Evidence Level
Strong
Black cohosh has the most extensive clinical evidence base of any herbal remedy for menopausal symptoms. The Cochrane review by Leach & Moore (2012) analyzed 16 randomized controlled trials and concluded that black cohosh showed a significant reduction in vasomotor symptoms compared to placebo, though study quality varied. Osmers et al. (2005) published a rigorous RCT of 304 menopausal women showing that isopropanolic black cohosh extract (iCR, the basis of Remifemin) significantly improved menopausal complaints over 12 weeks. The safety profile has been extensively reviewed, with the American Herbal Products Association and European Medicines Agency both concluding that hepatotoxicity risk is very low with standardized extracts.