

NMU 256 – 2021 Review Shows that Black Cohosh is Effective for Menopausal Symptoms

Nutrition/Natural Medicine Update No 256 (August 31, 2023)

with Dr. James Meschino

Topic: 2021 Review Shows that Black Cohosh is Effective for Menopausal Symptoms

Source: Climacteric J (2021)


Surprisingly, up to 80% of women who experience menopausal symptoms during the early menopausal years, including hot flushes, use natural supplements to help manage their symptoms. One of the most popular choices is the herb known as Black cohosh (Cimifuga racemose), which contains the active constituent’s triterpene glycosides and isopropanolic CR extract. Preparations of black cohosh are made from its roots and rhizomes (underground stems) and studies show that to be effective Black cohosh should be standardized to yield 2.5% triterpene glycosides. Black cohosh has been used by Native Americans for many years with literary references for its use dating back to the seventeenth century. It gained widespread acceptance over the years, where it continues to be prescribed by medical doctors in many places in the world for the treatment of menopausal symptoms. In Germany, Black cohosh is a prescription drug, but in many parts of the world, such as the US and Canada, Black cohosh is available as an over-the-counter natural supplement. Usually, 40 mg or 80 mg capsules are taken once or twice per day, depending on the severity symptoms. But the supplement should be standardized to contain 2.5% triterpene glycosides for it to be effective.

In 2011, and again in 2018, the European Medicines Agency issued an official monograph indicating a positive benefit-risk ratio for the use of Black cohosh in the treatment of menopausal symptoms, indicating that it is highly effective and side effects are rare and usually mild (GI upset, skin rash, headache). More recently a review of all available studies using Black cohosh for the treatment of menopausal symptoms was published in the journal Climacteric in 2021 (Vol 24, issue 2 2021). The researcher reviewed 35 clinical studies and one meta-analysis comprising 43,759 women, of which 13,096 were treated with a standardized grade of Black cohosh. They showed that compared to placebo, women taking Black cohosh for menopausal symptom management had a significantly superior reduction in severity and frequency of a variety of menopausal symptoms, including some psychological symptoms. They also showed that compared to low-dose estrogen replacement therapy, women using Black cohosh experienced equal symptomatic relief and had fewer side effects than the women using estrogen hormone replacement. As they indicated, Black cohosh was better tolerated than low-dose estrogen therapy.

The researchers concluded that as benefits clearly outweigh risks, the standardized grade of Black cohosh (which can be used in conjunction with St John’s wort) should be recommended as an evidence-based treatment option for natural climacteric (menopausal) symptoms. I personally like the combination of Black cohosh with Soy Isoflavones and Gamma-oryzanol as a 3-in-1 combination supplement to help manage menopausal symptoms. I have seen this combination supplement help about 80% of women who have used it to control menopausal symptoms. As we see from the 2021 review paper in the journal Climacteric, a large body of evidence supports the use of Black cohosh supplementation as a treatment option for a host of menopausal symptoms, from hot flashes, to insomnia, to night sweats, as well as providing in some cases improvement in psychological outlook and other quality of life parameters.

I have included the references for this information in the text below


1. Castelo-Branco C et al. Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms – an update on the evidence. Climacteric, 2021; 24 (2)

2. National Institutes of Health (office of dietary supplements): Black Cohosh

3. Mehrpooya M et al. A comparative study on the effect of “black cohosh” and “evening primrose oil” on menopausal hot flashes. J Educ Health Promot. 2018, 7 (36)

Eat Smart, Live Well, Look Great,

Dr. Meschino

Facebook Comments