Black cohosh (Cimicifuga racemosa)

Tier 3 — weak evidence · Menopause · Hot flashes · Mood

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