Rhubarb. Photo: Jbatt. Agency: Dreamstime.com

Several recent studies indicate that an extract of a specific form of rhubarb are highly effective in improving menopausal symptoms.

A standardized extract of the root of Rheum rhaponticum (Rhapontic or Sibiric rhubarb), known as ERr 731, has been used widely in Germany since 1993, for treating menopause symptoms. This species does not contain anthraquinone galactosides, which give other speces of rhubarb their laxative effects. ERr 731 is available as Phytoestrol N, made by the Mueller-Goeppingen pharmaceutical company, Germany (www.mueller-goeppingen.de).

Researchers at the University of Frankfurt undertook an observational study of 363 symptomatic menopausal women, who took 1 ERr tablet (4 mg R. rhaponticum extract) daily for 6 months. They used the Menopause Rating Scale (MRS) to evaluate symptoms, and a change in the MRS was the primary outcome measure.

A total of 252 women seen at 70 gynecology practices completed the study. There was a significant decrease in the total MRS score from an average of 14.7 points at baseline to 6.9 points at the end of the 6 months of rhubarb treatment (P < .0001). This was a very substantial decrease of 7.8 points.

The most pronounced improvement was within the first 3 months of treatment, and in women who were the most symptomatic at baseline (those who had MRS scores > 18 points). Symptom improvement was greatest for hot flashes, irritability, sleep problems, depressive mood, and physical/mental exhaustion (Kaszkin-Bettag M, et al. Altern Ther Health Med. 2008; 14(6): 32–38).

These encouraging findings prompted a just-published controlled study of ERr 731, in which 112 women were randomized to daily treatment with the rhubarb extract or placebo for 12 weeks.

Those taking ERr 731 showed a highly significant reduction of MRS total score, from 27.0 points to 12.4 points. In contrast, the placebo group showed a far smaller decrease, from 27 to 24 points (P < .0001). The rhubarb extract also produced significant reductions in the hot flush weekly weighted score, while the placebo did not (Kaszkin-Bettag M, et al. Altern Ther Health Med. 2009; 15(1): 24–34).

Five women in the rhubarb group reported a total of 11 minor adverse effects, versus 3 placebo-treated women reporting 3 AE’s. Overall, ERr 731 was well tolerated by the majority of patients, and clearly effective in reducing symptoms.

The Frankfurt studies echo an earlier trial involving 109 women randomized to placebo or 250 mg ERr 731 daily for 12 weeks. The MRS II composite score and each specific symptom score decreased significantly in the rhubarb extract group compared to the placebo group (P < .0001). The overall quality of life score was also significantly better in the treatment group compared with placebo. There were no adverse events associated with the rhubarb extract (Heger M, et al. Menopause. 2006; 13(5): 744–759).

We now have three solid studies demonstrating that this standardized extract of R. rhaponticum is an effective treatment for common menopause symptoms. I look forward to incorporating ERr 731 into my practice.

Maca: Manly, Yes, But Women Like It Too

Maca, a tuberous root vegetable grown in the high Andes mountains, and widely promoted for enhancing male vitality and sexual health, also has benefits for post-menopausal women, according to a recent placebo-controlled study.

This double-blind crossover trial involved 14 post-menopausal women who took 3.5 gm of powdered Maca (Lepidium meyenii) for 6 weeks and then a matching placebo for 6 more weeks. The investigators at the University of Victoria, St. Albans, Australia, measured estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and sex hormone binding globulin (SHBG) at baseline, and weeks 6 and 12. They also assessed severity of menopausal symptoms using the Greene Climacteric Scale (GCS).

There were no differences in serum concentrations of estradiol, FSH, LH and SHBG following either the maca treatment period or the placebo period. However, the GCS scores revealed a significant reduction in psychological symptoms including anxiety, depression and sexual dysfunction after maca consumption compared with baseline and placebo.

These findings were independent of any androgenic or alpha-estrogenic effects of maca, based on assays to measure hormone-dependent activity (Brooks N, et al. Menopause. 2008; 15(6): 1157–1162).

This new study adds to the growing body of evidence supporting the use of maca for menopause-related symptoms. Anything that has significant effects on menopause-related anxiety and depression is welcome, and many women will be pleased to know of this herb’s significant reduction in sexual dysfunction.

It is interesting that the effects observed in this study appear to be independent of any measurable influence on sex hormones or SHBG, and presumably, independent of any action related to the beta-sitosterol found in the maca root.

These findings diverge somewhat from those reported by Meissner et al., who found an elevation in LH and estradiol and a decrease in FSH in women taking maca daily (Meissner H, et al. Int J Biomed Sci. 2005; 1: 33–45). However, Meissner and colleagues were using a slightly different type of maca (L. peruvianum, not L. meyenii), and in a gelatinized preparation rather than as a powder.

The variation in findings between the studies may also be due to differences in dosing, extraction protocols and delivery techniques.

The observed positive effects on depression and anxiety are consistent in several other studies, and some researchers have suggested that the flavonoids in maca inhibit monoamine oxidase activity, which could account for the benefits. The improvement in sexual function in postmenopausal women observed in this study is consistent with research on maca use in men.