Life Extension Magazine®

Woman supplementing with Siberian rhubarb for menopause symptoms

Safely Alleviate 11 Symptoms of Menopause

Siberian rhubarb extract has been clinically shown to relieve 11 menopause symptoms up to 83%. Hot flashes decreased from about 15 a day to an average of less than 1.4 a day.

Scientifically reviewed by:  Dr. Carol Campi, RN, DC, in August 2023. Written by: Susan Lane.

Women approaching menopause know about hot flashes.

Hot flashes are one of 11 menopausal symptoms that can last for years.1-3

While menopause occurs at age 51 on average,4 a recent study found many women aged 60 to 65 are still experiencing moderate to severe menopausal symptoms.5

Another study found that only about 10% of women suffering menopausal symptoms are receiving treatment.6

Some women think nothing can be done. Others are concerned about the potential side effects of conventional hormone replacement therapy, including a possible increased risk of breast cancer, stroke, and clotting.7

But there is no need for women to suffer in silence anymore. Scientific evidence shows that menopausal women can safely benefit from an extract of Siberian rhubarb, a readily available plant extract that does not require a prescription.

Multiple clinical studies have demonstrated that Siberian rhubarb extract alleviates all 11 recognized menopausal symptoms by as much as 83%, often within just four weeks.8-12

For women who prefer to avoid hormone-based treatments, these findings point to a natural, safe, and effective way to restore well-being during menopausal years and beyond.

The 11 Menopause Symptoms

Woman discussing depression with her doctor

While hot flashes and night sweats are the most well-known menopause symptoms, many women suffer from an array of others.

The Menopause Rating Scale, or MRS, was developed in 2004 as a way of evaluating all of these symptoms.

It allows women to rate 11 separate symptoms, graded in severity from 0 (the symptom is not present) to 4 or to 5 (“very severe”) on the revised MRS II scale.2,3,9

The 11 potential menopause symptoms are:

  • Hot flashes/sweating,
  • Heart discomfort,
  • Sleep problems,
  • Depressive mood,
  • Irritability,
  • Anxiety,
  • Physical and mental exhaustion,
  • Sexual problems,
  • Vaginal dryness,
  • Bladder problems, and
  • Joint and muscle discomfort.

Having even one of these symptoms can lead to a significantly lower quality of life.

What You Need to Know

Menopause Relief

  • Multiple, controlled, clinical studies have demonstrated that Siberian rhubarb extract substantially reduces the 11 most important menopausal symptoms, including hot flashes and sleep problems, without any significant safety issues.
  • Siberian rhubarb extract has been used in Germany since 1993 to safely treat menopause symptoms.
  • Women taking Siberian rhubarb extract can expect broad improvements in mood-related menopause symptoms, including depression and irritability, that are not well-treated by conventional therapies.

How Siberian Rhubarb Works

Most symptoms of menopause are caused by a sharp drop in levels of the hormone estrogen.

That’s where Siberian rhubarb comes in. The root of this plant is rich in compounds that bind to cell receptors that normally bind to estrogen.9,10,13

By doing this, they trigger beneficial estrogen-like effects throughout the body, helping to relieve menopause symptoms.

Siberian rhubarb extract has been successfully used in Germany since 1993 for treating menopause symptoms.10 To further validate its benefits, scientists conducted a series of controlled, clinical trials to determine the extract’s effectiveness.

Easing All 11 Menopause Symptoms

plants growing in a beaker

First, a research team enlisted 109 women who were suffering from multiple symptoms of perimenopause, a stage just before menopause when the ovaries gradually begin to make less estrogen. In this study, women received either a daily placebo or 4 mg of Siberian rhubarb extract.9,11

After 12 weeks, scientists evaluated the women by using the MRS II, a respected scale which rates menopause symptoms. The researchers documented a 54% decrease in total symptom scores and significant improvements in all 11 symptom categories. There were no significant changes among the subjects receiving a placebo, who continued to experience all the same menopause symptoms.9

A similar study of 112 perimenopausal and symptomatic women found virtually identical results. After 12 weeks, patients receiving a placebo had no significant changes. But women getting 4 mg of Siberian rhubarb extract daily showed:12

  • A decrease of 54% in overall MRS scores,
  • Significant improvements in all MRS symptom categories, and
  • An 83% reduction in the median number of daily hot flashes.

