The Natural Connection

All things from eternity are of like forms and come round in a circle. (Marcus Aurelius, Roman emperor 121-180 AD). 

When I began my medical practice in South Georgia nearly a decade ago, I encountered a number of elderly women, who despite advanced age, had nary a wrinkle on their face and had never had a hot flash. I was surprised to find out that often they had never taken hormone replacements either, and I asked them their secret. 

That’s how I first heard about Lydia Estes Pinkham, the successful American businesswoman who produced and sold her patent medicine “Lydia E. Pinkham’s Vegetable Compound” in the late 1800’s. First marketed in 1875, the elixir was touted as a “positive cure for all those painful Complaints and Weaknesses so common to our best female population”. The medicine was sold in some form, either liquid or tablets, for nearly a hundred years, and many of my patients are living testimony to the herbal wizardry of Mrs. Pinkham. 

Originally, Lydia compounded her medicine from herbs grown on her Massachusetts farm, including gentian, black cohosh, unicorn root, dandelion, chamomile, licorice, fenugreek, and others. For good measure, she also added a hefty amount of alcohol, 36 proof, which she said was needed as a “solvent and a preservative”. The Pinkham medicine was often the only way for respectable women to partake of alcohol, and the product enjoyed its greatest success during the time of Prohibition. 

With the help of constant advertising and massive sales to satisfied customers, Lydia’s herbal tonic empire grew. At the time of her death in 1883, she was described as “the most famous woman of the nineteenth century, aside from Queen Victoria”. Her Vegetable Compound made the family fortune, grossing $3.8 million by 1925. The family-owned business went into decline in the mid 1900’s, as prescription medications became more widely available, and was finally sold in 1968. In addition, the passage of the Pure Food and Drug Act made it difficult for patent medicines based on herbal compounds to remain on the market. 

Today, more than 50 million women are in the menopause age group, and they face the same mid-life discomforts as their 19th century great-grandmothers did. But although physicians widely recommend hormone replacement therapy (HRT) for women for complaints such as hot flashes, only 10%-20% of menopausal women take it. Less than half of women who receive a prescription for HRT ever get it filled, and fewer than 40% of those are still taking it a year later. 

For a variety of reasons, many women are again looking towards herbal compounds to help manage the symptoms of their natural life transition. One of Lydia Pinkham’s key ingredients, black cohosh, has become of particular interest to patients and physicians in recent years. 

Black cohosh is a plant in the buttercup family grown in the woodlands of Canada and Eastern United States. Native Americans brewed the root of black cohosh as a tea for female complaints, earning it the nicknames of “squawroot” and “black snakeroot”. It has been widely available in Europe for decades. One formulation called Remifemin, is the most commonly recommended therapy for menopausal symptom relief in Germany, and is now available in this country. The usual dose is two tablets twice a day.  

Black cohosh seems to be very effective in managing some of the physical and psychological discomforts that can occur with menopause. In a German study involving 629 women, black cohosh improved symptoms such as hot flashes, headaches, heart palpitations, and anxiety in more than 80% of patients within eight weeks. Another well-designed study found black cohosh to be actually superior to estrogen in controlling hot flashes and vaginal dryness. The herb has almost no side effects, other than occasional stomach upset. It should not be used by pregnant women. 

While black cohosh is not truly an estrogen, it may have mild estrogenic properties. This has created controversy in some scientific circles as to whether it can safely be used in patients who have contraindications to hormone replacement, such as breast cancer patients. In Europe, however, where it has been used for over thirty years, there has not been an increase in breast cancer associated with the use of the herb.

 The NIH recently awarded the University of Chicago a $7.9 million grant to study the effectiveness of black cohosh, along with nine other popular herbs. Menopausal women and their doctors can look forward to hearing more about non-toxic, well tolerated herbal therapies to assist women through the change of life over the next few years.  

Lydia Pinkham lies in peace buried in the small Pine Grove Cemetery of Lynn, Massachusetts, the town where she was born. I like to think that she is looking down now from the heavens, smiling at all of us and wondering what all this fuss is about herbs. 

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©2000-2003 Pauline M. Bellecci, MD