Remifemin review, the black cohosh extract and what its trials show

The short version.

Remifemin is the most established black cohosh brand, and it has the best trial of any single black cohosh product. If you want to try black cohosh, it is the version we would pick. The problem is the herb, not the brand: the larger and more independent studies of black cohosh have not shown a clear benefit over placebo, and the Menopause Society does not recommend herbal remedies for hot flashes. Treat a Remifemin trial as a modest bet with a three month limit, and know the liver warning signs before you start.

What is in Remifemin.

Remifemin tablets contain a dry extract of black cohosh root and rhizome, Actaea racemosa, made with isopropanol and standardized so each batch is consistent. In the US it is marketed under the extract name RemiSure; the packaging calls it estrogen free and made in Germany. The label directs one tablet in the morning and one in the evening with food, and advises taking it for at least 3 months before judging the effect.

Remifemin Good Night adds a sleep blend of valerian root, lemon balm leaf and hops extracts to the same black cohosh extract. That is a reasonable idea for nights broken by sweats, but it also means more ingredients to clear with your clinician if you take sleep or anxiety medicines.

Black cohosh is a dietary supplement. The FDA does not review it for safety or effectiveness before sale, which is why a standardized extract with its own trial is a better bet than an unknown powder.

What the evidence shows.

The Remifemin trial. In 2005, a randomized, double blind trial in Obstetrics and Gynecology gave 304 women either the isopropanolic black cohosh extract used in Remifemin or a matching placebo for 12 weeks. The extract improved scores on the Menopause Rating Scale more than placebo. Hot flashes were the most responsive symptom, and women early in the menopause transition benefited more than those further along. Adverse events, lab results and tolerability were about the same in both groups. The authors described the size of the effect as similar to results from hormone therapy studies on the same scale; that comparison is theirs, and no head to head with hormones was run.

The larger picture. The 2012 Cochrane review pooled 16 randomized trials with 2,027 women using black cohosh monopreparations at a median of 40 mg a day. It found no significant difference from placebo in hot flash frequency or symptom scores, and found hormone therapy more effective than black cohosh. The authors rated trial quality as often unclear.

The HALT trial. A 1 year US trial of 351 women aged 45 to 55, published in Annals of Internal Medicine in 2006, compared black cohosh, two multibotanical blends, hormone therapy and placebo. None of the herbal groups differed from placebo on hot flashes or night sweats at 3, 6 or 12 months. Hormone therapy reduced them by about 4 a day. That trial used a different black cohosh product and dose, so it does not test Remifemin directly, but it is one of the strongest studies of the herb.

In breast cancer survivors. A 2001 randomized trial of 85 women with a history of breast cancer found black cohosh was not significantly better than placebo for the number or intensity of hot flashes.

Newer analyses. NCCIH notes a 2023 analysis of 22 studies that found black cohosh potentially beneficial for overall menopause symptoms and hot flashes, but not for anxiety or depression. The evidence is mixed rather than settled.

Liver safety.

This is the part to read before buying. Serious liver injury has been reported in people taking black cohosh, a few needing transplants. A US Pharmacopeia expert committee reviewed 30 case reports, rated all of them as possibly linked to black cohosh, none as probable or certain, and recommended that black cohosh products carry a cautionary statement. NCCIH says it is not proven that black cohosh caused the injuries, and that studies lasting up to a year generally found it well tolerated.

What that means in practice:

• Skip it if you have liver disease, unless a clinician says otherwise.
• Stop it and get checked for yellowing skin or eyes, dark urine or belly pain.
• Ask first if you take medicines that affect the liver, or several medicines in general.
• Avoid it in pregnancy and breastfeeding, and ask your oncologist if you have a hormone sensitive cancer history; NCCIH flags both groups.

Our black cohosh guide covers the herb in more depth.

Remifemin, our Remifemin pick.

Remifemin is the standardized extract tested in the 304 woman trial. If you want to try black cohosh at all, start here and give it 12 weeks.

Remifemin Good Night, with a sleep blend.

Remifemin Good Night is for people whose main complaint is waking at night. The sleep blend has not been tested together with the extract in the trials above.

Nature's Way Black Cohosh, budget black cohosh.

Nature's Way Black Cohosh is a standardized extract from a large supplement brand. It has no trial of its own; the general black cohosh evidence and cautions apply.

Estroven Complete, non black cohosh alternative.

Estroven Complete uses ERr 731 rhubarb root extract, which beat placebo in a 12 week trial of 109 women. It suits anyone who wants to avoid black cohosh. See our Estroven review.

Amberen, herb free alternative.

Amberen is a succinate, amino acid and mineral blend with several trials from one research network. The trials reported a rise in blood estradiol; our Amberen review explains why that matters.

Remifemin compared with Estroven and Amberen.

Product	Active ingredient	Best published evidence	Main caution
Remifemin	Isopropanolic black cohosh extract	304 woman trial, beat placebo over 12 weeks	Rare liver injury reports
Remifemin Good Night	Same extract plus valerian, lemon balm, hops	No trial of the combination	Liver caution, more ingredients
Nature's Way Black Cohosh	Standardized black cohosh	General black cohosh research only	Rare liver injury reports
Estroven Complete	ERr 731 rhubarb extract	109 woman trial, 12 weeks	Little long term data
Amberen	Succinates, glycine, minerals, vitamin E	Several trials, one network	Estradiol rose in trials

For every brand ranked together, see best menopause supplements.

Who Remifemin suits.

• A good fit. Mild to moderate hot flashes early in the transition, a healthy liver, no hormone sensitive cancer history, and a wish to try a nonprescription option for about three months.
• Think twice. Liver disease, several medicines, or a breast cancer history. Talk to your clinician or oncologist first.
• Not the right tool. Severe hot flashes, or dryness and painful sex, which black cohosh does not treat; see lube for menopause dryness and vaginal atrophy.

When to see a clinician.

See a clinician if hot flashes or night sweats disrupt sleep or work, if you have bleeding after menopause, or before starting Remifemin if you have liver disease, a hormone sensitive cancer history or take other medicines. Stop and get checked promptly for yellowing skin or eyes, dark urine or belly pain. Ask about hormone therapy and nonhormonal prescriptions such as fezolinetant if a supplement is not enough; our hot flashes guide lists the questions. This page is general information, not medical advice.