Nutrient guide to black cohosh

 Black cohosh is a medicinal root that has made a name for itself as a treatment for hormonal related symptoms that occur in women, particularly menopause. With a number of treatments available for hormonal conditions, it’s no wonder that women are constantly on the lookout for more natural and less invasive methods to relieve such symptoms. 

What does black cohosh do?

The effects of black cohosh are thought to be due to unique substances such as cimifugoside that are present in the root and which interact with the brain to help normalise hormone balance. This is why it works so well for conditions like menopause. The most common symptoms that women experience during the menopause include hot flashes, sleeping problems, mood changes, and a reduced sex drive. 1

Menopause related symptoms

One study looked at the effectiveness of black cohosh on women who experience hot flashes more than twice a day on average and found that it was successful in reducing them. Weekly hot flashes were reduced by an average of 56% and it also improved sleeping, fatigue and sweating. 2 A separate review found that black cohosh could reduce menopause symptoms by 26%. 3 Another study found that after six months of treatment, black cohosh reduced the hot flush score by 85%, compared with a 62% result for fluoxetine (an alternative treatment for hot flushes).4 It was also more successful at treating night sweats.

According to the research, it would appear that hot flashes are the symptoms that black cohosh has the strongest effect over. 5

When reviewing the effect of herbal supplements on menopausal mood swings and anxiety, black cohosh was found to have the most consistent results. 6 The paper found strong evidence to suggest the extract can reduce depression and anxiety in menopausal women.

Postmenopausal symptoms

Symptoms that rise after the menopause is complete can also have a huge impact on women. For instance, postmenopausal women are susceptible to osteoporosis since the condition is closely related to oestrogen deficiency. 7 Black cohosh may work as a successful method to manage such symptoms, as studies have found that it can help enhance two bone building markers, bone‐specific alkaline phosphatase activity and osteocalcin expression.8

More research is needed to understand this relationship but it is promising for those experiencing reductions in bone density.

Getting black cohosh in your diet

Black cohosh extract can be prepared in a number of different ways, including tablets, tincture, and powder. Another way to incorporate black cohosh into your diet is to create a black tea out of the root. However, the flavour can be a bit much for most people, which is why supplements are more popular.


A 2003 review of the safety of black cohosh found that adverse reactions were rare and when they did occur, they were mild and reversible. The most common side effects were gastrointestinal disturbances and rashes.9

Black cohosh is commonly used as a herbal therapy for menopausal symptoms, it is important to assess the safety among this group.

It’s good to ensure that any herbal medicine products you’re using have been granted traditional herbal registration (THR) by the Medicines & Healthcare Products Regulatory Agency. This ensures they are regulated for their safety and efficacy. 10

Correct dosage

According to research, the recommended dosage of black cohosh is 40-80 mg a day 11 or 6.5mg of standardised extract. Evidence also suggests that a minimum of 4-12 weeks of treatment is needed in order for the benefits to become apparent.12

As differing preparations of black cohosh may require varying dosages to provide the desired effects, always follow the recommendations provided by the manufacturer.

If you are struggling with menopausal symptoms and are unable or unwilling to take prescribed hormone replacement therapy (HRT), then black cohosh could provide some much-needed relief. In the UK it is a licensed herbal medicine used to help relieve symptoms of the menopause such as hot flushes, night sweats and mood changes.

Dr Sarah Brewer 

1  Menopause. [online]. NHS Choices
2  B.P, C.L, J.S, P.N, D.B, A.H. (2004). Pilot Evaluation of Black Cohosh for the Treatment of Hot Flashes in Women. Journal of Cancer Investigation
4  M.O, D.E, H.K, N.T, E.K, H.Z. (2007). Black cohosh and fluoxetine in the treatment of postmenopausal symptoms: A prospective, randomized trial. Advances in Therapy
5  O.R, F.M, L.E, S.J, F.J, H.Z. (2005). Efficacy and Safety of Isopropanolic Black Cohosh Extract for Climacteric Symptoms. Obstetrics & Gynecology
6  S.G, L.S. (2007). Botanical and dietary supplements for mood and anxiety in menopausal women. Menopause
7  M-X.J, Q.Y. (2015). Primary osteoporosis in postmenopausal women. Chronic diseases and translational medicine
8  V.V, C.G, S.F, K.F, D.R, M.S, T.N, G.E, L.H. (2009). Isopropanolic Extract of Black Cohosh Stimulates Osteoprotegerin Production by Human Osteoblasts. Journal of bone and mineral research
9  H.A, E.E. (2003). A systematic review of the safety of black cohosh. Menopause
10  A.H. (2005). The safety of black cohosh (Actaea racemosa, Cimicifuga racemosa). Expert opinion on drug safety
11  G.M. (2012). Black Cohosh (Actaea/Cimicifuga racemosa). Treatments in endocrinology.
12  G.M, D.F, L.C, B.D. (2002). Black Cohosh: An Alternative Therapy for Menopause? Nutrition in Clinical Care

Nothing beats a healthy, balanced diet to provide all the nutrients we need. But when this isn't possible, supplements can help. This article isn't intended to replace medical advice. Please consult your healthcare professional before trying supplements or herbal medicines.



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