Also known as: Actaea racemosa, Cimicifuga racemosa, Black Bugbane
Black cohosh (Actaea racemosa) is a North American woodland herb traditionally used to alleviate menopausal symptoms, particularly hot flashes and night sweats. Clinical evidence is moderate, with several trials supporting its efficacy.
Black cohosh is a perennial plant native to eastern North America, historically used by Indigenous peoples for gynaecological conditions, pain, and inflammation. The rhizome and root contain triterpene glycosides (notably actein and 23-epi-26-deoxyactein), phenolic acids, and formononetin. Unlike earlier assumptions, black cohosh does not appear to have direct oestrogenic activity; instead, current research suggests it may act through serotonergic, dopaminergic, and opioidergic pathways to modulate the thermoregulatory centre in the hypothalamus. Multiple randomised controlled trials have demonstrated reductions in the frequency and severity of hot flashes, with the proprietary isopropanolic extract (Remifemin) being the most studied preparation. The North American Menopause Society and German Commission E have endorsed its use for menopausal vasomotor symptoms. While generally well tolerated, rare cases of hepatotoxicity have been reported, prompting safety warnings in some jurisdictions.
Multiple RCTs have shown that black cohosh extract reduces the frequency and intensity of hot flashes and night sweats in perimenopausal and postmenopausal women, with effects typically appearing after 4–8 weeks of use.
Clinical trials suggest that black cohosh may improve mood, anxiety, and sleep quality in menopausal women, potentially through serotonergic modulation rather than hormonal effects.
Once or twice daily, with or without food
Isopropanolic extract (Remifemin) is the most studied. Effects may take 4–8 weeks. Use should not exceed 6 months without medical supervision.
Menopausal hot flashes and vasomotor symptoms
General supplementation
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