Black Cohosh and Reduced Vasomotor Symptom

Research synthesisLow evidenceSmall effect3 studies · 1 beneficial · 2 neutral · 0 harmful

Across 3 studies, 1 reported a beneficial small effect of black cohosh on reduced vasomotor symptoms, while 2 found neutral effects. The predominant effect size was small, and the median study duration was 365 days. Evidence suggests that black cohosh does not consistently reduce vasomotor symptoms compared to placebo, with only one systematic review showing moderate-certainty benefit.

Studied populations: menopausal women

Caveats: Evidence base is small (only 3 studies) — conclusions should be considered preliminary. Many of the included studies did not reach statistical significance — effect may be smaller than the predominant direction suggests.

Generated Jul 16, 2026

Time to effect

Median: 12.2 months · IQR 12.2 months–12.2 months · Range 12.2 months–12.2 months — Reported in 1 of 3 studies

Safety in these studies

Overall tolerabilityNo significant difference
Secondary measures indicated that both botanicals were safe as administered.
from: Safety and efficacy of black cohosh and red clover for the management of vasomotor symptom
Overall tolerabilityNo significant difference
The two RCTs using black cohosh and dong quai found no measurable effects.
from: The Effectiveness of Non-Soy Oral Herbal Supplements for Menopausal Symptoms: A Systematic
Overall tolerabilityReported
Most complementary therapies are safe.
from: Complementary therapies for management of menopausal symptoms: a systematic review to info
Overall tolerabilityReported
Safety monitoring indicated that chemically and biologically standardized extracts of black cohosh and red clover were safe during daily administration for 12 months.
from: Safety and efficacy of black cohosh and red clover for the management of vasomotor symptom

3 of 3 papersPopulation:

Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial.
- 2009-11
- RCT · n = 89
- Menopause (New York, N.Y.) 16(6)
- - Stacie E Geller
  - Lee P Shulman
  - Richard B van Breemen
  - Suzanne Banuvar
  - Ying Zhou
  - Geena Epstein
  - Samad Hedayat
  - Dejan Nikolic
  - Elizabeth C Krause
  - Colleen E Piersen
  - Judy L Bolton
  - Guido F Pauli
  - Norman R Farnsworth
- PubMed: 19609225
- DOI: 10.1097/gme.0b013e3181ace49b
4 Insights on
- Reduced Vasomotor Symptom
- High evidence
- Highly Cited
- Clinical
Reductions in number of vasomotor symptoms after a 12-month intervention were as follows: ... red clover (57%), placebo (63%)... with only CEE/MPA differing significantly from placebo. Black cohosh and red clover did not significantly reduce the frequency of vasomotor symptoms as compared with placebo.
Effect
Neutral
Effect size
Small
Significant
No
Dose
standardized extract, dose not specified
The Effectiveness of Non-Soy Oral Herbal Supplements for Menopausal Symptoms: A Systematic Review.
- 2026-06-23
- Systematic Review
- Nutrients 18(13)
- - Grace Jing
  - Clara M Keane
  - Clare M Reynolds
- PubMed: 42451042
- DOI: 10.3390/nu18132037
1 Insight on
- Reduced Vasomotor Symptom
- High evidence
- Rigorous Journal
The two RCTs using black cohosh and dong quai found no measurable effects.
Effect
Neutral
Effect size
Small
Significant
No
Complementary therapies for management of menopausal symptoms: a systematic review to inform the update of the International Menopause Society recommendations on women's midlife health.
- 2026-01-07
- Systematic Review
- Climacteric : the journal of the International Menopause Society 29(2)
- - Alison Maunder
  - Amelia K Mardon
  - Vibhuti Rao
  - Sophia Torkel
  - Najwa-Joelle Metri
  - Jing Liu
  - Guoyan Yang
  - Nora Giese
  - Evangeline Mantzioris
  - Nur K Abdul Jafar
  - Geovanna E Rodrigues de Souza
  - Ieman Al-Kanini
  - Lorena Romero
  - Nick Panay
  - Hugo Pedder
  - Carolyn Ee
- PubMed: 41498229
- DOI: 10.1080/13697137.2025.2584061
2 Insights on
- Reduced Vasomotor Symptom
- High evidence
- Clinical
moderate-certainty evidence supports black cohosh (vasomotor/menopausal symptoms)
Effect
Beneficial
Effect size
Small
Significant
Yes

Black Cohosh and Reduced Vasomotor Symptom

Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial.

The Effectiveness of Non-Soy Oral Herbal Supplements for Menopausal Symptoms: A Systematic Review.

Complementary therapies for management of menopausal symptoms: a systematic review to inform the update of the International Menopause Society recommendations on women's midlife health.