27 Sep 2011

Menopause and complementary medicines

By Chemist+Druggist

What advice could you offer a patient wanting to manage her menopause symptoms with herbal remedies, vitamins or minerals

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Amanda Kemp, Non healthcare professional

Posted on 16 October 2011.

Although there is some evidence that Black Cohosh may alleviate some of the vasomotor symptoms, I wish to alert readers to the potential hepatotoxic effects of this herbal remedy.

In July 2006 the MHRA published a report from the Herbal Medicines Advisory Committee and the Commission on Human Medicines which warned of rare but serious liver disorders associated with its use. As of March 2006, 31 yellow cards relating to Black Cohosh had been received by the MHRA, 21 of these suggesting associations with adverse liver reactions. Of these, 14 cases seem to support an association with adverse liver reactions including cases of hepatitis, increased LFTs and jaundice. The MHRA considers it important to inform users of Black Cohosh of this potential risk and advised that warnings regarding rare adverse reactions in the liver should be added to the product information for black cohosh for both licensed and unlicensed products, as is currently the case in Germany and Australia.

Indeed a relative of mine experienced raised LFTs after being recommended Black Cohosh by her GP when she stopped HRT. This was picked up by a routine blood test after only a few months of use and her LFTs appear to be returning to normal after stopping it.

Therefore I urge pharmacists to ensure they are aware of potential side effects when recommending herbal remedies, as they would with any licenced medicine. Interestingly, Leicester School of Pharmacy are doing some research into the different species in the genus as they believe that the hepatotoxic effects are not caused by all species.
references;
UK public assessment report –Black Cohosh. MHRA 31st July 2006

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Niall Hunt, Other healthcare professional

Posted on 28 October 2011.

In June this year there was the first published clinical study to show efficacy of a sage mono-preparation (produced by Bioforce) in relieving both hot flushes and symptoms associated with menopause.

The data supports sage’s traditionally accredited value in treating climacteric complaints in general and especially hot flushes.

Bommer S, Klein P, Suter A. First time proof of sage's tolerability and efficacy in menopausal women with hot flushes. Adv Ther. 2011 Jun;28(6):490-500.
doi: 10.1007/s12325-011-0027-z. Epub 2011 May 16.

Comment on behalf of
Eoghan O’Brien
Bannside Pharmacy

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