Ever since the Women's Health Initiative halted a study of hormone replacement therapy in 2002 because of increased risk of breast cancer and heart disease, menopausal women have struggled with what to do about hot flashes. Many have turned to the herbal remedy, black cohosh, despite a lack of definitive evidence that it works.
There's no definitive evidence that it causes any harm, either, although there have been anecdotal reports of liver damage, hepatitis and even one report of the death of a woman as she awaited a liver transplant after taking the remedy.
Now, a committee of the U.S. Pharmacopeia, a nongovernmental organization that sets standards for food ingredients and dietary supplements, has recommended cautionary labeling for black cohosh because of the possibility of liver damage.
Its report, in the recent issue of the journal Menopause, is a change from the organization's 2002 report, which called for no such labeling. An editorial points out that, because of the great variability in the contents of largely unregulated herbal remedies, science will likely have difficulty proving or disproving the danger of black cohosh.
"We must also be willing to state without shame that there is much we don't know about black cohosh," according to the editorial.
The committee also recommends that women consult a physician before using the remedy if they've ever had liver disease, or immediately if they develop symptoms including dark urine, jaundice or abdominal pain after taking it.
-- Susan Brink