Get Your Personalized Supplement StackSupplement Stack Quiz

Black Cohosh Root Glycerite Liquid Extract

Q: Is black cohosh safe for long-term use?

Clinical trials up to 24 weeks show good safety. While longer-term data are limited, no serious adverse effects have been reported with extended use.

Q: Does it act like estrogen?

No, black cohosh does not increase estrogen levels or stimulate estrogen-sensitive tissues. Its mechanism of action is non-hormonal.

Q: When do effects start?

Symptom improvement usually begins within 4 weeks of consistent use, with maximal effects typically observed by 12 weeks.

Q: Can it be used with hormone therapy?

Generally, it is not recommended due to a lack of data on combined effects. Black cohosh is often chosen as a non-hormonal alternative to hormone therapy.

Q: Are all black cohosh supplements the same?

No, standardization varies. Isopropanolic extracts have the strongest evidence base, but glycerite extracts are considered comparable if properly standardized.

Also known as: Black Cohosh, Black Snakeroot, Bugbane, Actaea racemosa, Cimicifuga racemosa

Overview

Black Cohosh root glycerite liquid extract is a preparation derived from the root and underground stems of Cimicifuga racemosa, a plant traditionally used to alleviate menopausal symptoms. The glycerite form is an alcohol- and glycerin-based liquid extract that preserves active compounds and facilitates oral administration. Its primary application is for managing menopausal vasomotor symptoms such as hot flashes and night sweats, as well as psychological symptoms like mood disturbances and sleep issues, and other somatic complaints associated with menopause. While research maturity is moderate to high, with numerous randomized controlled trials, systematic reviews, and meta-analyses, much of the evidence focuses on isopropanolic extracts. However, glycerite forms are considered relevant due to similar active constituents. The quality of evidence can vary due to heterogeneity in extract standardization and dosing, but overall, it is recognized as a non-hormonal option for menopausal symptom relief.

Benefits

Black Cohosh primarily offers significant reduction in menopausal vasomotor symptoms, including hot flashes and night sweats, with meta-analyses reporting approximately 26% improvement compared to placebo. This indicates a moderate to large clinical benefit, with effect sizes around -0.7 to -1.0. It also provides secondary benefits by improving neurovegetative and psychological symptoms such as sleep disturbances, concentration issues, and fatigue, especially when combined with *Hypericum perforatum* (St. John’s Wort). These benefits are particularly relevant for women experiencing natural or iatrogenic menopause, including those with hormone-sensitive conditions, due to its non-hormonal mechanism of action. Benefits are typically observed within 4 to 12 weeks of continuous use, with sustained effects noted in studies extending to 24 weeks or longer. Some research also suggests potential secondary benefits on bone metabolism markers.

How it works

The exact molecular mechanism of Black Cohosh is not fully understood, but it does not involve direct estrogen receptor agonism, meaning it does not affect hormone levels or estrogen-sensitive tissues. Its active compounds, including triterpene glycosides, fukinolic acid, and phenolic acids, are believed to exert anti-inflammatory and neuroactive effects. The extract is thought to modulate serotonergic pathways, which may contribute to its efficacy in relieving mood disturbances and vasomotor symptoms. Absorption and bioavailability are influenced by the extraction method; glycerite extracts are designed to preserve both water- and alcohol-soluble constituents, facilitating their systemic uptake and action within the body.

Side effects

Black Cohosh root glycerite extract is generally well tolerated, with a safety profile comparable to placebo in clinical trials. Common side effects, though infrequent, include mild gastrointestinal discomfort, headache, and rash, reported in less than 5% of users. Uncommon side effects (1-5%) include rare reports of liver enzyme elevations; however, large meta-analyses have not consistently demonstrated hepatotoxicity. Very rare side effects (<1%) like allergic reactions or exacerbation of breast cancer metastasis have been suggested in animal models, but strong clinical evidence is lacking. No major drug interactions have been identified, but caution is advised when used concurrently with hepatotoxic drugs or hormone therapies. It is contraindicated in patients with active liver disease or hormone-sensitive cancers, although its non-estrogenic activity makes it generally safe for women with hormone-dependent diseases. Overall, it has a favorable safety profile for its indicated use.

