A good deal of their interest is centered on black cohosh, the herb Doty found so helpful. A member of the buttercup family, the plant is a perennial that is native to much of North America. Medicinal preparations use its roots and rhizomes, or underground stems.

American Indians used black cohosh to treat a variety of ills, among them gynecological disorders, malaria, constipation and hives. Americans in the 19th century used black cohosh as a home remedy for rheumatism and fever, as a diuretic and to bring on menstruation.

According to the California-based Nutrition Business Journal, sales of black cohosh increased a mind-boggling 1,900 percent from 1997 to 2003, jumping from annual sales of $4 million to more than $59 million. Even so, Richardson and many other health care providers remain uncomfortable prescribing it or any other herb. "My concern is always safety," Richardson says, "and I think there is a widespread misconception that alternative or natural products are safe. They may be, but I don't think we know until they've been studied."

Sauter is well qualified to undertake such a study. Before coming to MU in July 2002, he served as an associate professor of surgery at Thomas Jefferson Medical College in Philadelphia. Previous to this he was an assistant member of the Fox Chase Cancer Center, where he completed a fellowship in surgical oncology. He earned his M.D. in 1986 at Louisiana State University's School of Medicine and a molecular biology doctorate from the University of Pennsylvania in 1998.

Soft-spoken and unfailingly polite, Sauter is skilled at putting those around him at ease. It takes only a few moments with him to discern his motive as an investigator: He cares about his research because he cares about the women his findings could help.

Sauter has spent much of his career working to improve breast cancer diagnostics. His current project springs from a similar urge to improve the lives of his patients, in this case those who are desperate to relieve their menopausal symptoms. "They want something to deal with them, but we are concerned about using estrogen and progesterone after menopause. So the question is, 'Are there any alternatives that are safer?' The most commonly used natural substitute is black cohosh."

While black cohosh shows promise, important questions remain. "The two questions are 'Does it work?' and 'If so, how?' " Sauter says. "If you say it works, but you don't know how it works, your concern is that it's a placebo effect. We want to find out how it works, what's its mechanism of action."