Consider Using Plant-Derived Therapies to Address Menopausal Symptoms

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By Nilima Desai, RD

If you have ever experienced hot flashes, night sweats, etc., due to menopause, you are not alone. About 80% of menopausal women suffer from hot flashes, night sweats, sleep disturbances, depression, anxiety, and vaginal dryness,¹ which can significantly affect their quality of life. Menopause is characterized by a decrease in estrogen levels, which triggers these uncomfortable symptoms. Most women report hot flashes to be the most bothersome symptom and the reason for starting hormone therapy.²

Symptom Relief Options

In addition to lifestyle recommendations, such as following a plant-based diet, increasing physical activity, and minimizing smoking and alcohol intake, the addition of hormone replacement therapy (HRT) has been most effective in reducing vasomotor symptoms (hot flashes, night sweats) commonly associated with decreased estrogen levels.²,³

However, current recommendations from the American Congress of Obstetricians and Gynecologists suggest limiting HRT to the lowest effective dose for the shortest amount of time possible.⁴ As a result, 40-50% of women choose to use practical alternative options, such as plant-derived therapies to address menopause-related symptoms.³ Various plant-derived therapies including phytoestrogens such as isoflavones, lignans, and other Chinese and herbal remedies such as ginseng, black cohosh, etc., have been studied for the relief of menopausal symptoms.

Plant-Derived Therapies

Phytoestrogens are a group of nonsteroidal plant-derived compounds with estrogen-like properties. The chemical structure contains a phenolic ring that enables them to bind to estrogen receptors in the body.⁵ They bind to both types of estrogen receptors, Erα and Erβ.⁵ However, research suggests that majority of the phytoestrogens have a higher affinity to bind to Erβ as compared to steroidal estrogens.⁵ Therefore, they may exert their actions through different pathways and may potentially induce different beneficial responses.

There are four classes of phytoestrogens: isoflavones, lignans, coumestans, and stilbenes.⁶

  • Isoflavones are the most common phytoestrogens derived mainly from soy and its derivatives, with genistein and diadzein being the most abundant and containing the highest estrogenic properties.⁶
  • Lignans can be found in flaxseed, wheat, rye, oats, and berries.⁶
  • Coumestans are less common and therefore have been less studied. They can be found in clover, alfalfa sprouts, sunflower seeds, and lima beans.⁶
  • Stilbenes include resveratrol, the most studied stilbene, which is present in grapes, peanuts, and cranberries.⁶ Siberian rhubarb root also belongs to this group and has been well studied and utilized in Europe since 1993.

Results from 21 randomized controlled trials (RCTs) examining the association between different phytoestrogens and menopausal symptoms (frequency and duration of hot flashes, vaginal dryness, etc.) included in a meta-analysis concluded that there was an association of overall phytoestrogen use with a decrease in the number of daily hot flashes and in vaginal dryness scores.³ However, the use of phytoestrogens was not associated with significant changes in 24-hour night sweat episodes.³

ERr 731® is a standardized extract of Siberian rhubarb root, a plant-derived, nonhormonal therapy designed to alleviate menopausal symptoms, including hot flashes.

In a confirmatory RCT involving 119 perimenopausal women, compared with perimenopausal women receiving placebo, those receiving ERr 731® experienced a median 83% decrease in daily hot flashes over the course of 12 weeks.⁷ Compared to placebo, perimenopausal women who received ERr 731® (the extract found in Estrovera) experienced a decrease in symptoms (as indicated by an average [mean] reduction) of up to 83% in individual Menopause Rating Scale scores.⁸ Clinical benefits of ERr 731® appear to be related to selective binding of Erβ and lack of affinity for Erα.9,10

Black cohosh is an herb that has a long history of use for the relief of menopausal symptoms, including hot flashes and night sweats. Results from four RCTs examining the association between black cohosh with menopausal symptoms included in a meta-analysis concluded that black cohosh was not associated with changes in the number of hot flashes and night sweats within a 24-hour period.³ Therefore, although black cohosh is a popular herbal remedy to address menopausal symptoms, research has shown no significant association between black cohosh supplementation and relief in menopausal symptoms.³

Other herbs: There aren’t many studies conducted on the associations of Chinese and non-Chinese medicinal herbs with menopausal symptoms. The few RCTs conducted on the various herbs were not consistent and in general didn’t show any association with symptom relief.³

Although many RCTs have been conducted on phytoestrogens and herbal remedies in relation to menopausal symptom relief, further studies are needed to determine potential long-term adverse health effects.

Next Steps

Use of HRT needs to be evaluated carefully, and the clinician should assess the risks and benefits associated with prescribing HRT for each individual woman based on her symptoms and personal and family medical history. For women who choose to avoid or have contraindications to HRT, plant-derived therapies in conjunction with a patient-centered approach may potentially provide an alternative in relieving certain symptoms associated with menopause. To determine the best options, patients should always consult with their healthcare provider.


  1. Vollmer G, et al. Treatment of menopausal symptoms by an extract from the roots of rhapontic rhubarb: the role of estrogen receptors. Chin Med. 2010; 5:7
  2. Chen MN, et al. Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review. Climacteric. 2015;18(2):260-269
  3. Franco OH, et al. Use of plant-based therapies and menopausal symptoms-a systematic review and meta-analysis. JAMA. 2016;315(23):2554-2563
  4. accessed September 13th 2017
  5. Glazier MG, et al. A review of the evidence for the use of phytoestrogens as a replacement for traditional estrogen replacement therapy. Arch Intern Med. 2001; 161:1161-1172
  6. Moreira AC, et al. A Review: Phytoestrogens as alternative hormone replacement therapy in menopause: what is real, what is unknown. J steroid Biochem Molecular Biology. 2014;143:61-71
  7. Kaszkin-Bettag M, et al. Confirmation of the efficacy of ERr 731 in perimenopausal women with menopausal symptoms. Altern Ther Health Med. 2009;15(1):24-34
  8. Heger M, et al. Efficacy and safety of a special extract of Rheum rhaponticum (ERr 731) in perimenopausal women with climacteric complaints: a 12-week randomized, double-blind, placebo-controlled trial. Menopause. 2006;13(5):744-759
  9. Papke A, et al. Effects of the special extract ERr 731 from Rheum rhaponticum on estrogen-regulated targts in the uterotrophy model of ovariectomized rats. J Steroid Biochem Mol Biol. 2009;117:176-184
  10. Wober J, et al. Activation of estrogen receptor-beta by a special extract of Rheum rhaponticum (ERr 731), its aglycones and structurally related compounds. J Steroid Biochem Mol Biol. 2007;107:191-201
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About Nilima Desai

Nilima Desai is a Registered Dietitian who received her undergraduate degree from California State University Long Beach in Nutrition and Dietetics and her Master’s in Public Health Nutrition from Loma Linda University. She has over 14 years of experience providing medical nutrition therapy in diabetes, renal disease, weight management, and vegetarian nutrition. She also served on the board of the Renal Practice Group of the Academy of Nutrition and Dietetics from 2012-2016 as the Membership Chair. Her passion about living and teaching a healthy lifestyle led her to collaborate with a nephrologist on creating the Pocket Dietitian app, which offers the user personalized, easy-to-use dietary prescription on conditions such as diabetes, hypertension, renal disease, weight management, etc. In her free time she runs half marathons and shuttles her two kids to their activities.

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