Black cohosh: a cause of abnormal postmenopausal liver function tests

The health scares restricting the use of hormone replacement therapy have made women tend to opt for 'natural' remedies that are generally perceived as safe. Unfortunately, there is lack of definite opinion on the safety of herbal remedies. Black cohosh is commonly used for postmenopausal symptoms. We present two cases of liver toxicity related to this and recommend close monitoring of women on this herbal preparation.