Black Cohosh & Liver Disease

Black cohosh is used to treat symptoms of menopause such as mood swings and hot flashes. It's approved in Germany for this use and also for painful menstruation and premenstrual discomfort. Rare reports of liver damage associated with this herb have raised concern. Always consult a health care professional before trying a new supplement.

Regulation

Black cohosh is sold as a dietary supplement in the United States, so is regulated as a food rather than a drug. Manufacturers don't have to provide the U.S. Food and Drug Administration with evidence that dietary supplements are safe or effective before selling them.

Reports

There are reports of liver damage in a few people taking black cohosh, according to the U.S. Office of Dietary Supplements, or ODS. For example, in one published case a 47-year-old woman using black cohosh to treat menopause symptoms developed acute hepatitis. Three weeks after she started taking black cohosh she received a liver transplant. No other cause for the woman's liver disease was found, according to ODS. As of May 2007, 47 cases involving liver reactions were reported worldwide.

Evidence

In the reported cases of liver toxicity, a direct association with taking black cohosh hasn't been conclusively demonstrated, according to the experts at University of Maryland Medical Center, or UMMC. No studies of black cohosh have provided scientific evidence that establish this herb actually causes liver damage, according to ODS, and millions of people have used black cohosh without this apparent adverse health effect.

Expert Insight

The medical experts at UMMC advise that you should avoid using black cohosh if you drink excessive quantities of alcohol or have liver damage. One country, Australia, requires a warning on products that contain black cohosh that states it may cause harm to your liver and shouldn't be used unless you have medical supervision. The country's Therapeutic Goods Administration advises that there appears to be an association between liver damage and using black cohosh, but that it is extremely rare. Black cohosh also may raise your risk of liver damage if it's taken along with other supplements that can cause hepatoxicity or destructive effects to your liver. These include borage, uva ursi, bishop's weed and chaparral, according to "The Essential Herb-Drug-Vitamin Interaction Guide," by George T. Grossberg and Barry Fox.