What does the research say about black cohosh, red clover and dong quai? In short: black cohosh has the most studies and mixed results, red clover's results are inconsistent, and dong quai has barely been studied. In careful placebo-controlled trials, none of the three reliably reduced hot flashes more than a placebo did, and black cohosh carries a rare liver-safety signal. So expectations should stay modest, and a talk with your clinician comes first.
Below is a herb-by-herb summary of the trials, the safety notes that matter, and how these three botanicals appear in our own formula, Meno Balance+™.
Key takeaways
- Black cohosh has the most research of the three, and the results are mixed.
- In a year-long NIH-funded trial, black cohosh and a multi-botanical formula did no better than placebo for hot flashes and night sweats.
- Red clover supplies isoflavones, and trials of red clover extracts on hot flashes have had inconsistent results.
- Very little research has been done on dong quai, and it may interact with the blood thinner warfarin.
- Meno Balance+ contains all three herbs inside a proprietary blend, so its label warnings matter more than any single study.
Black cohosh, red clover and dong quai at a glance
The three herbs are often sold together, but each has its own research record.
| Herb | What it is | What the research shows | Safety note |
|---|---|---|---|
| Black cohosh | North American root | Most studied; the largest trials found no clear edge over placebo for hot flashes | Rare liver injury reports |
| Red clover | Flower rich in isoflavones | Inconsistent results for hot flashes | May be unsafe in pregnancy or breastfeeding |
| Dong quai | Root used in traditional Chinese herbal practice | Very little research; one trial found no benefit over placebo | May interact with warfarin |
What does the research say about black cohosh?
Black cohosh has the most research of the three, and the results are mixed. A 2012 Cochrane review pooled 16 randomized trials with 2,027 participants and found no significant difference between black cohosh and placebo in how often hot flushes happened or in overall menopause symptom scores. The authors called the evidence insufficient to support its use for menopause symptoms.
In a year-long NIH-funded trial, black cohosh and a multi-botanical formula did no better than placebo for hot flashes and night sweats. That study, known as HALT, followed 351 participants and compared black cohosh alone, a ten-ingredient botanical blend containing black cohosh, the same blend plus soy diet counseling, hormone therapy and placebo. Only hormone therapy clearly reduced symptoms.
The picture is not entirely negative. The National Center for Complementary and Integrative Health (NCCIH) notes that a 2023 review found black cohosh products potentially helpful for overall menopause symptoms, though not for anxiety or low mood.
Black cohosh and liver safety
NCCIH reports rare cases of liver damage, some serious, in people taking black cohosh products. It is uncertain whether the herb itself was responsible, and some products tested have contained the wrong plant or unlisted ingredients. That is one reason batch testing matters. NCCIH also says it is uncertain whether black cohosh is safe for people who have had hormone-sensitive conditions such as breast or uterine cancer.
What does the research say about red clover?
Red clover supplies isoflavones, and trials of red clover extracts on hot flashes have had inconsistent results. Isoflavones are phytoestrogens, plant compounds with a structure similar enough to estrogen that they can interact with estrogen receptors, which is why red clover is studied for this life stage.
- The big review: a 2013 Cochrane review of 43 trials of phytoestrogen foods and supplements found no conclusive evidence that they reduce the frequency or severity of hot flushes. When five trials of one standardized red clover extract were pooled, there was no significant difference from placebo.
- The head-to-head trial: a 12-month trial comparing black cohosh, red clover, hormone therapy and placebo found that neither botanical reduced hot flashes and night sweats significantly more than placebo. Both standardized extracts were well tolerated over the year.
- Safety: NCCIH says red clover extracts have been used in studies for as long as two years with apparent safety, but they may be unsafe during pregnancy or breastfeeding, and the long-term safety of phytoestrogens has not been established.
What does the research say about dong quai?
Very little research has been done on dong quai, and it may interact with the blood thinner warfarin. NCCIH says too little research exists to draw conclusions about its effects on menopause symptoms.
The best-known trial, published in 1997, gave 71 participants dong quai or placebo for 24 weeks. Used alone, dong quai produced no estrogen-like changes in the uterine lining and was no more helpful than placebo for hot flashes.
Why do studies of menopause herbs disagree?
Headlines call each of these herbs both "proven" and "useless." Four things explain the gap:
- Different products. Extracts vary by species, plant part and standardization.
