Black cohosh is an herbal remedy that’s long been used by Native Americans to treat a variety of conditions.
Today, it’s used as a supplement to treat symptoms of menopause in older women, including hot flashes and excessive sweating, as well as some of the psychological symptoms that can be caused by menopause.
These include irritability, anxiety, and insomnia. Whether it’s for physical or psychological problems caused by menopause, black cohosh is a popular way to alleviate these problems.
Our research team has ranked and reviewed the ten best sources of black cohosh on the market.
Research
Rankings
1. Nature’s Way Black Cohosh
Nature’s Way Black Cohosh uses careful processing to ensure that each capsule contains 40 mg of black cohosh extract (not raw root material), and has a standardized diterpene content of 2.5%.
This makes it an excellent choice for those looking to mirror the clinical research on black cohosh as closely as possible—many of the studies that have found black cohosh to be an effective treatment for menopause use doses of 40 mg of standardized black cohosh extract.
Additionally, this supplement has no binders or fillers save for the cellulose that makes up the capsule. Thanks to all of these perks, it’s our top pick.
2. Nested Naturals Menopause
Nested Naturals Menopause is a good balance between pure black cohosh-only supplements and more comprehensive menopause supplements that include a long list of ingredients.
Nested Naturals Menopause focuses on four key herbal supplements to treat the symptoms of menopause: dong quai, chamomile, milk thistle, and of course black cohosh.
The black cohosh is standardized to 40 mg of extracted root material, of which 2.5% is diterpene glycosides. Nested Naturals is a great pick for all-around menopause symptom relief that still contains a clinically tested dosage of black cohosh.
3. Pure Encapsulations Black Cohosh 2.5
Pure Encapsulations Black Cohosh 2.5 is another supplement that uses a standardized extract of black cohosh instead of the raw plant root.
These capsules provide 250 mg of standardized extract, though, so it’s a good choice if you are aiming for the higher end of doses that have been tested in clinical settings. The supplement design is very clean, too—the vegan-friendly cellulose used to make up the capsule is the only additional ingredient.
4. Staying Cool Vitex and Black Cohosh
Staying Cool is an herbal blend from Eu Natural that’s specifically designed to fight hot flashes, headaches, and other symptoms of menopause. It uses a sophisticated combination of vitamins, minerals, and herbal extracts.
Chief among these herbal extracts is black cohosh, but you’ll also find chaste tree extract, ashwagandha, and St. John’s Wort, among other ingredients. If you are looking for a total nutritional solution for menopause, Staying Cool is the best choice you can make, but if you specifically want to harness the power of black cohosh along, there are better options on the market.
5. Solaray Black Cohosh
Solaray Black Cohosh is a very simple supplement that delivers 540 mg of raw black cohosh root, with only a vegetable-derived cellulose capsule and no binders or fillers.
It’s a good choice if you are specifically looking for raw plant material, and not a standardized extract. Among the black cohosh supplements that deliver raw materials, it’s the most pure.
6. Herbal Roots Black Cohosh
Herbal Roots delivers a hefty 600 mg dose of raw black cohosh in a vegan-friendly capsule.
While the dose might be a bit high for some users, the purity and quality are excellent, making this a good choice if you want to lean towards a higher dose and don’t want any extraneous ingredients.
7. Gaia Herbs Black Cohosh
Gaia Herbs Black Cohosh has a solid 400 mg dosage of black cohosh root extract, and comes in a vegan-friendly capsule.
It has no additional binders or fillers, making it an excellent choice for purists and those looking for a simple, straightforward product.
8. Nature’s Bounty Black Cohosh
Nature’s Bounty Black Cohosh is a high dose option that delivers 540 mg of black cohosh root in a gelatin capsule. It also contains silica and magnesium stearate to stabilize the capsule, and while it won’t be the favorite among purists, the higher dosage is a distinct appeal.
9. Amazing Formulas Black Cohosh
Amazing Formulas Black Cohosh has a higher than average dose of 540 mg of black cohosh and only a few binders, which includes silica and magnesium stearate.
It’s a good though not spectacular source of black cohosh, and will mostly appeal to people looking for a high dosage supplement.
