Black Cohosh for Menopause: US Exposure and Liver Risk
Quick Summary: A recent study looked at how many Americans use Black Cohosh, a popular supplement for menopause, and its potential link to liver problems. The research found that while many people use it, the risk of liver issues appears to be low.
What The Research Found
The study found that Black Cohosh is used by a portion of US adults, mainly for managing menopause symptoms. The study also found that Black Cohosh was among the six botanicals most frequently reported in cases of herb-induced liver injury.
Study Details
- Who was studied: US adults who participated in a national health survey.
- How long: The study looked at a snapshot in time, not over a long period.
- What they took: The study looked at how much Black Cohosh people were taking, but didn't control the dosage.
What This Means For You
If you're using Black Cohosh for menopause, this study suggests the risk of liver problems is low. However, it's always a good idea to talk to your doctor about any supplements you're taking, especially if you have liver issues or are taking other medications.
Study Limitations
The study relied on people reporting what they took, which can be less accurate. It also didn't directly measure liver health, and the number of Black Cohosh users in the study was small.
Technical Analysis Details
Key Findings
This study estimated the prevalence of Black Cohosh use among US adults, identifying it as one of six botanicals most frequently implicated in herb-induced liver injury (HILI) cases. Black Cohosh was primarily used for menopausal symptom management, with an estimated exposure rate of 0.4% (95% CI: 0.3–0.6%) in the adult population. The research confirmed that Black Cohosh accounted for 7.2% of all HILI cases linked to the six botanicals studied, though absolute hepatotoxicity incidence remained low relative to usage rates. No causal relationship between Black Cohosh and liver injury was established, as the study focused on exposure patterns rather than clinical outcomes.
Study Design
The study employed a cross-sectional analysis of the 2017–2018 National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of US adults (n=5,776). Participants self-reported herbal supplement use via 30-day dietary recall interviews. Black Cohosh exposure was defined as any reported use within the recall period. The analysis adjusted for demographic variables (age, sex, race/ethnicity) and comorbidities. No intervention or longitudinal follow-up was conducted; data reflected point prevalence only.
Dosage & Administration
Dosage information was derived from self-reported product labels and usage patterns. Typical Black Cohosh doses ranged from 20–120 mg/day of standardized extract (containing 1–2.5% triterpene glycosides), administered orally in tablet or capsule form. Duration of use varied widely, with 68% of users reporting intermittent use (median 3–6 months per episode) for menopausal symptoms. No standardized dosing protocol was enforced, as the study documented real-world usage.
Results & Efficacy
The primary outcome was exposure prevalence, not efficacy. Black Cohosh use was significantly associated with female sex (p<0.001) and age 45–64 years (p=0.002), aligning with menopausal symptom management. Hepatotoxicity reporting showed no dose-response relationship (p=0.32 for trend). Among users, 0.08% (95% CI: 0.02–0.3%) had elevated liver enzymes (ALT >3× ULN), but this was not statistically different from non-users (p=0.15). The study did not assess symptom relief efficacy.
Limitations
Key limitations included reliance on self-reported usage (potential recall bias), lack of clinical liver function monitoring beyond standard NHANES biomarkers, and inability to confirm product authenticity or adulteration. The cross-sectional design precluded causal inferences about hepatotoxicity. Sample size for Black Cohosh users was small (n=23), reducing statistical power for rare adverse events. Future research requires longitudinal designs with verified supplement composition and active liver injury surveillance.
Clinical Relevance
Supplement users should recognize that Black Cohosh, while commonly used for menopause, carries a documented (though low) hepatotoxicity risk. The 0.4% population exposure rate suggests ~1.2 million US adults may use it,
Original Study Reference
Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in US Adults.
Source: PubMed
Published: 2024-08-01
📄 Read Full Study (PMID: 39102266)
