Some women have chosen herbal remedies to relieve menopause symptoms over concerns about health risks associated with hormone replacement therapy (HRT). One of the herbs used is black cohosh.

After reviewing all the data on black cohosh, used by women to relieve menopausal symptoms of hot flashes, insomnia, excessive sweating, palpitations, headaches, poor sleep, depression, and irritability, Britain's Medicines and Healthcare Regulatory Agency (MHRA) has decided to require black cohosh products come with a warning about the potential for liver damage.

While liver damage is rare, the agency wants women to be aware of the possibility and be mindful of the symptoms of liver damage. Symptoms of liver problems include pain on the right side of the stomach just below the ribs, unexplained nausea, flu-like symptoms, dark urine and yellowing of eyes or skin.

According to the news report, black cohosh has been used for many years in Europe and North America and gained popularity after a highly publicized study found HRT raised the risk of heart attack, stroke and breast cancer.

The Office of Dietary Supplements black cohosh fact sheet states that black cohosh is sold as a dietary supplement, and dietary supplements are regulated as foods -- not drugs. Manufacturers do not have to provide the Food and Drug Administration (FDA) with evidence that dietary supplements are effective or safe before marketing. They indicate there is one published case of a 47-year-old woman who used black cohosh for symptoms of menopause and required a liver transplant three weeks after she started taking the herb -- and that liver damage has been reported in a few other cases, but add in the fact sheet that millions of women have taken the herb without apparent adverse health effects.

Because it does have an estrogen effect, women with breast cancer are advised to avoid the herb until more studies are done to determine the safety of black cohosh for women with breast cancer suffering symptoms of menopause.