10. DrFormulas Menopause Support
DrFormulas Menopause Support is a multi-ingredient herbal supplement designed to treat menopause symptoms. It includes a high dose of black cohosh (160 mg standardized extract), but it also has high doses of other herbs like licorice, chasteberry, blessed thistle, and several others.
Some of these, like red clover, have also been researched for their ability to treat specific menopause symptoms, but the wide range of herbs included increases the likelihood of negative interactions or adverse effects.
Category winners
Best black cohosh overall: Nature’s Way Black Cohosh
Nature’s Way Black Cohosh is our top overall pick thanks to its super-simple formulation: standardized black cohosh root and nothing else. Since each capsule is standardized to contain exactly 1 mg of triterpene glycosides (the biologically active compound in black cohosh), you know you’re getting a consistent dosage.
Best black cohosh for hot flashes: Eu Natural Staying Cool
Eu Natural Staying Cool is specially formulated to counteract hot flashes, and to do so, uses black cohosh in combination with chaste tree extract, ashwagandha, and other herbal extracts. It’s a solid broad-spectrum supplement to target hot flashes.
Best black cohosh for menopause: Nested Naturals Menopause
If you’re looking for a multi-ingredient supplement to address the full range of symptoms that come along with menopause, Nested Naturals is the way to go. It’s got black cohosh and dong quai for hot flashes, chamomile for better sleep, and milk thistle for liver health, which all work together to manage menopause effectively.
Best black cohosh for fertility: Nature’s Way Black Cohosh
Not in menopause yet, but want to support estrogen function for fertility? Stick with something simple. For this use case, we recommend Nature’s Way Black Cohosh, as its highly standardized and ultra-pure formulation are perfect for providing estrogen support with no extraneous ingredients.
Best black cohosh for PMS: Nature’s Way Black Cohosh
For the cramps, irritability, and other issues that come along with premenstrual syndrome, Nature’s Way is our recommendation. Like with fertility, your goal should be supporting estrogen function, which means you likely don’t need many of the other ingredients in a full-fledged menopause supplement.
Best black cohosh for men: Pure Encapsulations Black Cohosh 2.5
While it’s most popular for female health problems, black cohosh finds a niche application for men’s prostate health. For this purpose, we recommend Pure Encapsulations thanks to its moderate dose and clean, simplistic formulation.
Who Should Buy Black Cohosh?
Black cohosh is safe for most individuals but should be primarily consumed by women due to its estrogen-mimicking effects on the body. Black cohosh should not be taken by children and pregnant women unless otherwise directed by a medical professional.
How We Ranked
When formulating or ranks for the best black cohosh supplements, we only wanted pure black cohosh supplements. We did decide to include DrFormulas Menopause Support because it included high doses of black cohosh, alongside other proven menopause supplements like red clover, licorice, and chasteberry.
Stay Cool was also included for these reasons. Nested Naturals Menopause Complete Natural Care earned higher rankings than the other two menopause blends because it contained 40mg of black cohosh, which is closer to the doses used in scientific studies.
In terms of pure black cohosh supplements, purity and dosage were both important factors to consider. Gaia herbs black cohosh comes in a vegan-friendly capsule and has no fillers or binders making it one of the purest on the market.
Pure Encapsulations Black Cohosh earned 3rd spot for providing a clean and pure supplement (the vegan-friendly cellulose used to make up the capsule is the only additional ingredient) that was on the higher end of the effective dosage range according to scientific studies.
Our top pick, Nature’s Way Standardized Black Cohosh contains 40 mg of black cohosh extract (not raw root material), with a standardized diterpene content of 2.5%. This dosage is almost identical to what a lot of the scientific studies used.
Furthermore, the small dosage allows for better individual tailoring. Being vegan-friendly with no binders or fillers, it’s no surprise that Nature’s Way Standardized Black Cohosh took the top spot.
Benefits
Black cohosh could reduce the incidence or severity of hot flashes. One of the most aggravating effects of menopause is hot flashes, which are sudden surges of feeling hot, sweaty, and feverish.
These seem to be related to changes in your body’s thermoregulation process that accompany the changes in hormone levels that coincides with menopause. Black cohosh has been researched extensively for use as an herbal remedy to reduce the severity or incidence of hot flashes.
