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COMMON over-the-counter herbal remedies used by hundreds of women to relieve symptoms of menopause have been linked to at least four cases of liver failure requiring transplants.
In the latest case, an Adelaide woman has undergone a second transplant following complications with the first.
South Australian Liver Transplant Unit director Dr John Chen this week urged women using the herb – black cohosh – to see their GP for a liver test.
The herb is an ingredient in a range of remedies available without prescription in supermarkets, health food shops and pharmacies.
More than 200 products containing black cohosh are listed in the Australian Register of Therapeutic Goods.
While it is successful in relieving symptoms of menopause, medical literature has documented more than 49 cases of severe liver disease worldwide linked to the herb, including nine in Australia.
Three documented cases resulted in the sudden need for a transplant in women in Queensland, Victoria and Utah in the US.
Mrs Marie Furler, 52, of Athelstone, will be the fourth once her case is written up and published.
She was a fit, healthy woman who worked as a nurse and enjoyed fishing and life with her husband Glen, and children Samuel and Jeannie.
But she suddenly became so tired she could barely stay awake, and after she began turning noticeably yellow a test showed her liver enzymes were "sky high".
She was sent to Flinders Medical Centre and within days was on the transplant list as her inflamed liver was on the verge of failure.
She had been taking the German-made herbal remedy Remifemin, which contains black cohosh. Doctors blame the herb for causing her liver to fail.
"I had been taking it formenopause for about three years and it really worked," Mrs Furler said.
"I was only taking one tablet a day but the packet said you could take up to four tablets a day.
"If you can buy it in a supermarket you assume it is safe."
The Therapeutic Goods Administration last year ruled there was "sufficient evidence of a causal association between black cohosh and serious hepatitis".
It went on to note: "However, considering the widespread use of black cohosh, the incidence of liver reaction appears to be very low."
The TGA ruled that products with the herb should carry the alert: "Warning: Black cohosh may harm the liver in some individuals. Use under the supervision of a healthcare professional."
However, Mrs Furler said few people would bother to read the fine print on an over-the-counter product.
Her first liver transplant initially was a success but chronic rejection saw her need a second transplant.
Recovering in hospital, she was full of praise for FMC staff, describing them as "miracle workers".
"Everyone from the doctors, nurses, radiographers, Libby the transplant co-ordinator, through to all other staff have been absolutely terrific, and I can't thank them enough for their care," she said.
"I am also eternally grateful to the families of the people who agreed to allow the organ donation."
Dr Chen said black cohosh was responsible for Mrs Furler's initial liver failure.
"Every year in Australia there are severe problems with herbal remedies so it is quite important to get this information to the public," he said.
"Women who have been on herbal products containing black cohosh should go to the GP for a liver function test, it is a simple blood test.
"They should be extremely careful, herbal treatments can be extremely dangerous."
Remifemin is imported from its German maker Schaper & Brummer by Queensland company SciNat Australia, whose company spokesman Carl Thompson flatly rejected any link. "The doctors are completely wrong – there is absolutely no scientific evidence to say black cohosh causes liver problems," he said.
"Remifemin has been used around the world since 1951 and we have very detailed scientific advice from Schaper & Brummer that black cohosh has not caused any problems.
"Schaper & Brummer have looked at cases where black cohosh was supposed to be responsible for problems and found the patients already had pre-existing conditions."
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