- A strong placebo effect. In the 12-month red clover and black cohosh trial, hot flashes fell by 63% in the placebo group. Any supplement has to beat that, not zero.
- Short or small trials. Many studies are small or short, so chance findings are common.
- Combination formulas. Few multi-herb combinations have been tested as a whole.
Professional bodies have weighed all of this. The North American Menopause Society's 2023 position statement on nonhormone therapies does not recommend supplements or herbal remedies for hot flashes, based on the evidence available, and it names hormone therapy as the most effective option for those symptoms.
How these herbs appear in Meno Balance+
Meno Balance+ contains all three herbs inside a proprietary blend, so its label warnings matter more than any single study. Black cohosh extract, red clover extract and dong quai sit in the Proprietary Balance Blend (600 mg per 3-capsule serving), alongside turmeric extract, DIM (diindolylmethane) and wild yam extract. Blend totals are on the label; the amounts inside each blend are not. The black cohosh on our label is listed as Cimicifuga foetida root extract, a species related to the one used in most of the trials above.
The rest of the formula adds vitamins D, E and B6, a 7 billion CFU probiotic with a prebiotic blend, and two more botanical blends (Mood and Enhance). The serving is three delayed-release capsules taken 20 to 30 minutes before a meal. Meno Balance+ is formulated to support hormonal balance and female health, digestive and gut health, and energy and mental clarity.* It does not replace care for hot flashes or any other symptom your clinician is managing.
Meno Balance+ is third-party tested, every batch, for purity and potency, and manufactured in USA with globally sourced materials in an NSF-certified, GMP-certified, FDA-registered facility. You can read how that testing works on our standards page.
Who should not use these herbs
The Meno Balance+ label states it plainly:
Warning: Meno Balance+ contains DHEA (dehydroepiandrosterone), a hormone precursor, together with black cohosh, red clover, dong quai, wild yam and chaste berry — all hormone-active botanicals. Talk with your healthcare provider before starting Meno Balance+, and do not use it if you are pregnant or nursing, if you have or have had a hormone-sensitive condition such as breast, uterine or ovarian cancer or endometriosis, or if you take hormone therapy, tamoxifen, or a blood thinner. Black cohosh has also been associated with liver problems in rare cases; stop use and contact your provider if you notice symptoms such as unusual fatigue, abdominal pain, dark urine or yellowing of the skin or eyes.
The same cautions apply to any of these herbs bought on their own.
Frequently asked questions about black cohosh, red clover and dong quai
Is black cohosh safe to take long term?
Most trials lasted from a few months to a year, so long-term safety is not well established. Rare liver injury has been reported, and NCCIH advises stopping and contacting a provider if you notice symptoms such as dark urine or unusual fatigue.
Does red clover act like estrogen in the body?
Red clover's isoflavones can bind to estrogen receptors, which is why they are called phytoestrogens. Because of that activity, anyone with a hormone-sensitive condition should not use red clover without medical advice.
Can I take dong quai if I use a blood thinner?
No, not without your prescriber's approval. NCCIH notes dong quai may interact with warfarin, and the Meno Balance+ label says not to use the formula if you take a blood thinner.
Why would a formula include herbs with mixed evidence?
These herbs have long traditional use, and some studies suggest possible benefits even though the strongest trials have not confirmed them. A blend also combines them with nutrients and other botanicals. We describe what a formula is designed to support rather than promising a result, and we print the safety warnings in full.
How long should I try a botanical formula before deciding?
The trials above ran from about six months to a year. A practical approach is to agree on a goal with your clinician, use the product as the label directs, and review how you feel after a set period. Our guide on how long menopause supplements take to work covers that timeline.
Related reading from our Wellness Hub
- Perimenopause vs. Menopause: What's the Difference?
- Menopause Supplement Ingredients: Inside the Meno Balance+ Label
- How to Read a Supplement Certificate of Analysis (COA)
Sources
- NCCIH: Black Cohosh
- NCCIH: Red Clover
- NCCIH: Menopausal Symptoms and Complementary Health Approaches
- NIH Office of Dietary Supplements: Black Cohosh Fact Sheet
- Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012.
- Newton KM et al. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo. Ann Intern Med. 2006.
- Geller SE et al. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms. Menopause. 2009.
- Lethaby A et al. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Syst Rev. 2013.
- Hirata JD et al. Does dong quai have estrogenic effects in postmenopausal women? Fertil Steril. 1997.
- The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023.
Individual results vary.
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
