Herbal remedies for menopausal symptoms: are we cautious enough?

To evaluate adverse effects of herbal remedies consumed by menopausal women for control of the climacteric syndrome.

We examined the long term safety and herb-drug interactions of commonly used herbal therapy such as soy, black cohosh, dong quai, ginseng and vitamin E.

Even carefully designed studies on herbal treatments for vasomotor menopausal symptoms never addressed specifically safety issues. Sporadic reports show dangerous adverse effects of these herbal preparations as well as hazardous interactions between botanic compounds and conventional medications.

The unrestricted sale of plant products constitutes a new situation for physicians with little training in phytotherapy. The qualitative and quantitative diversity of the commercially available preparations, the absence of precise prescribing guidelines, and the risk of self-prescribed medication justify the introduction of 'phyto-vigilance'. Physicians should warn their patients about the lack of evidence regarding safety and possible interactions of herbal remedies with concurrent medications.