By comparison, conventional hormone therapy was found, in a review of 24 placebo-controlled trials, to reduce the frequency of hot flashes by about 75%.14 In other words, Siberian rhubarb extract improved hot flashes as much as, or even more than, conventional treatment.

Studies Confirm Long-Term Benefits

Woman holding kale

Next, investigators set out to validate these results with a larger group over a longer period.

A total of 252 women took part in a study that lasted six months. Notably, this group included women ranging from perimenopausal to postmenopausal, all of whom had concerning symptoms.10

Each of the women took 4 mg of Siberian rhubarb extract daily, and at the end of the study, each of the 11 MRS symptoms was significantly reduced. There was also a 52% decrease in overall MRS (Menopause Rating Scale) scores.10

The study team found that women with the most severe symptoms achieved the greatest overall improvements. In general, the most commonly improved symptoms were:10

  • Hot flashes/sweating,
  • Sleep problems,
  • Irritability, and
  • Depressed mood.

But menopause symptoms can last for years. So researchers set out to study whether this extract would be effective over a significantly longer term.

For a period of 96 weeks scientists conducted a follow-up study.8 Women who had been taking the Siberian rhubarb in a previous, double-blind clinical trial were asked to continue supplementing, while the previous placebo group was asked to now start taking the Siberian rhubarb extract.

After switching to the Siberian rhubarb, the former placebo group rapidly caught up to the supplementing test group. At the end of 96 weeks, they demonstrated identical results of a median 83% decrease in total MRS II scores. What’s more, hot flashes decreased from about 15 a day to an average of less than 1.4 a day.8

Improving Mood

plants growing in a beaker

Some of the most troubling menopause symptoms are mood-related: depression, anxiety, and irritability.

Although conventional hormone treatments address hot flashes and night sweats, they have not proven effective for improving mood symptoms. In fact, some evidence suggests they may even aggravate them.7,15

Not Siberian rhubarb.9,12 In a randomized, controlled clinical trial, the extract led to a resolution of or improvement in depressed mood in more than 90% of those taking it.11

The group receiving the extract in this study also achieved a 66% reduction in total scores on the Hamilton Anxiety Scale.11

Why It’s Safe

No relevant safety issues arose in any of the above studies of Siberian rhubarb extract, which involved more than 400 women in total.

No changes were seen in vital signs, or in breast, vaginal, or endometrial tissues.8-10,12 And from 1993-2014, an average of 6.7 million doses of this extract were sold in Germany every year.16

The remarkable safety record of Siberian rhubarb appears to be rooted in the fact that this unique extract preferentially binds to beneficial receptors (ER-beta) while binding only weakly to undesirable receptors (ER-alpha).13,17

Within the body, there are two types of cell receptors to which estrogen normally binds:

Estrogen receptor-alpha (ER-alpha)


Estrogen receptor-beta (ER-beta).

When estrogen lost during menopause is replaced by non-selective hormone drugs, both ER-alpha and ER-beta receptors are activated.18

The problem is that these two receptor types tend to be concentrated in different body tissues, and activating them leads to very different results.

Activating ER-beta receptors promotes beneficial estrogenic effects on skin, brain, bone, cardiovascular, and other tissues.

But activating ER-alpha receptors can produce undesirable growth in reproductive tissues, including initiating and promoting cancer. In fact, increased activity of the ER-alpha receptor is believed to cause the ill effects of conventional hormone therapy.18

When scientists performed lab studies with Siberian rhubarb, though, they discovered that its desirable activation of ER-beta receptors is 13.5-fold greater than its undesirable activation of ER-alpha receptors.13,17

When compared to other known natural compounds or even to natural estrogen itself, this standardized extract has the highest selectivity for ER-beta over ER-alpha.13,17


Woman holding kale

Siberian rhubarb extract is a unique approach to controlling menopausal symptoms, and provides an alternative to hormone replacement therapy.

