Black Cohosh-Induced Abdominal Pain: Sometimes More Than Just a Supplement
Bibliographic record
Abstract
Introduction: Black cohosh, Cimicifuga racemosa, is a North American plant. Extracts of the plants have been used for treatment of symptoms associated with menopause. Although adverse effects of black cohosh are mild and usually reversible, a few severe side effects including hepatic, cardiac and musculoskeletal have been documented but without a clear causal relationship. We report a case of black cohosh-induced abdominal pain. Case: 48 year-old female with past medical history significant for hypertension, anxiety, and uterine fibroids was referred to gastroenterology clinic for evaluation of abdominal pain going on for almost 3 months. The pain was located in the hypogastric area with no radiation, intermittent, and crampy in nature. Patient denied nausea, vomiting, constipation, diarrhea, hematemesis, melena, hematochezia, or weight loss. Abdominal cramps got worse during bowel movements. Upon examination her vitals were stable. Her examination was normal including gastrointestinal exam showing soft, non-tender, non-distended, normal bowel sounds with no organomegaly. Her routine labs and CT scan of the abdomen ordered by her PCP was unremarkable except for diverticulosis. She had a pelvic ultrasound which showed two small fibroids and was thought not be causing her abdominal pain. Upon further history, she recently started an OTC menopausal product (black cohosh) for hot flushes and sleep disturbances and her symptoms started 3 weeks after starting black cohosh. She stopped taking it and noticed improvement in her symptoms of abdominal cramps. Discussion: Black cohosh was traditionally used by Native Americans of Canada and the eastern United States to treat malaria, impaired kidney function, sore throat, rheumatism, menstrual irregularities, and pain during childbirth. Recently, there has been interest in its use in the treatment of menopausal symptoms. The exact mechanism by which it exerts its action is unknown. The most common side effects are mild and reversible, such as headache, nausea, vomiting, and abdominal pain. There have been case reports mentioning severe side effects, including fulminant hepatic failure, bradycardia with heart block, and myopathy. However, causal association could not be established in these cases. This case demonstrates the need to perform a thorough history of all OTC supplements patients ingest since some may be harmful and mistaken for other diagnoses.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".