Remifemin review: does this black cohosh supplement work for menopause?

Name: Remifemin review: does this black cohosh supplement work for menopause?
Creator: MenoWoman

Remifemin's black cohosh extract has weak and mixed evidence for hot flashes, and a large Cochrane review found black cohosh no better than placebo. Regulators in Europe, the UK and Australia warn that black cohosh can rarely harm the liver.

Researched by the MenoWoman team. Edited by Marcela Sat. Updated 7 November 2026. We may earn from links.

Get medical help urgently if you notice yellow skin or eyes, dark urine, unusual tiredness, nausea or stomach pain while taking black cohosh. Talk to a doctor first if you have liver disease, have had breast cancer, or take other medicines.

What Remifemin is and what the brand claims

Remifemin is a hormone-free herbal product made by the German company Schaper & Brümmer. Its active ingredient, iCR, is described by the brand as a special isopropanol extract of black cohosh (Cimicifuga) root.¹

The range includes a standard tablet, a once-daily "mono" version and a version combined with St John's wort. The brand says they relieve menopausal complaints such as hot flushes, and that many clinical studies prove their effect and safety. The page does not name those studies.¹

In the EU, black cohosh can be registered as a herbal medicine. In the US it is sold as a dietary supplement, so rules differ by country.^3,4 This page is an evidence review, not a hands-on test. It is based on published research, regulator statements and the brand's own claims.

What is in it and how it might work

Every Remifemin product is built around black cohosh root extract. The NIH Office of Dietary Supplements says Remifemin is standardized to a set amount of root, not to one plant compound.³

No one knows exactly how black cohosh might work. Its active compounds have not been identified, and products vary a lot in their chemistry.³ If you are thinking about the St John's wort version, ask a doctor or pharmacist to check it against any other medicines you take.

What the research shows

The best overview is a 2012 Cochrane review of 16 randomized trials in 2,027 women. Black cohosh did no better than placebo for hot flush frequency or overall symptom scores, and hormone therapy worked better.² The reviewers rated the evidence low quality and said it was not enough to support use.²

Remifemin itself was used in several of those trials.³ Later independent trials of other black cohosh products, with 351 and 88 women, also found no clear benefit over placebo.³

The picture is not entirely one-sided. The NIH's complementary health center says some extracts, mostly Remifemin, may ease certain symptoms, while results for other products are inconsistent.⁵ European regulators also list black cohosh as a "well-established use" herbal medicine for hot flushes and sweating.⁴ The Menopause Society's 2023 statement on non-hormone treatments does not recommend supplements or herbal remedies for hot flashes.¹⁰ Because pooled trials are mostly negative, we rate the evidence as weak.

Safety: rare liver injury and who should avoid it

The main safety concern is rare liver injury. In 2006 the European Medicines Agency reviewed 42 poorly documented case reports and treated the link as a warning signal.⁶ The UK regulator, the MHRA, then brought in a label warning that black cohosh may rarely cause liver problems.⁶

The MHRA also reported 53 suspected liver-related reactions and one suspected liver failure that needed a transplant.⁷ It urged people to choose registered herbal products, which carry a THR mark in the UK.⁷

Australia's TGA was the first regulator to require a liver warning, in 2006, after reviewing 47 cases worldwide.^8,9 It later added wording about rare liver failure and symptoms to watch for.⁹ The NIH says cause and effect is not proven, and wrong plant species or contaminants may explain some cases.³

The current EU monograph advises caution for anyone with past liver disease.⁴ It tells users to stop and see a doctor straight away if signs of liver injury appear.⁴ If you have liver disease, it is safest to avoid black cohosh unless your doctor advises otherwise.

Other cautions from the monograph:⁴

Not recommended in pregnancy or breastfeeding. Pregnancy is still possible in perimenopause.
Do not use after breast cancer or other hormone-sensitive tumors without medical advice.
Get medical advice if you also use estrogen, or before using it for more than six months.
Reported side effects include stomach upset, diarrhea, rashes, itching and swelling.

Who it might suit and alternatives

Remifemin may appeal to someone with mild hot flushes who wants a hormone-free option. It only makes sense with a healthy liver and an acceptance that the evidence is weak. Read our full guide to black cohosh for more detail.

Options with stronger evidence include hormone therapy (HRT), non-hormonal prescription treatments and CBT for menopause. See also hot flashes and do menopause supplements work.

Price and value

Remifemin is sold as packs of tablets, bought one pack at a time from pharmacies and online shops where it is available. Check current price. Given the weak evidence and liver warnings, discuss it with a doctor or pharmacist before paying for long-term use.

What it is used for: evidence rated

Option	Evidence	What the research shows
Hot flashes (hot flushes)	Weak evidence	A Cochrane review of 16 trials found black cohosh no better than placebo for hot flush frequency; some Remifemin data look more positive.^2,5
Overall menopause symptoms	Weak evidence	Pooled symptom scores did not differ from placebo, and hormone therapy worked better.²
Night sweats	Weak evidence	A 351-woman trial of black cohosh found no improvement in night sweats compared with placebo.³
"No risk" to breast and uterine tissue	Weak evidence	This is a brand claim; the EU monograph says an effect on hormone-sensitive tumors cannot be excluded.^1,4

Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.