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Climacteric. 2010 Apr;13(2):187-91. doi: 10.3109/13697130902939921.

Coagulation activation and fluid retention associated with the use of black cohosh: a case study.

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Department of Transfusion Medicine and Hemostaseology, University Hospital Erlangen, Erlangen, Germany.


Black cohosh is one of the most popular herbal therapies for premenstrual discomfort, hot flushes and other climacteric and menopausal symptoms. Most often, it is tolerated well. However, there are some recent reports on serious adverse events, probably associated with this complementary and alternative herbal medicine. We report a case of coagulation activation, fluid retention and transient autoimmune hepatitis most likely triggered by the use of black cohosh. Diagnostic procedures aimed to explain lower leg edema are not uncommon in the age group of women suffering from climacteric and menopausal symptoms. Therefore, black cohosh-induced fluid retention and coagulation activation should be considered in differential diagnosis, especially if thrombosis has been excluded.

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