Imagine you’re sitting in an important meeting at work, trying to concentrate on the (boring) presentation, but all you can think about is the wave of heat coming up from inside you. Sweat’s beading on your forehead and you’re starting to feel anxious and embarrassed about turning beet red. Or maybe it's the middle of the night, and you're jolted awake with a night sweat. You’re suddenly soaked from head to toe and you have to jump out of bed and change your pajamas, maybe even your sheets. You’re shivering in the aftermath and forget getting back to sleep. These scenarios might sound all too familiar.

I’m Steve Goldring, the Hormone Pharmacist. I’ve spent a couple of decades helping women navigate the often confusing world of menopause treatments. One question that comes up frequently is “Can’t I take something natural for menopause . . . like Black Cohosh?” Or this one . . . “Is Black Cohosh an effective solution for hot flashes, or is it just another myth?”

In this post, we’ll dive into the science and stories behind Black Cohosh, taking a realistic look at whether this ancient herb can truly provide the relief you need.

What is Black Cohosh?

Black Cohosh, scientifically known as Actaea racemosa, is a tall, flowering plant native to North America. For centuries, Native American women have used this herb to help manage a variety of health issues, especially for women's health issues. Picture a group of native women gathered around a fire in 1835, sharing stories and remedies passed down through generations. Black Cohosh was one of the remedies these women relied on, valued for its potential to ease menstrual cramps, labor pains, and even menopausal symptoms.

The secret lies in its active compounds, which interact with serotonin receptors in the brain. Imagine these compounds as tiny messengers, working to balance your body’s thermostat, potentially reducing the frequency and intensity of hot flashes and night sweats. While it’s not a magic bullet, many women report feeling more comfortable and less plagued by these disruptive symptoms.

How Black Cohosh Works

Black Cohosh is believed to work by interacting with serotonin receptors in the brain, which can help regulate body temperature and reduce the occurrence of hot flashes. Think of it as a natural thermostat, helping to keep your body's temperature more stable and reducing those unexpected waves of heat. Some doctors prescribe anti-depressants like Zoloft® or Paxil® for menopause because of this mechanism.

Now that we understand how Black Cohosh might work, the next question is, "Does black cohosh work?"

Anecdotal Evidence - Personal Stories

  • Joan’s Story: Joan had been suffering from intense hot flashes for years. After reading about Black Cohosh online, she decided to give it a shot. She took it regularly for a month and noticed that her hot flashes became less frequent and less intense.
  • Nana: Nana, who commented on my YouTube channel, shared that her sister takes Black Cohosh menopause support supplements and reported improvements not only in her hot flashes but also in her ability to sleep, reduced anxiety, and relief from arthritis pain.
  • LivingTheDream’s: LivingTheDream, also from YouTube, shared that Black Cohosh helped nearly eliminate her hot flashes in the early days of menopause. As her estrogen level dropped, her doctor prescribed HRT. She is now considering resuming Black Cohosh while waiting for the HRT to take effect and is curious about its safety when combined with a low-dose estrogen and progestin combo pill.

Personal stories are known as "anecdotal evidence" - one-off stories of women who have experienced symptom relief from herbal supplements. However, to determine the true effectiveness of a treatment, we need to take a broader view looking at clinical trials. Clinical trials provide a more comprehensive understanding of how well a treatment works across a larger group of people, accounting for the variability in individual responses.

Effectiveness of Black Cohosh for Hot Flashes

The effectiveness of Black Cohosh has been studied extensively, but the results have been mixed. Some studies support its use, while others find no significant difference compared to a placebo.

Black Cohosh vs HRT for Hot Flashes
  • Menopause Journal Study: One study published in the journal Menopause found that women who took Black Cohosh experienced a significant reduction in the frequency and severity of hot flashes compared to those who took a placebo. However, this same study also highlighted that while some participants experienced relief, the overall effectiveness was similar to that of a placebo. A graph from the study (shown above) illustrates that herbal remedies like Black Cohosh are substantially less effective for hot flashes than hormone replacement therapy. I explain the graph in the video but the bottom line (the pink one!) shows that hormone replacement is dramatically more effective than either placebo or black cohosh at relieving hot flashes.
  • Annals of Internal Medicine Clinical Trial: The Annals of Internal Medicine published a clinical trial comparing Black Cohosh, multibotanicals, soy counseling, and a form of hormone replacement therapy called CEE or conjugated equine estrogen. In this trial, herbal treatments performed about the same as placebo in reducing hot flashes and night sweats. Hormone replacement substantially decreased vasomotor symptoms, outperforming herbs and placebo.
  • Cochrane Review Meta-Analysis: A Cochrane Review of 16 studies concluded that Black Cohosh has potential benefits, but more rigorous studies are needed to confirm its efficacy. The meta-analysis found that while some evidence supports the use of Black Cohosh, the overall quality of the studies was not sufficient to draw definitive conclusions.
Cochrane Review Black Cohosh

These mixed findings suggest that although Black Cohosh might work for some women, it may not be effective for everyone. The variability in individual responses highlights the importance of consulting with a qualified, experienced healthcare provider to determine the best approach for managing menopausal symptoms.

Additional Resources

My friends at are really good at in-depth explanations of the science behind dietary supplements. If you really want to dive deep into Black Cohosh and the research about whether it works, visit their comprehensive Black Cohosh monograph.


While Black Cohosh has shown potential in relieving some menopausal symptoms for some women, it is not a guaranteed solution for everyone. The root problem in menopause isn’t a lack of herbs; it’s the loss of hormones. A deficiency in estradiol and progesterone is the reason you’re experiencing hot flashes, night sweats, weight gain, vaginal dryness, painful intimacy, insomnia, joint pain, and dozens of other common menopause symptoms. Unless you address the root problem in menopause—the loss of your hormones—you’ll never be truly free from menopause symptoms or the long-term health risks associated with the loss of hormones.

By weaving scientific insights with personal stories, I aim to present a balanced view of Black Cohosh's effectiveness. Whether it's backed by research or personal testimonials, the potential of this herb to ease menopausal symptoms makes it an option to consider. However, for symptom relief and long-term health, it's crucial to address hormone deficiencies at the core of menopause.

Helping You Make Your Decision

If you're struggling with menopause symptoms like hot flashes and haven't found relief from herbal remedies or non-hormonal treatments, consider exploring hormone replacement therapy (HRT) as a potential solution. My comprehensive course, The Menopause Solution, is specifically designed to help women answer the question: "Is hormone replacement therapy (HRT) right for MY menopause . . . or not?" In about 2 hours, you'll gain the clarity and confidence you need to make an informed decision about your treatment options. Visit The Menopause Solution to learn more and take the first step towards finding the relief you deserve.

The Menopause Solution!

Confused about whether HRT is right for your  menopause? My digital course helps you gain the confidence and clarity to make your HRT decision . . . in about 2 hours.

Hormone Practitioners: Find out how you can use The  Menopause Solution to simplify your hormone practice.

About the Author

With over 26 years of experience as a licensed pharmacist in Utah and Colorado, I specialize in hormone optimization and menopause management. I hold certifications in Advanced Bioidentical Hormone Replacement Therapy (ABHRT) from Worldlink Medical, C4 Hormone Replacement Therapy from the Professional Compounding Centers of America and the American Academy of Anti-Aging Medicine, and I am a Brain Health Coach certified by Amen Clinics.

I also share my expertise on my Simple Hormones YouTube channel where my videos have been viewed over 950,000 times and over 18,000 viewers have subscribed.

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