Black cohosh is a traditional herbal option for menopausal hot flushes, night sweats and temporary mood changes. Discover its uses and benefits, what the research shows and how to choose a suitable registered product.
🕒 6 min read
What is black cohosh?
Native to the US and Canada, black cohosh (Actaea racemosa, also known as Cimicifuga racemosa) is a wildflower with long, creamy flower stalks. Its rhizome, or underground stem, and roots are used in herbal preparations for menopausal symptoms.
In the UK, registered black cohosh medicines are used for the relief of symptoms such as hot flushes, night sweats and temporary changes in mood. Their indication is based on traditional use only.
Look for the Traditional Herbal Registration (THR) mark when comparing herbal medicines. The scheme assesses quality, safety and traditional use; it does not establish a guaranteed benefit for everyone.1
Black cohosh benefits: what can it help?
Menopause can be a distressing and disruptive time for many women. Black cohosh's traditional uses focus on particular menopausal symptoms, rather than a promise to balance hormones or improve every aspect of wellbeing.
Hot flushes
A 2010 review combined results from seven trials and estimated a 26% overall improvement in vasomotor symptoms with preparations containing black cohosh compared with placebo. However, the trials differed substantially, and some used combination products. That figure should not be treated as a prediction for an individual product or person.2
A 2023 meta-analysis also found potential benefits for overall menopausal symptoms and hot flushes. The formulation matters, and findings from different extracts are not automatically interchangeable.3
Night sweats
Night sweats are hot flushes that happen during sleep and can make nights uncomfortable. They are included in the traditional-use indication for Healthspan Black Cohosh Menopause Relief. Keeping a note of their frequency can help you judge whether your chosen approach is helping.
Temporary changes in mood
Nervous irritability and restlessness are also included in the product's traditional-use indication. These temporary symptoms are different from a diagnosis of anxiety or depression.
A 2006 trial of a fixed combination of black cohosh and St John's wort reported improvements in menopausal and psychological symptoms. It was not a review of black cohosh alone, and its results do not establish that separately combining products will give the same benefit.4
The more recent meta-analysis did not find significant improvements in anxiety or depressive symptoms. If changes in mood are persistent or affecting daily life, discuss treatment options with your GP.3
For a registered option, Black Cohosh Menopause Relief contains 6.5mg of extract per tablet. Its indication is based on traditional use only. Always read the patient information leaflet.
Black Cohosh Menopause Relief
Traditional herbal medicine for menopause symptoms, based on traditional use only.
- For menopausal hot flushes and night sweats.
- For temporary mood changes such as nervous irritability and restlessness.
- 6.5mg black cohosh extract per tablet.
How does black cohosh work?
Exactly how black cohosh may affect menopausal symptoms is not fully understood. It has been studied for effects on pathways involved in temperature regulation and other processes, but there is no established explanation that justifies saying it restores hormonal balance.
It is a plant extract, rather than oestrogen replacement. This does not mean it is suitable for everyone with a hormone-sensitive condition or safe to combine freely with hormone medicines.5
How much black cohosh should I take?
Follow the directions for the specific product. Healthspan Black Cohosh Menopause Relief contains 6.5mg of dried rhizome and root extract per tablet, equivalent to 29.25mg to 55.25mg of the herb.
Its adult dose is one tablet daily, swallowed whole with water or another liquid. Aim for the same time each day, morning or evening. Do not chew it or exceed the stated dose.
The leaflet advises professional advice if symptoms worsen or have not improved after 12 weeks. Do not use it for more than six months without medical advice.
Available forms and choosing a product
Black cohosh is sold in tablets, capsules and other herbal preparations. A tea or tincture is not equivalent to a registered tablet. Check the THR mark, ingredient details, directions and leaflet for the product you are considering.
For more context, explore our guide to menopause supplements and menopause range.
Safety and watchpoints
Check the full leaflet before starting. Healthspan's product must not be used during pregnancy or breastfeeding, under age 18, with current or previous liver or kidney problems, or with a history of breast cancer or another hormone-dependent tumour. It is also unsuitable with relevant ingredient allergies or lactose intolerance. Women who could become pregnant must use contraception.
If you use an oestrogen-containing medicine, including HRT, take black cohosh only if your doctor advises it is safe. Ask a pharmacist to check other medicines or herbal products too.
Possible side effects include digestive upset and skin reactions. The leaflet also warns about rare liver problems: stop taking it and seek medical advice for symptoms such as yellowing skin or eyes, dark urine or abdominal pain. Consult a healthcare professional about new or changed menstrual bleeding.
For troublesome menopause symptoms, HRT and non-hormonal options can be discussed with your GP. Your choice can reflect your symptoms, medical history and preferences.6
Other menopause products to compare
Sage and soy are other ingredients found in menopause products. They differ from black cohosh and have their own formulations and evidence:
- Sage 2000mg is a single-herb option.
- Soy Isoflavones Hormone Balance combines soy isoflavones with vitamin B6 and calcium.
- MenoSerene combines soy isoflavones, flaxseed and sage.
Compare them as individual options and check overlapping ingredients before combining products. Ask a pharmacist about suitability, particularly if you take medicines. For a wider overview, read our guide to alternatives to HRT.
Black cohosh FAQs
What are the benefits of black cohosh for women?
Registered black cohosh herbal medicines are traditionally used for menopausal hot flushes, night sweats and temporary mood changes such as nervous irritability and restlessness. The indication is based on traditional use only. Choose a product suited to your symptoms and read its leaflet.
How long does black cohosh take to work?
There is no guaranteed response time. Take it as directed and keep a short symptom diary to assess changes. The Healthspan leaflet advises seeking professional advice if symptoms worsen or have not improved after 12 weeks.
Should I take black cohosh in the morning or evening?
For Healthspan Black Cohosh Menopause Relief, either morning or evening is suitable. The directions recommend the same time each day where possible. Swallow the tablet whole with water or another liquid.
Does black cohosh contain oestrogen?
Black cohosh is a plant extract, rather than an oestrogen medicine. Its mechanism is not fully understood, so describing it as a way to replace oestrogen or restore hormone levels would be misleading.
Can I take black cohosh with HRT?
The Healthspan leaflet says not to take it with a medicine containing oestrogen unless your doctor advises it is safe. Ask your prescriber or pharmacist to check your particular HRT and other medicines first.
What does the THR mark mean?
Traditional Herbal Registration is a UK scheme covering the quality, safety and traditional use of herbal medicines. It is useful when choosing a product, but does not mean its benefit has been established in the same way as a conventional medicine.
How do I compare black cohosh strengths?
Check the extract amount, extraction details and daily serving, not only a large root-equivalent figure. Extracts can differ between products, so follow the specific leaflet rather than transferring a dose or research finding from another preparation.