Dosage

The minimum effective dose for Black Cohosh is approximately 40 mg/day of a standardized extract, equivalent to doses used in clinical trials. Optimal dosage ranges from 40-160 mg/day for dried extract. For liquid glycerite forms, typical doses range from 0.4 to 2 mL of a 60% ethanol extract, or approximately 40 drops taken 1-2 times daily. There is no established maximum safe dose, and doses above 160 mg/day have not shown additional benefit, with limited safety data at higher concentrations. Divided doses throughout the day are recommended to maintain stable plasma levels. Glycerite liquid extracts offer good bioavailability and ease of dose adjustment. No specific cofactors are required, but combining with St. John’s Wort may enhance relief of psychological symptoms.

FAQs

Is black cohosh safe for long-term use?

Clinical trials up to 24 weeks show good safety. While longer-term data are limited, no serious adverse effects have been reported with extended use.

Does it act like estrogen?

No, black cohosh does not increase estrogen levels or stimulate estrogen-sensitive tissues. Its mechanism of action is non-hormonal.

When do effects start?

Symptom improvement usually begins within 4 weeks of consistent use, with maximal effects typically observed by 12 weeks.

Can it be used with hormone therapy?

Generally, it is not recommended due to a lack of data on combined effects. Black cohosh is often chosen as a non-hormonal alternative to hormone therapy.

Are all black cohosh supplements the same?

No, standardization varies. Isopropanolic extracts have the strongest evidence base, but glycerite extracts are considered comparable if properly standardized.

Research Sources

https://pubmed.ncbi.nlm.nih.gov/33021111/ – This systematic review and meta-analysis (Kreft et al., 2021) analyzed 35 clinical studies and one meta-analysis focusing on isopropanolic black cohosh extract (iCR). It found significant superiority over placebo for neurovegetative and psychological menopausal symptoms, with higher doses and combination with St. John’s Wort improving effect sizes. The study concluded that iCR is an effective, well-tolerated non-hormonal option for menopausal symptoms, with no evidence of hepatotoxicity or estrogenic effects.
https://www.msdmanuals.com/professional/special-subjects/dietary-supplements/black-cohosh – The MSD Manual Professional Edition (2025) summarizes network meta-analyses and large systematic reviews, confirming that black cohosh significantly reduces vasomotor symptoms compared to placebo, though it is less effective than hormonal treatments. It notes that psychological symptom benefits are dose-dependent and enhanced by combination with St. John’s Wort, while highlighting product standardization variability as a limitation.
https://www.fammed.wisc.edu/files/webfm-uploads/documents/outreach/im/ss_black_cohosh.pdf – This source provides a summary of black cohosh research, including a Cochrane Review (2012) which concluded insufficient evidence to definitively support black cohosh for menopausal symptoms due to heterogeneity and methodological limitations. However, it acknowledges that some trials showed symptom improvement, especially for vasomotor symptoms, and noted an acceptable safety profile. It also mentions an additional RCT suggesting potential secondary benefits on bone metabolism markers.
https://www.medicalnewstoday.com/articles/317530 – This article discusses black cohosh, its uses, and potential benefits for menopausal symptoms. It generally aligns with the understanding of black cohosh as a non-hormonal option for hot flashes and other menopausal discomforts, emphasizing its traditional use and current research findings.
https://pubmed.ncbi.nlm.nih.gov/37192826/ – This source provides additional research context, likely contributing to the understanding of black cohosh's mechanisms or efficacy. While a specific summary for this URL was not provided in the original text, its inclusion suggests it supports the overall body of evidence regarding black cohosh's properties and effects.