Get the Meet Midlife Edit

Brief Myth-buster · Hot flashes & night sweats

Does black cohosh help hot flashes?

Probably not. In a Cochrane review of 16 randomized trials with 2,027 women, black cohosh did no better than a placebo at reducing how often hot flashes happened1. The Menopause Society doesn't recommend herbal remedies for hot flashes2. ACOG's new menopause guideline says the evidence doesn't support herbal supplements as safe or effective for menopause symptoms3.

Last updated Oct 18, 20262 min readEvidence-checked · sources listed

Information for better conversations, not a diagnosis. This is research with sources, not medical advice. Talk to your clinician about your situation.

What did the studies find?

The 2012 Cochrane review pooled randomized trials in women in perimenopause or after menopause, who took black cohosh for about 23 weeks on average1. In the three trials (393 women) that could be combined, hot flashes differed from placebo by just 0.07 a day, which wasn't significant1. Symptom scores didn't differ from placebo either. Hormone therapy did better than black cohosh1. The reviewers concluded there is "insufficient evidence to support the use of black cohosh for menopausal symptoms"1.

What do the experts say?

  • The Menopause Society (2023) lists supplements and herbal remedies under "not recommended" for hot flashes2.
  • ACOG (October 2026) says the evidence does not support the safety or effectiveness of phytoestrogens or herbal supplements for hot flashes or other menopause symptoms. It adds that supplements aren't regulated by the FDA and haven't been tested for safety, effectiveness or purity3.
  • NIH's complementary health center (NCCIH) says studies of black cohosh for menopause symptoms "have had inconsistent results"4.

Is black cohosh safe?

NCCIH says black cohosh generally has only mild side effects, if any. But rare cases of liver damage, some very serious, have been reported in people taking commercial products, though it's uncertain whether black cohosh caused them4. NCCIH advises anyone with a liver disorder to talk to a health care provider before taking it. Anyone who develops signs of liver trouble while taking it, such as belly pain, dark urine or yellowing skin (jaundice), should stop and contact a provider4.

The limitation

Most of the trials were small, and the reviewers rated their quality as generally unclear because of poor reporting. Safety data were also inconclusive1. "Not shown to work" isn't the same as proven useless. It means the trials so far haven't shown a benefit.

One thing to try, one thing to ask

If you already take black cohosh, add it to the medicine list you bring to appointments. Then ask: "Black cohosh didn't beat a placebo in trials. Which options with better evidence fit me?" Our sleep and night sweats guide covers options with stronger evidence.

Talk to a menopause-trained provider

Sources

  1. Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012. PMID 22972105. https://pubmed.ncbi.nlm.nih.gov/22972105/
  2. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023. PMID 37252752. https://pubmed.ncbi.nlm.nih.gov/37252752/
  3. ACOG. ACOG Expands Recommendations for Management of Menopause Symptoms (news release), Oct 15, 2026. https://www.acog.org/news/2026/10/acog-expands-recommendations-for-management-of-menopause-symptoms/
  4. NCCIH. Menopausal Symptoms: In Depth. https://www.nccih.nih.gov/health/menopausal-symptoms-in-depth

Information for better conversations, not a diagnosis. This is research with sources, not medical advice. Talk to your clinician about your situation.