Autoimmune hepatitis associated with the use of black cohosh: a case study

Menopause. 2004 Sep-Oct;11(5):575-7. doi: 10.1097/01.gme.0000142914.55849.6a.


Herbal remedies generate more than 1.8 billion dollars in annual sales in the United States. Herbal products have been associated with a wide spectrum of hepatic toxicities. With the recent Women's Health Initiative Study demonstrating increased risk of breast cancer and cardiovascular events associated with hormone therapy, many women may resort to herbal remedies for persistent menopause symptoms. We report a case of autoimmune hepatitis likely triggered by the use of black cohosh (Actaea racemosa), an agent marketed to treat menopause symptoms. Given this case report, we recommend close monitoring of women using this herbal preparation.

Publication types

  • Case Reports

MeSH terms

  • Biopsy, Needle
  • Cimicifuga / adverse effects*
  • Complementary Therapies / adverse effects
  • Female
  • Follow-Up Studies
  • Hepatitis, Autoimmune / etiology*
  • Hepatitis, Autoimmune / pathology
  • Hot Flashes / drug therapy
  • Humans
  • Immunohistochemistry
  • Liver Function Tests
  • Middle Aged
  • Monitoring, Physiologic
  • Phytotherapy / adverse effects*
  • Plant Extracts / adverse effects*
  • Plant Extracts / therapeutic use
  • Risk Assessment
  • Severity of Illness Index


  • Plant Extracts