ingestible · for menopause symptoms
Black Cohosh
Reviewed by the Nimbera editorial team · Last updated May 2026
How to use
Take 20-40 mg of standardised black cohosh root extract (standardised to triterpene glycosides) twice daily. The most studied formulation is Remifemin (20 mg extract per tablet, taken twice daily). Most trials lasted 6-12 months. Do not exceed 12 months of continuous use without consulting a doctor.
How it works
Black cohosh contains triterpene glycosides (actein, deoxyactein) and flavonoids that may act on serotonin receptors in the hypothalamus, influencing the thermoregulatory centre responsible for hot flashes. Contrary to earlier theories, it does not appear to act directly as a phytoestrogen or bind to oestrogen receptors significantly.
Where to buy
Remifemin (Amazon, iHerb, pharmacies - the most clinically studied brand), Nature's Way Black Cohosh Standardized (Whole Foods, Amazon), Solgar Black Cohosh Root Extract (iHerb, Vitamin Shoppe).
Typical cost: $15-$35 per month
Safety notes
Rare but serious cases of liver damage (hepatotoxicity) have been reported, though causality is uncertain. Stop use and seek medical attention if you experience dark urine, yellowing of the skin or eyes, or unusual fatigue. Women with a history of hormone-sensitive cancers (breast, ovarian, uterine) should consult their oncologist before use - the safety data in this population is insufficient. Do not confuse with blue cohosh, which has serious cardiovascular risks. Avoid during pregnancy and breastfeeding.
Drug & supplement interactions
- Always tell your doctor or pharmacist about any supplements you take.
- Interactions can occur with prescription medications, blood thinners, and immunosuppressants.
- Herbal remedies can affect how the body absorbs or metabolises drugs.
- Check drugs.com interactions checker before starting.
This information is compiled from primary clinical literature and is for informational purposes only. It is not a substitute for professional medical advice. Read our full disclaimer.