‘Menopause herb alert' – unsubstantiated claims

Why suddenly scapegoat black cohosh?
Because it is a safe and effective alternative to HRT (hormonal replacement therapy) for menopausal symptoms.
·    Black cohosh has been administered to about 2,600 patients in case reports, drug-monitoring trials and randomised clinical studies during the last 40 years.
·    In the last two decades clinical research activities of this black cohosh have concentrated on the relief of hot flushes and emotional symptoms associated with menopause.
·    In a review of eight human studies on the effectiveness of an extract of black cohosh for alleviating menopausal symptoms, it appears to be a safe, effective alternative to oestrogen replacement therapy for those patients in whom oestrogen replacement therapy is either refused or contraindicated.
A detailed and fully referenced report of the safety and efficacy of black cohosh is available from the NHAA.
Menopause herb (black cohosh) safe and effective
A report by Brisbane gastroenterologists this week in the Medical Journal of Australia, attributing a case of hepatotoxicity to the herb Black Cohosh presents unnecessary hysteria around alternative therapies without addressing some fundamental information.

The authors supply no details regarding verification of the herbal ingredients. Failing to authenticate the plant preparations or review their quality and dosage means that any conclusion is subject to doubt. No information about plant part used, solvent, concentration, type of manufacturing or chemical analysis is supplied. The debate over the potential toxicity of herbal products would be advanced and clarified if importance were placed on establishing identity and purity of the plant material as a prerequisite.

Secondly, and of potentially great significance, is the fact that no information is supplied about the woman's past or present medical history, concurrent use of medical or recreational drugs, lifestyle, dietary intake and other factors, which may have influenced her health status.

No attempt was made by the authors to investigate the adverse reaction in detail. The authors state that "all the biopsies were typical of acute hepatitis such as is seen in severe viral hepatitis. These changes are typically found in severe immunological reactions and are not the changes of direct toxic injury." In other words, therefore, it is entirely possible that the reaction was not the result of direct toxicity but of some, possibly immunological, reaction. Without further pathological and biochemical investigation into the specific reaction, no conclusion can be made as to the exact mechanism causing the acute hepatitis.

Finally, to date, a large body of clinical evidence and research has been accumulated in regard to Black Cohosh and there has been no suggestion to date that the herb is hepatotoxic. Neither have any of the individual compounds been found to be hepatotoxic.

The public has an absolute right to be informed if any medicines used are a potential risk, but without careful examination of the evidence, such reporting equates to little more than scaremongering. Herbal medicines have a long history of safe and effective use and professionals in the field recognize the need for research and controls. It is a little too convenient to blame an event on a herbal remedy without the full factual background - especially given that the recent HRT scare has led many women to seek alternatives. These alternatives must of course be safe, but as stated, there is no solid evidence to suggest that Black Cohosh is unsafe.

The National Herbalists Association of Australia (NHAA) represents the practitioners of herbal medicine such as herbalists and naturopaths. The NHAA supports full disclosure of ingredients and tighter control of herbal medicine manufacturing. The association furthermore supports greater medical training as well as government registration of herbalists.
ENDS

CONTACTS
National Herbalists Association of Australia Susan Dean, President, PO Box 601, BALLARAT, VIC 3353 Tel (03) 5333 7227 Fax (03) 5332 3142
sdean@netconnect.com.au   

For a detailed and fully referenced report of the safety and efficacy of black cohosh contact:Michael Thomsen Tel: 03 9440 9787mobile: 0438 700 287, michael.thomsen@optushome.com.au

Sources
Initial report, The Age Monday 21 October, 2002-10-23
‘Menopause herb alert'
"Doctors have bee warned about a common herbal menopause treatment known as black cohosh after a woman, 47, needed an urgent liver transplant after suffering acute hepatitis, according to an article in the Medical Journal of Australia.
It is the first time black cohosh, which is freely available and widely used by women in Australia, has been linked to liver damage. The report comes as many women turn to alternative treatments after the hormone replacement therapy scare.
Black cohosh is also an alternative treatment for menopause recommended by the Sydney Menopause Centre at the Royal Hospital for Women.
NSW vice-president of the Australasian Integrative Medicine Association, Dr Ramesh Mocha, said studies had shown black cohosh was effective in treating hot flushes and sweating with few side effects."

Original Report
·    Whiting, PW, Clouston A, Kerlin P (2002) Black cohosh and other herbal remedies associated with acute hepatitis MJA 177: 432-435
·    Avaialable from: http://www.mja.com.au/public/issues/177_08_211002/whi10119_fm.html





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