A study in Journal of environmental science and health. Part C, Toxicology and carcinogenesis published in 2025 reviewed in detail the toxicity of black cohosh, a plant widely used to alleviate menopausal symptoms. The authors collected data from laboratory experiments and clinical cases in women taking commercial extracts of this root. The central finding was clear: relevant safety problems were observed, with severe liver damage in some cases.
This result has direct implications for perimenopausal and menopausal women seeking herbal alternatives for hot flushes, mood swings or sleep disturbances. The practical message is cautious, not all herbal extracts are equivalent or safe, and quality and toxicological profile matter as much as potential symptom relief.
What the toxicological review of black cohosh in women looked at
The publication is a safety review, i.e. it is not a single clinical trial, but a pooled analysis of many previous papers. It includes animal studies, cell studies and case reports on women taking black cohosh supplements for menopausal symptoms.
The authors describe that black cohosh rhizome and root extract, also called Actaea racemosa, has been popularised for its supposed oestrogen-like effect. However, the review concludes that its efficacy in relieving symptoms is limited and that there are worrying signs of genotoxicity, i.e. damage to genetic material, along with cases of liver toxicity, including severe acute damage.
Why black cohosh raises concerns about liver health
Black cohosh contains over a hundred different compounds, including triterpenes, polyphenols and alkaloids. This chemical complexity makes commercial extracts highly variable, meaning that two products with the same name can have very different active compound and impurity profiles.
The review describes an aneugenic mechanism, i.e. alterations in chromosome partitioning during cell division. In addition, there are multiple reports of women who, after taking black cohosh supplements, developed from mild discomfort to acute liver damage. In some cases, hospitalisation was required and deaths have been reported, reinforcing the need for extreme caution with these extracts.
Wise habits for wellbeing in the menopause
The hormonal transition years are a sensitive time, with changes in body temperature, mood, sleep and body composition. The black cohosh study is a reminder that choosing any plant just because it is natural may not be a safe strategy.
Evidence-based habits include eating a diet rich in vegetables, legumes and quality protein sources, maintaining regular physical activity with strength work and aerobic exercise, getting a good night’s rest with steady schedules, and reducing alcohol consumption, which adds to the burden on the liver. These pillars help the body adapt to the new hormonal stage and reduce the need to resort to extracts with a dubious toxicological profile.
Black cohosh-free supplements and clean formulations for responsible support
The toxicology review on black cohosh highlights a key point: not all herbal ingredients are equivalent and safety must be on a par with efficacy. For many women, it makes sense to prioritise supplements that avoid ingredients with signs of toxicity and use nutrient forms with good bioavailability, without unnecessary additives.
In this context, a prudent approach is based on three criteria: choosing formulas that do not include black cohosh when there is reasonable doubt about their safety, preferring advanced forms of vitamins and minerals that are better recognised and absorbed by the body, and opting for products without controversial excipients such as certain colourings or anti-caking agents, which do not add physiological value.
A menopausal supplement with a physiological approach and no black cohosh, designed for women who prioritise clean formulations.
Choosing wisely and listening to your body’s signals
In summary, the review on black cohosh reminds us that the same plant ingredient can offer theoretical benefits and, at the same time, present significant risks if its composition and toxicological profile are not well controlled. For women going through the menopause, this translates into an invitation to inform themselves, to prioritise sound lifestyle habits and, if they decide to use supplements, to choose formulas that are committed to the safety and quality of the ingredients.
This content is for informational purposes only and is not a substitute for the advice of a healthcare professional.
Frequently asked questions
What does the review conclude about the safety of black cohosh?
The review describes black cohosh as having limited efficacy for menopausal symptoms and reports signs of genotoxicity and cases of liver damage, some severe. It therefore raises reasonable doubts about its long-term use in women.
Why it is important to check the toxicity of medicinal plants
The fact that a product is herbal does not guarantee safety. Some plants concentrate compounds that, in high doses or in poorly controlled extracts, can damage the liver or genetic material. Knowing these risks allows more informed decisions to be made.
What alternative habits can support menopausal wellness?
A diet rich in vegetables and legumes, regular exercise, weight control, good sleep hygiene and reduction of alcohol help the body to adapt to hormonal changes. These habits are the basis on which responsible supplements can then be assessed.
Why it makes sense to prefer non-black cohosh supplements
Since the review reports cases of liver toxicity associated with black cohosh, many women and practitioners prefer to avoid it. Opting for formulas without black cohosh reduces a potential risk factor and focuses attention on other nutrients with a better safety profile.
What to look for when choosing a menopausal supplement
Check the list of ingredients, avoid those with safety concerns such as black cohosh, prioritise well-absorbed forms of vitamins and minerals, and choose products with clean formulations, without unnecessary additives. All this should always go hand in hand with good lifestyle habits.