According to the Office of Dietary Supplements at the National Institutes of Health, the precise mechanism of action of black cohosh is still up for debate (1). Some researchers believe that it affects estrogen levels, or the biological activity of estrogen, while others believe its effects are concentrated in the brain.
Regardless, several studies have indicated that black cohosh may help control hot flashes that are associated with menopause.
A systematic review article by Francesca Borrelli and Edzard Ernst published in 2008 cited multiple randomized controlled trials that found a beneficial effect of black cohosh, though other studies they cited found no benefits (2).
The authors concluded that black cohosh may exert beneficial effects on hot flashes, and recommended additional research.
Black cohosh may be able to improve anxiety and sexual dysfunction as well. Hot flashes and night sweats are not the only symptoms of menopause that black cohosh addresses—other research has focused on its ability to address some of the other problems that accompany the transition away from regular ovulation.
Much like decreases in testosterone can cause sexual dysfunction in men, the decreases in estrogen that accompany menopause seem to be associated with sexual dysfunction in women.
One such study was published in 2013 in the journal Chinese Medicine compared the effects of a black cohosh supplement to a placebo (3).
However, unlike previous work, this study included measurements on sexual dysfunction as well as anxiety and other psychological symptoms.
After eight weeks of taking the black cohosh supplement or the placebo, the researchers found that the people taking the real supplement experienced significant improvements in both anxiety and sexual function compared to the placebo group.
These findings make the case that black cohosh does not exert effects on just heat regulation, but addresses several of the overlapping effects of menopause.
When it comes to dosage, more black cohosh may not be better. One of the reasons why it’s been difficult for researchers to definitively establish how much of a benefit you can derive from black cohosh for menopause symptoms has to do with differences across various studies with respect to dosage.
Black cohosh is, of course, a plant, and so herbal preparations derived from its roots will vary in the concentration of the biologically active compounds that the roots contain.
Scientists have tried to combat this inherent variability by using standardized preparations of black cohosh extract.
Even then, the precise dosage used from one study to the next varies. One study published in in 2002 in the Journal of Women’s Health & Gender-Based Medicine directly addressed this issue by testing a 39 mg dose of standardized black cohosh extract with a 127 mg dose among a sample of women with menopause (4).
After following both the low dose and high dose black cohosh groups for six months, the researchers found that both treatments were equally effective.
These results suggest that a lower dose of about 40 mg of standardized black cohosh per day, which is the most commonly studied dosage in clinical research, is adequate to get the benefits of black cohosh, and that a higher dose may not be automatically better when it comes to relieving menopause symptoms.
Side effects
In large controlled trials, black cohosh is generally well-tolerated, though some studies have reported side effects of gastrointestinal problems and rashes (5).
One limitation of these studies is that their follow-up time has been fairly short; they are almost always less than a year in length.
Some case studies have indicated that there are more serious side effects of black cohosh related to liver function. One paper published in 2002 by a team of doctors in Australia described two patients who were taking black cohosh supplements who developed symptoms of serious liver dysfunction; one of these patients needed a liver transplant (6).
While these case reports are isolated, they do suggest that you should exercise caution with black cohosh, and realize that there is some risk of the supplement affecting your liver.
Further, people with a history of liver problems should definitely not use black cohosh without talking to their doctor first.
Recommended dose
While research to date has used a wide range of doses of black cohosh to treat menopause, several studies have converged on a dosage of 40 mg of standardized black cohosh root extract per day.
Further, one study even compared a daily dosage of 39 mg head to head with a daily dosage of 127 mg, and found no significant difference between these two protocols (7).
This makes the case for trying a moderate dosage of 40 mg of black cohosh, at least to start with, since higher doses don’t seem to be related to better outcomes.
FAQ
What is black cohosh? Black cohosh is a plant product that’s native to Canada and the United States. It’s considered a flowering plant that is cultivated for its role as a dietary supplement and herbal product. For centuries, black cohosh has been used as an all-natural remedy for conditions like inflammation, pain, and treatment of menopause symptoms.
How long can you take black cohosh? The general consensus of doctors and scientists is that black cohosh should not be consumed regularly for longer than six months at a time. The best thing you can do is consult your doctor and determine whether taking black cohosh for longer than six months would be a good idea for your situation and health goals.
