Black cohosh (Actaea racemosa): herbal relief for hot flashes

Hot flashes, night sweats and restless nights are among the most common complaints during menopause — and many women look for gentler alternatives to hormonal therapy. One herb increasingly discussed by clinicians and pharmacists is black cohosh (Actaea racemosa).

Native to North America, black cohosh is now cultivated and sold worldwide for women's health. Its root extract is used in standardized supplements — typically capsules or tablets — aimed at easing vasomotor symptoms such as sudden hot flashes, which affect up to about 80% of women in peri‑ and postmenopause.

How it works and what research is looking at

Unlike some plant remedies, black cohosh is not a source of phytoestrogens. Researchers believe its benefit comes from modulation of the serotonergic system in the hypothalamus, a brain region involved in regulating body temperature. Users often report fewer hot flashes, less nighttime sweating and improved sleep and daytime energy after a period of regular use.

Scientists are also studying other possible effects of black cohosh: anti‑inflammatory actions, a role in maintaining bone density, and potential applications for conditions such as PCOS (polycystic ovary syndrome). Evidence is evolving, and findings vary between studies.

Results are not instant — the body usually needs several weeks of daily dosing before benefits become noticeable. When choosing a product, look for a standardized extract and follow the manufacturer’s dosing guidance.

Good news for women in North Macedonia: standardized black cohosh preparations are available in many larger pharmacies across the country. Ask your pharmacist about natural supplements containing Actaea racemosa, review the product composition on the box, and discuss any existing medications or health conditions with a healthcare professional before starting.

Photo: press material from the event