Hormones & Menopause
Hormones & Menopause
Black Cohosh for Hot Flashes
Black cohosh may reduce hot flashes for some women, but studies have produced conflicting results and different extracts may not perform the same way.
Limited evidence About $5–$20 per month for many black cohosh supplements. Standardized extracts and combination products may cost more.
What it is
Black cohosh (Actaea racemosa) is a North American plant whose roots and underground stems are used in dietary supplements. It is commonly sold as capsules, tablets, or extracts and is marketed for menopause symptoms, especially hot flashes and night sweats.
What it claims to do
Reduce hot flashes and night sweats, improve overall menopause symptoms, and sometimes improve sleep, mood, or other symptoms associated with menopause.
What research actually shows
Research on black cohosh has produced conflicting results. Older randomized trials and reviews did not consistently find that black cohosh reduced hot flashes more than placebo. However, a 2023 meta-analysis of 22 studies involving 2,310 menopausal women found that black cohosh extracts were associated with improvements in overall menopause symptoms and a modest improvement in hot flashes compared with placebo. The same analysis did not find significant improvement in anxiety or depressive symptoms. An important limitation is that black cohosh products and extracts vary considerably, making it difficult to assume that every product sold as black cohosh will produce the same results.
Hot flashesLimited evidence
Overall menopause symptomsLimited evidence
Anxiety symptomsInsufficient evidence
Depressive symptomsInsufficient evidence
What it may realistically help
Black cohosh may modestly reduce hot flashes and some overall menopause symptoms in some women. The available evidence suggests a possible benefit, but results are not consistent enough to predict who will respond or whether a particular commercial product will work.
What it probably won't do
Black cohosh should not be expected to eliminate hot flashes completely, work reliably for every woman, or provide proven treatment for every menopause symptom. Evidence does not establish meaningful benefits for anxiety or depressive symptoms.
Time before results could be expected
Studies have generally evaluated black cohosh over several weeks to several months. It should not be assumed to provide immediate relief.
Risks, downsides & cautions
Black cohosh is generally well tolerated in studies, but mild side effects such as stomach upset, cramping, headache, or rash can occur. Rare cases of serious liver injury have been reported in people using products labeled as black cohosh, although it is uncertain whether black cohosh itself caused these cases. Product quality is another concern because some commercial products have contained the wrong herb or ingredients not listed on the label. Safety is uncertain for people with hormone-sensitive conditions, and black cohosh may not be safe during pregnancy or breastfeeding.
Typical cost range
About $5–$20 per month for many black cohosh supplements. Standardized extracts and combination products may cost more.
Questions to ask before spending money
- 1.Am I primarily trying to reduce hot flashes or expecting this supplement to treat several different menopause symptoms?
- 2.Does the product contain black cohosh alone or a mixture of several ingredients?
- 3.Does the label identify the type of black cohosh extract and the amount provided?
- 4.Has the product been independently tested for identity, quality, and purity?
- 5.Do I have liver disease, a hormone-sensitive condition, or other medical concerns I should discuss with a healthcare professional?
- 6.Am I expecting complete hot-flash relief when the research suggests any benefit may be modest and variable?
If your goal is
Reduce hot flashes and night sweats
Options to consider alongside or instead of this one for this goal.
Insufficient evidence
Hormones & Menopause
Menopause Supplements
“Menopause supplement” is a broad marketing category, not one treatment. Evidence varies by ingredient and symptom, and many popular combination products have not been adequately studied.
From About $20–$60 per month for many over-the-counter menopause supplements. Multi-ingredient and premium products may cost more.Read card
Strong evidence
Hormones & Menopause
Menopausal Hormone Therapy (MHT)
Hormone therapy is the most effective treatment for menopause-related hot flashes and night sweats and can prevent bone loss—but its benefits and risks depend on the individual.
From Varies widely. Generic hormone therapy may cost roughly $10–$100+ per month without insurance depending on the medications and route used. Insurance coverage can substantially change out-of-pocket cost.Read card
Strong evidence
Hormones & Menopause
Estradiol Patch for Menopause
Estradiol patches are highly effective for hot flashes and night sweats and deliver estrogen through the skin, avoiding the first-pass liver metabolism that occurs with oral estrogen.
From Generic estradiol patches may cost roughly $30–$60 per month without insurance, depending on dose, pharmacy and quantity. Insurance may reduce out-of-pocket cost; branded patches can cost more.Read card
References & sources
- 01Black cohosh extracts in women with menopausal symptoms: an updated pairwise meta-analysis
- 02Black Cohosh: Usefulness and Safety — National Center for Complementary and Integrative Health
- 03Black Cohosh — Health Professional Fact Sheet, NIH Office of Dietary Supplements
- 04Black cohosh (Cimicifuga spp.) for menopausal symptoms — Cochrane Review