What is the best black cohosh to buy? Online retailers are saturated with different black cohosh products that vary in purity, dosage, and medical intentions. For example, many black cohosh products are not pure black cohosh and are actually a combination of several healthy herbs and supplements. Others may advertise themselves as reducing hot flashes while others claim to reduce cramping of the muscles. Dosage varies from a low of about 40 milligrams to well over 500 milligrams. The best option is to look ar our above list and pick one of the top 3.
How does black cohosh work? The primary reason that black cohosh seems to work for women’s health issues like menopause is that black cohosh contains phytoestrogens. While these aren’t exactly estrogen, they do appear to imitate the effects that estrogen – which may explain why black cohosh can help reduce symptoms of menopause. When the body believes it has higher levels of estrogen as a result of the phytoestrogens, the body adapts accordingly.
Is black cohosh safe? Generally speaking, black cohosh is regarded as being safe for consumption by adults. As of now, there are no confirmed long-term consequences, but there are some mild side effects that may occur as a result of usage. Because black cohosh is used as an at-home treatment method for many women’s health issues, there was a concern that the phytoestrogens in the product can cause an unhealthy increase in estrogen in women.
In a review study released in 2014, scientists examined previous studies to determine whether black cohosh use increased the risk of developing breast cancer in women who were already considered “high risk.” Though high estrogen levels are sometimes linked to an increased risk of developing breast cancer, the study determined that there was no confirmed connection between using black cohosh and developing cancer (8).
The mild side effects of using black cohosh include headaches, nausea, vomiting, and mild weight gain, though the development of side effects will vary widely from person to person.
Does black cohosh help with menopause? Black cohosh is an herbal supplement that’s been heavily researched as a potential treatment for many of the symptoms of menopause, such as hot flashes, night sweats, anxiety, and irritability.
These symptoms are fundamentally rooted in your body’s decreased estrogen production as you age and enter menopause. Though many of these symptoms of menopause were historically treated using hormone replacement therapy, concerns about the health risks associated with hormone therapy led health and nutrition researchers to seek out other ways to either address the decrease in estrogen associated with menopause or modify the body’s reaction to this decrease in estrogen.
How much black cohosh should you use? The amount of black cohosh you should use depends on what you’re attempting to gain from it. When scientists conduct studies on the role black cohosh may play in reducing menopause symptoms, the usual dosage is below 40 milligrams. However, there are supplements on the market that go well above this value at over 500 milligrams per capsule.
If you’ve never used black cohosh before, the best dosage would be the smallest dosage. After observing the potential side effects that occur after using the black cohosh, you can slowly increase your dose in order to reap greater benefits. You should immediately stop using black cohosh if you begin to experience any side effects.
What does black cohosh do for your body? One of the most popular uses of black cohosh today is to reduce menopause symptoms such as hot flashes, development of osteoporosis, and hyperlipidemia. In fact, black cohosh is deemed so effective at treating these symptoms that scientists have begun the search for other food products that have the same drastic effects on the condition (9).
There are also advocates for using black cohosh for other medical conditions. Using black cohosh as a treatment method for these conditions is still unconfirmed scientifically, but there is anecdotal evidence that black cohosh could be used to treat conditions like acne, bone weakness, and even PMS.
Should you take black cohosh with food? The time of day you take black cohosh depends on whatever fits into your schedule. Like most supplements and medications, the best way to reduce gastrointestinal side effects like nausea, diarrhea, and upset stomach is to consume black cohosh with food.
However, it’s all based on personal preferences and, if you don’t seem to develop these side effects when consuming black cohosh on an empty stomach, feel free to use black cohosh at any point of the day.
Can men use black cohosh? Due to the possible estrogenic effects of taking black cohosh, men are advised not to take it. When a male’s estrogen levels begin to rise, there are potential side effects like breast enlargement. However, the actual amount of phytoestrogens in black cohosh is limited, and there is no reason to believe that men taking black cohosh would result in substantially higher estrogen levels in the body.
