Black Cohosh

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Black cohosh is a studied herbal option for menopausal hot flashes and night sweats, though evidence is inconsistent across preparations and reviews, and its exact mechanism isn't fully understood.
Form: Standardized root extract (standardized to triterpene glycosides)
Typical dose studied: 20–40 mg twice daily
Timing: With food, morning and evening
Evidence is inconsistent across different product preparations. Rare case reports of liver toxicity exist without firmly established causality — still worth monitoring, especially with any pre-existing liver condition.
? Emerging / limited evidence
Avoid with: End-stage liver disease / Cirrhosis; Chronic Hepatitis C — active / untreated; Chronic Hepatitis B — active / on antiviral therapy; Cancer — active or within past 12 months
Already taking it? Discontinue and consult a doctor if symptoms of liver problems develop — rare case reports of liver injury exist, though causality remains debated.
Leach MJ et al. Cochrane review of black cohosh for menopause. Franco OH et al. BMJ review of non-hormonal menopause treatments.
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