Black cohosh (Cimicifuga racemosa)
What it is
One of the most clinically studied natural options for menopause, though evidence is mixed. The 2012 Cochrane review of 16 trials concluded there was insufficient evidence to support use over placebo for hot flashes, though several standardised-extract trials (isopropanolic Remifemin) do show modest reductions in frequency and severity. Rare but serious liver injury reported — use only standardised extracts and limit to 6 months. Avoid in pregnancy, with tamoxifen, or hormone-sensitive cancers.
Dose
20–40 mg/day standardised extract (Remifemin, 1 mg triterpene glycosides); limit strictly to 6 months
Time of day & tips
Take with food and water to reduce nausea. Stop after 6 months and revaluate. Avoid if pregnant, on tamoxifen, or with a history of hormone-sensitive cancer.
Cycling
Maximum 6 months at standard doses. Liver function monitoring recommended during use. Rare liver injury cases reported with prolonged use.
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