The “systematic” review by Nedrow et al1 seems less than reliable. The authors claim that they included all relevant randomized controlled trials and meta-analyses published in English. However, the exclusion of non-English articles seems not very systematic, particularly in areas that are dominated by investigators from non–English-speaking countries. Even accounting for this factor, we fail to understand why the authors only included 4 randomized controlled trials of black cohosh. Our systematic review published in 2002 (not mentioned by Nedrow et al1) already included 4 randomized controlled trials.2 It is now outdated, since several new studies have emerged. To make matters worse, the “Adverse Effects” subsection in the article by Nedrow et al1 is woefully incomplete. Virtually none of the numerous treatments reviewed by Nedrow et al1 is free of adverse effects.3 Yet the authors only mention those of soy, black cohosh, and kava. When Nedrow et al1 conclude that “data are insufficient,” we should perhaps take this with a pinch of salt.
Ernst E, Borrelli F. Alternatives for Menopause. Arch Intern Med. 2007;167(5):515-516. doi:10.1001/archinte.167.5.515-a