Does black cohosh increase estrogen? Several scientific studies have been looking for a connection between black cohosh use and increased levels of estrogen in women. A 2003 study discovered that black cohosh does not actually increase concentrations of estrogen in the body, but effectively mimics the effects of estrogen (10).
This explains why black cohosh is used as an alternative to major treatment methods such as estrogen replacement therapy. Because it does not actually increase estrogen levels within the body, there is also no significant increased risk of developing cancers connected to high estrogen levels, like breast cancer.
What medications does black cohosh interact with? If you’re on any type of medication, it would be best to consult a healthcare professional before you begin taking black cohosh. There are plenty of medications (up to 300) that can be affected by taking black cohosh. The best thing you can do is research your particular medication and determine whether there are negative interactions with black cohosh. Black cohosh has the potential to interact with both prescription and over-the-counter medications, so always err on the side of caution before taking a new supplement like black cohosh.
Does black cohosh help you sleep? In terms of direct effects, the answer would be no. There is no evidence that black cohosh affects any of the body systems, chemicals, or hormones that play essential roles in the sleep-wake cycle. That being said, there is a potential to improve sleep quality due to other beneficial side effects of the supplement. If you’re currently going through menopause, you might experience difficulty sleeping due to incidences of hot flashes throughout the night.
There also seems to be some evidence that taking black cohosh can help reduce stress and anxiety in consumers, which can also help improve sleep quality in certain types of people.
How long does it take for black cohosh to kick in? Just how long it takes for black cohosh to work depends on the dosage you’re taking and the symptoms you’re attempting to treat. For example, taking a low dosage, like 20 milligrams likely won’t cause significant effects while taking 540 milligrams, will probably demonstrate more positive results more quickly.
In general, the effects will probably take several days or weeks to change the baseline of your body’s functioning. If you’re looking for short-term relief of symptoms like hot flashes, you might experience results between 30 minutes and a few hours after taking a high dose.
Does black cohosh make you gain weight? This depends on several factors, including how much you’re taking, the condition of your body, and other habits that you currently have. In particular, it would be difficult to determine whether black cohosh is the culprit for your weight gain without analyzing your entire lifestyle, dietary, and exercise habits. Since black cohosh mimics the effects of estrogen in the body, it can cause weight fluctuations.
Does black cohosh raise blood pressure? There is currently no evidence that shows that black cohosh may increase blood pressure. Instead, black cohosh tends to act as a blood thinner within the body, which can help to reduce blood pressure. With that said, you should be careful when using black cohosh due to the effects it may have on your blood pressure, especially when combined with medicaitons. Extremely low blood pressure can cause serious health consequences.
Can you drink alcohol while taking black cohosh? Some have theorized that the use of black cohosh can directly lead to the development of liver damage, and combing black cohosh with alcohol may exacerbate these effects. However, since there are no current scientific studies that back up these claims, the general recommendation would be to limit your intake of both black cohosh and alcohol, especially when consuming either of them.
Will black cohosh start my period? There is currently no science supporting the concept of starting your period as a result of using black cohosh. That being said, it does have great potential to help you better regulate your menstrual cycle.
Can black cohosh improve sexual dysfunction? The decrease in estrogen due to menopause can cause sexual dysfunction in women. Thankfully, black cohosh may be able to improve this.
A 2013 study found that people taking black cohosh experienced significant improvements in both anxiety and sexual function compared to the placebo group (11).
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Recap
Black cohosh is an herbal remedy that’s been extensively researched as a treatment for the symptoms of menopause. While there is conflicting evidence, some research suggests that it could be an effective way to treat night sweats and hot flashes that accompany menopause.
A dosage of 40 mg of standardized black cohosh extract per day is the best-supported dosage that’s been researched, though several studies have explored larger or smaller doses with varying success.
Side effects may include gastrointestinal problems and rashes, and their have been rare reports of serious liver problems associated with black cohosh usage.
For this reason, it’s a good idea to talk to your doctor first if you have concerns about the potential effects of black cohosh on your liver.
Still, black cohosh does show promise when it comes to treating hot flashes, night sweats, sexual dysfunction, and anxiety, so black cohosh might be a good solution to many of the troublesome symptoms of menopause.
For BodyNutrition’s #1 black cohosh recommendation, click here.