In clinical studies, including large, long-term trials, a daily dose of just 4 mg of Siberian rhubarb extract significantly relieved the 11 most important menopausal symptoms, including hot flashes, exhaustion, bladder problems, and more.

Bioidentical hormone-replacement therapy can be effective for many women for hot flashes. But rhubarb extract provides an effective option for those interested in broad, non-hormonal relief of all known menopausal symptoms.

These clinical trials with Siberian rhubarb extract show a notable improvement in mood symptoms like depression, a benefit conventional hormone therapy does not provide. And this plant extract has been demonstrated to be safe.

If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.


  1. Available at: Accessed July 2, 2018.
  2. Available at: Accessed July 3, 2018.
  3. Heinemann LA, DoMinh T, Strelow F, et al. The Menopause Rating Scale (MRS) as outcome measure for hormone treatment? A validation study. Health Qual Life Outcomes. 2004 Nov 22;2:67.
  4. Available at: Accessed April 8, 2019.
  5. Gartoulla P, Worsley R, Bell RJ, et al. Moderate to severe vasomotor and sexual symptoms remain problematic for women aged 60 to 65 years. Menopause. 2018 Nov;25(11):1331-8.
  6. Worsley R, Bell RJ, Gartoulla P, et al. Low use of effective and safe therapies for moderate to severe menopausal symptoms: a cross-sectional community study of Australian women. Menopause. 2016 Jan;23(1):11-7.
  7. Available at: Accessed April 10, 2019.
  8. Hasper I, Ventskovskiy BM, Rettenberger R, et al. Long-term efficacy and safety of the special extract ERr 731 of Rheum rhaponticum in perimenopausal women with menopausal symptoms. Menopause. 2009 Jan-Feb;16(1):117-31.
  9. Heger M, Ventskovskiy BM, Borzenko I, 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 Sep-Oct;13(5):744-59.
  10. Kaszkin-Bettag M, Beck S, Richardson A, et al. Efficacy of the special extract ERr 731 from rhapontic rhubarb for menopausal complaints: a 6-month open observational study. Altern Ther Health Med. 2008 Nov-Dec;14(6):32-8.
  11. Kaszkin-Bettag M, Ventskovskiy BM, Kravchenko A, et al. The special extract ERr 731 of the roots of Rheum rhaponticum decreases anxiety and improves health state and general well-being in perimenopausal women. Menopause. 2007 Mar-Apr;14(2):270-83.
  12. Kaszkin-Bettag M, Ventskovskiy BM, Solskyy S, et al. Confirmation of the efficacy of ERr 731 in perimenopausal women with menopausal symptoms. Altern Ther Health Med. 2009 Jan-Feb;15(1):24-34.
  13. Wober J, Moller F, Richter T, 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 Nov-Dec;107(3-5):191-201.
  14. Maclennan AH, Broadbent JL, Lester S, et al. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev. 2004 Oct 18(4):CD002978.
  15. Toffol E, Heikinheimo O, Partonen T. Hormone therapy and mood in perimenopausal and postmenopausal women: a narrative review. Menopause. 2015 May;22(5):564-78.
  16. Chang JL, Montalto MB, Heger PW, et al. Rheum rhaponticum Extract (ERr 731): Postmarketing Data on Safety Surveillance and Consumer Complaints. Integr Med (Encinitas). 2016 Jun;15(3):34-9.
  17. Konda V, Swick A, Troup JD, et al. Efficacy of Rheum rhaponticum ERr 731® extract in alleviating vasomotor menopausal symptoms in an ovariectomized rat model. Paper presented at: NAMS Annual Meeting2014; Washington, D.C.
  18. Farzaneh S, Zarghi A. Estrogen Receptor Ligands: A Review (2013-2015). Sci Pharm. 2016 Apr 13;84(3):409-27.