Research

Black cohosh for Menopause: Evidence, Interactions and Cautions

By Andreea · Last reviewed September 2026 · 2 min read

Black cohosh is an ingredient used in menopause supplements marketed to women. Below is what it has actually been studied for, how strong that evidence is, the drug interactions and cautions on record, and the primary source our grade rests on — all drawn from the HerWellReport ingredient dataset.

HerWellReport Evidence Gradelimited for hot flushes; none for stress incontinence

Studied forhot flushes and night sweats; overall menopausal symptom scores

Used inMenopause supplements

Helps stress leaks?No

Helps hot flushes?Unclear

Also sold as: Actaea racemosa; Cimicifuga racemosa; black snakeroot

What the evidence says about Black cohosh

The 2012 Cochrane review pooled 16 randomised trials in 2,027 women and found no difference from placebo in daily hot flush frequency (mean difference 0.07 flushes per day, 95% CI -0.43 to 0.56, P=0.79; three trials, 393 women), concluding there is insufficient evidence to support its use. Trials were mostly short and used varied preparations, so the question is unsettled rather than closed. The Menopause Society's 2023 nonhormone therapy position statement names black cohosh on its not-recommended list (Level I). NIH LiverTox assigns black cohosh a likelihood score of A, its highest category, meaning products sold as black cohosh are a well-established cause of clinically apparent liver injury.

The grade "limited for hot flushes; none for stress incontinence" means: limited — One or two small human trials, or trials for a closely related outcome. none — No human trial evidence we could find for this use. Grades are explained in full on our methodology page.

Read the primary source this grade rests on (opens in a new tab).

Black cohosh drug interactions

tamoxifen
doxorubicin
docetaxel
simvastatin
drugs metabolised by CYP3A4

Who should be careful with Black cohosh

Established cause of clinically apparent liver injury (LiverTox likelihood score A), with onset typically 2 to 12 weeks
stop and seek medical advice for jaundice, dark urine or right upper abdominal pain
avoid if you have liver disease
avoid in pregnancy as it may act as an abortifacient
products have been found to contain the wrong Actaea species

Products we have researched that contain Black cohosh

MenoRescue — marketed for hot flushes, night sweats and broken sleep. 180-day money-back guarantee.

We have read the label and the research behind every ingredient. We have not tested the product and we publish no ratings. Full ingredient breakdown

Read our MenoRescue review →

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