Black Cohosh

Traditional women's health herb that helps manage menopausal symptoms, hot flashes, and hormonal balance naturally

Scientific nameActaea racemosa FormulaComplex triterpene glycosides Molecular weightVariable bioactive compounds g/mol CASVarious natural compounds

70 absorption score

6 safety / 10

25 USD per month

5 documented interactions

Check it against something

Evidence level C

Black Cohosh with:

80 out of 100

Works better together Take together — same timing window amplifies the synergy.

Check it against your whole stack →

What it does

mechanism and evidence for each claim

Menopause symptom relief

Reduces hot flashes, night sweats, and menopausal discomfort

Triterpenes may modulate estrogen receptors and neurotransmitters Evidence B-grade 4-12 weeks

Hot flash reduction

Significantly reduces frequency and intensity of hot flashes

May affect serotonin and dopamine pathways regulating temperature Evidence B-grade 4-8 weeks

Mood and sleep improvement

Helps improve mood swings and sleep quality during menopause

Neurotransmitter modulation may improve mood and sleep Evidence C-grade 6-12 weeks

Bone health support

May help maintain bone density in postmenopausal women

Potential mild estrogenic effects on bone metabolism Evidence C-grade Long-term use

PMS symptom relief

May help reduce premenstrual syndrome symptoms

Hormonal modulation effects on menstrual cycle Evidence C-grade 2-3 cycles

Others take these for the same thing

Same goal, different mechanism — check any of them against this one

Melatonin Sleep support & circadian rhythm 0.5-3mg A 50% Boron - Essential Trace Mineral for Bone and Hormone Health Bone health & hormone support 3-10mg daily B 85% Iodine (Thyroid Support) Thyroid hormone production 150-300mcg A 95% Iodine (Potassium Iodide) Essential thyroid & metabolism support 150-300 mcg A 95% Fenugreek Blood sugar control & testosterone support 500-1000mg B 75% T4 Levothyroxine - Primary Thyroid Hormone Thyroid hormone replacement PRESCRIPTION ONLY - 25-200mcg A 80%

Every pair we checked

12 combinations scored by the engine

Black Cohosh + Caffeine No documented interaction either way No known interaction 70

Black Cohosh + Creatine Monohydrate No documented interaction either way No known interaction 70

Black Cohosh + Vitamin D3 No documented interaction either way No known interaction 70

Black Cohosh + Whey Protein No documented interaction either way No known interaction 70

Black Cohosh + Lactase No documented interaction either way No known interaction 70

Black Cohosh + Bovine Collagen No documented interaction either way No known interaction 70

Black Cohosh + DHA No documented interaction either way No known interaction 70

Black Cohosh + Turmeric No documented interaction either way No known interaction 70

Black Cohosh + Fish Oil (EPA/DHA) No documented interaction either way No known interaction 70

Black Cohosh + Evening Primrose Oil Enhanced hormonal balance and PMS relief Works better together 75

Black Cohosh + Calcium Carbonate Enhanced bone health and mood stability Works better together 78

Black Cohosh + Red Clover Enhanced menopausal symptom relief Works better together 80

Dosage

With meals

Daily40-80mg

Menopause symptoms40-80mg daily

Hot flash relief40-80mg daily

Hormonal balance40-80mg daily

Pms support40-80mg daily

Before you take it

Pregnancyavoid

VeganYes

When to expect it

First Effects4-6 weeks for initial menopause symptom relief

Peak Benefits8-16 weeks for sustained hormonal and symptom benefits

Deficiency DevelopmentReturn to baseline menopausal symptoms

Toxicity OnsetRare, mainly with long-term high-dose use

How to measure it

$100-200

MarkerLiver function tests, hormone levels

OptimalNormal liver function, balanced hormone levels

Deficient belowNot applicable for supplement

FrequencyMonitor liver function every 6 months with long-term use

What people actually reported to the FDA

CAERS, 66 reports naming it as the suspect

Most reported effects

Hepatic enzyme increased 10

Dizziness 10

Dyspnoea 8

Nausea 6

Abdominal pain 6

Named as the suspect 66 reports of 83 that mention it at all

Serious outcome 80% hospitalisation, emergency room or worse

Other Serious or Important Medical Event40

Hospitalization25

Visited Emergency Room22

Reports are voluntary and unverified — they record what someone experienced while taking something, not what the compound caused. Counts skew towards products people take a lot of, and a serious outcome is more likely to be reported than a mild one, so these are not rates. How we filter them →

What actually reaches you

The label counts the carrier, your body does not

Absorption High 70 of 100 · absorbs well relative to other forms

Delivered daily 42 mg

Cost per 100 mg delivered $1.98 comparative — uses the absorption score, not a measured percentage

