Black cohosh A woman's herb comes of age

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Many women are plagued by menstrual cramps, premenstrual syndrome, or hot flashes at some point during their lifetimes. Now they can take a tip from European women, who are increasingly turning to one herb more than any other for relief from these discomforts. Known as black cohosh, the herb has been used by more than one-and-a-half million German women, according to one manufacturer of a black cohosh supplement. And the German Commission E, a government-sponsored panel that evaluates herbal therapies, has given black cohosh its stamp of approval, recommending it for treating PMS, painful menstruation, and menopausal problems.

Some predict that black cohosh (Cimicifuga racemosa) will soon become as popular in the United States as it is in Europe. That would bring history full circle, ­because black cohosh was known in North America long before Europeans dis­covered it.

Taking a cue from Native Americans

At the turn of the century, U.S. medical doctors were of three general persuasions: They prescribed drugs, homeopathic remedies, or herbs. Allopaths used substances such as mercury; homeopaths preferred preparations made with highly diluted herbs and minerals.

The herbally oriented doctors were called the Eclectics, who learned about herbs through interactions with their patients. They observed reactions, both good and bad, of botanical medicines that had been used by Native Americans, including black cohosh, echinacea, wild indigo, osha, cramp bark, snakeroot, lobelia, and pokeroot. The Eclectics, taking their cue from Native Americans, prescribed black cohosh to treat “female complaints”, including menstrual problems, hormonal imbalances, fibroid cysts, and false and true labor pains. They also recommended the herb to calm the nervous system, reduce pain after labor, or relieve painful, late menstrual periods. They combined it with cramp bark to ease menstrual cramps, and used it alone to treat neuralgia, rheumatism, arthritis, and headaches.

After the 1930s, pharmaceuticals replaced herbal remedies as the treatment of choice in the United States, but the experience of the Eclectic physicians wasn’t lost. Their knowledge of many Native American herbs made its way to Europe, where German researchers, aware of the clinical effectiveness of some of these remedies, began looking for marketable drugs among them.

Today, black cohosh remains on a European short list of proven remedies for “women’s conditions”. Thanks to the body of evidence that has accumulated during the past century, we now understand much more about the symptoms and syndromes for which black cohosh is proving beneficial and safe. This includes knowledge about its proper dose, the length of time it should be used, and other therapeutic aspects.