Black Cohosh
What it’s good for
Black Cohosh for Hot Flashes
No Benefit4 studies · 0 supporting · 4 against
How it was tested: Dietary supplements and herbal remedies as a category are 'not recommended' for treatment of vasomotor symptoms given the lack of rigorous, evidence-based scientific research supporting their use (Level I-II evidence). Black cohosh is not named as a specific exception.
Proposed to act on serotonin and dopamine pathways in the brain's temperature-control center rather than as a classic estrogen; its estrogenic activity in the body appears to be minimal, which undercuts the traditional 'phytoestrogen' explanation.
Dose: 40–160 mg
Tested as: isopropanolic black cohosh extract (Remifemin), 40 mg/day median dose across trials in the Cochrane review; 160 mg/day black cohosh root extract in the NIH-funded HALT trial. Preparation and extraction method vary widely between commercial products.