Works better with

3 documented

Red Clover

Enhanced menopausal symptom relief

Both provide phytoestrogen-like effects for menopause · level C

Evening Primrose Oil

Enhanced hormonal balance and PMS relief

Both support women's hormonal health · level C

Calcium Magnesium

Enhanced bone health and mood stability

Minerals support bone health and nervous system · level B

What not to take with Black Cohosh

2 documented

Hormone Replacement Therapy

May have overlapping hormonal effects

Both affect estrogen pathways · moderate significance

Alcohol Excess

Alcohol may increase liver toxicity risk

Both can stress liver function · moderate significance

Medication interactions

Discuss these with a pharmacist before combining

hormone-replacement-therapy Moderate

May have additive estrogenic effects

What to do: Consult healthcare provider

hepatotoxic-medications Moderate

May increase liver toxicity risk

What to do: Monitor liver function

blood-pressure-medications Minor

May have mild blood pressure effects

What to do: Monitor blood pressure

Available forms

bioavailability compared

Standardized Black Cohosh Extract (2.5% triterpenes) 75

Remifemin (Specific Extract) 80

Whole Root Extract 65

Root Powder 50

Standardized Black Cohosh Extract (2.5% triterpenes): Standardized potency, Research backed, Consistent effects, Quality controlled

Remifemin (Specific Extract): Most researched brand, Clinical studies, Standardized, German quality

Whole Root Extract: Complete spectrum, Traditional form, Natural, More affordable

Root Powder: Traditional form, Complete plant, Lower cost, Natural

Food sources

before you supplement

Fresh black cohosh root Traditional preparation, bitter taste · 40

Black cohosh extract supplements 40-80mg per capsule · 70-80

Black cohosh tea Lower concentration · 35

Black cohosh tincture Variable concentration · 60

Too little

deficiency signs

Not essential - but symptoms addressed by black cohosh:
Severe menopausal symptoms and hot flashes
Mood swings and irritability during menopause
Sleep disturbances and night sweats
PMS symptoms and menstrual irregularities
Bone loss in postmenopausal women
Hormonal imbalance symptoms

Too much

toxicity signs

Generally safe but potential concerns:
Rare liver toxicity with long-term use
Stomach upset and nausea
Possible hormonal effects
Monitor liver function with long-term use

Who benefits most

menopause-perimenopause

Excellent for managing menopausal symptoms naturally

40-80mg daily

hot-flashes-night-sweats

Specifically effective for reducing hot flashes

40-80mg daily

hormonal-imbalance-women

Helps balance hormones naturally in women

40-80mg daily

pms-menstrual-irregularities

May help with PMS and menstrual issues

40-80mg daily

mood-swings-irritability

May help stabilize mood during hormonal changes

40-80mg daily

Where to buy it

compare forms first

Look for Black Cohosh at 40-80mg per serving. The form that matters here is Standardized Black Cohosh Extract (2.5% triterpenes).

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What else affects it

Beyond other supplements

Alcohol excess

Alcohol may increase liver toxicity risk

Both can stress liver function

How it works

May bind to estrogen receptors providing mild estrogenic effects
Modulates serotonin and dopamine pathways affecting mood and temperature
Triterpene glycosides may influence hypothalamic-pituitary axis
May affect GABA neurotransmission for calming effects
Potential anti-inflammatory effects on reproductive tissues
May influence bone metabolism through hormonal pathways

Key findings

what the evidence supports

Good evidence for menopause symptom relief and hot flash reduction
Generally safe for short to medium-term use
Monitor liver function with long-term use
Avoid in hormone-sensitive cancers

Sources: NIH Examine.com · data reviewed 2026-08-02

Compiled by Denis, who maintains this database and holds no medical qualification — every figure here is sourced or derived, never asserted. How we calculate it →

Common questions

What are the benefits of Black Cohosh?

Documented effects: Menopause symptom relief; Hot flash reduction; Mood and sleep improvement; Bone health support. Reduces hot flashes, night sweats, and menopausal discomfort

How much Black Cohosh should you take per day?

The common daily range is 40-80mg. By goal — menopause symptoms: 40-80mg daily; hot flash relief: 40-80mg daily; hormonal balance: 40-80mg daily; pms support: 40-80mg daily.

When is the best time to take Black Cohosh?

With meals. First effects are typically reported within 4-6 weeks for initial menopause symptom relief.

What are the side effects of Black Cohosh?

At excessive doses: Generally safe but potential concerns:, Rare liver toxicity with long-term use, Stomach upset and nausea, Possible hormonal effects, Monitor liver function with long-term use. Safety rating at normal doses is 6 out of 10.

What should you not take with Black Cohosh?

Separate it from Hormone Replacement Therapy, Alcohol Excess by two to four hours. May have overlapping hormonal effects

Does Black Cohosh interact with medications?

Documented interactions with hormone-replacement-therapy, hepatotoxic-medications, blood-pressure-medications. Discuss these with a pharmacist before combining.

How do you know if you need Black Cohosh?

The marker is Liver function tests, hormone levels, optimal range Normal liver function, balanced hormone levels. Common deficiency signs: Not essential - but symptoms addressed by black cohosh:, Severe menopausal symptoms and hot flashes, Mood swings and irritability during menopause, Sleep disturbances and night sweats.

Taken for

27 Hormones

Melatonin · Vitamin B6 (Pyridoxine HCl) · Vitamin B6 (P5P)