Siberian Rhubarb for Perimenopause

By Suzanne Fenske, MD, FACOG, ABOIM, MSCP

With so many supplements marketed towards perimenopausal women, it’s challenging to discern what works from ineffective or low-quality options with fancy marketing strategies.

The truth is that supplements during this time need to be highly personalized. What addresses your concerns and supports your health will likely look different from your peers. As an integrative practice, we want to have many effective choices at our disposal to support our patients.

Siberian rhubarb (Rhapontic rhubarb) provides a solid option for women in perimenopause and menopause.

Today’s article will dive into the research on Siberian rhubarb, how it helps, and best practices for supplementation. Keep reading as we explore:

• What is Siberian rhubarb? What is ERr 731?
• Hormone actions of Siberian rhubarb
• Its use for perimenopause and menopause symptoms
• The safety profile of Siberian rhubarb
• Incorporating Siberian rhubarb into your integrative care plan

What is Siberian Rhubarb?

Siberian or Rhapontic rhubarb (Rheum rhaponticum) is a plant native to Siberia. It’s not the same as the rhubarb you use to make pies and tarts in the spring, but the two plants are in the same family.

The root of Siberian rhubarb is used in botanical preparations and supplements. Its main constituent, rhaponticin, is responsible for most of its medicinal benefits. It also contains other constituents, including hydroxystilbene, which shares a pathway with resveratrol (the anti-aging phytonutrient in red wine).

ERr 731 is a standardized extract of Siberian rhubarb containing primarily rhaponticin and desoxyrhaponticin compounds. This formulation is used in clinical research and high-quality supplements. In the United States, ERr 731 is available from Metagenics as HerWellness Estrovera.

Hormone Actions of Siberian Rhubarb

Siberian rhubarb (ERr 731) has estrogenic actions in the body and is considered a phytoestrogen (or plant estrogen). It doesn’t contain human estrogen, nor does it raise estrogen levels in the body, but it does interact with estrogen receptors to elicit a response within cells.

More specifically, Siberian rhubarb is a SERM, a selective estrogen receptor modulator. This distinction is important; Siberian rhubarb selectively binds to estrogen receptors, specifically ER-beta (estrogen receptor-beta), not ER-alpha. Binding to ER-beta produces estrogenic actions in breast and endometrial tissue, without causing proliferative (growth) effects as occurs with ER-alpha.

Because of these actions, Siberian rhubarb may support perimenopausal and menopausal symptoms. It offers a non-hormonal alternative to hormone replacement therapy (HRT) for women who aren’t good candidates or desire a non-hormonal solution. It’s also an alternative to other phytoestrogens, such as isoflavones from soy or black cohosh, which may act on all receptor types.

Siberian Rhubarb in Perimenopause and Menopause

Menopause symptoms affect physical, psychological, and emotional health. They often start in perimenopause and last for years or decades. Over 70% of women report symptoms like hot flashes, sleep disturbances, and mood changes impair their quality of life. In addition, there can be significant long-term complications of menopause, as midlife hormone changes increase the risk for chronic diseases.

Siberian rhubarb root extract has been used in Germany since 1993 to treat menopausal symptoms. In one German study, researchers gave ERr 731 to 250 menopausal women and compared symptoms to baseline over 6 months. At the end of the trial, the women experienced a significant reduction in menopausal symptoms, producing an increase in quality of life. In addition, the treatment was well-tolerated and safe.

Clinical trials show similar benefits. A 2024 systematic review and meta-analysis examined four high-quality studies with controls that measured menopausal symptoms using the Menopausal Rating Scale (MRS). The study concluded that Siberian rhubarb root/ERr 731 is an effective intervention for reducing menopause symptoms.

In addition to a general reduction in symptoms, researchers have explored the benefits of Siberian rhubarb for specific symptoms. One study compared ERr 731 to a placebo in perimenopausal women and found a significant reduction in anxiety symptoms. Additionally, the decrease in anxiety correlated with a decrease in hot flashes and an increase in general well-being.

In summary, here’s what we know from the research. ERr 731:

• Decreases MRS (menopausal symptom) scores
• Decreases frequency and severity of hot flashes
• Decreases anxiety symptoms
• Increases health-related quality of life

Siberian rhubarb is well-tolerated and generally safe when taken as a high-quality standardized extract (ERr 731). It’s safe over the long term, and is not associated with an increased risk of breast cancer compared to HRT users and non-users.

Final Thoughts

At TārāMD, we offer integrative, personalized care, which includes recommending Siberian rhubarb when appropriate. We always recommend working with your healthcare provider for supplemental guidance that complements a comprehensive care plan, including nutrition, lifestyle medicine, stress reduction, monitoring, and prevention.

To learn more about our supplement philosophy and perimenopause-specific recommendations, please read these articles:

• Supplements for Perimenopause
• Phytoestrogens for Perimenopause
• Evidence-Based Brain Health Supplements
• Turmeric and Curcumin Benefits for Women
• Spotlight on Omega-3s and Women’s Health
• Vitamin D
• Magnesium for Women’s Health

Siberian rhubarb is an evidence-based tool that helps us comprehensively support women in midlife with a personalized approach. Are you ready to build your perimenopause care plan? Please reach out!

References

1. Vollmer, G., Papke, A., & Zierau, O. (2010). Treatment of menopausal symptoms by an extract from the roots of rhapontic rhubarb: the role of estrogen receptors.Chinese medicine, 5, 7.
2. Wilson, M., Konda, V., Heidt, K., Rathinasabapathy, T., Desai, A., & Komarnytsky, S. (2021).Rheum rhaponticum Root Extract Improves Vasomotor Menopausal Symptoms and Estrogen-Regulated Targets in Ovariectomized Rat Model. International journal of molecular sciences, 22(3), 1032.
3. Dubey, V. P., Sureja, V. P., & Kheni, D. B. (2024). Efficacy evaluation of standardized Rheum rhaponticumroot extract (ERr 731 ^®) on symptoms of menopause: A systematic review and meta-analysis study. Journal of biomedical research, 38(3), 278–286.
4. Kaszkin-Bettag, M., Beck, S., Richardson, A., Heger, P. W., & Beer, A. M. (2008). Efficacy of the special extract ERr 731 from rhapontic rhubarb for menopausal complaints: a 6-month open observational study.Alternative therapies in health and medicine, 14(6), 32–38.
5. Kaszkin-Bettag, M., Ventskovskiy, B. M., Kravchenko, A., Rettenberger, R., Richardson, A., Heger, P. W., & Heger, M. (2007). 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 (New York, N.Y.), 14(2), 270–283.
6. NDNR Journal of Applied Natural Medicine. Reduce Hot Flashes and Other Menopausal Symptoms: A Beneficial Proprietary Siberian Rhubarb Root Extract. Accessed 5/6/2026.
7. Chang, J. L., Montalto, M. B., Heger, P. W., Thiemann, E., Rettenberger, R., & Wacker, J. (2016). Rheum rhaponticum Extract (ERr 731): Postmarketing Data on Safety Surveillance and Consumer Complaints.Integrative medicine (Encinitas, Calif.), 15(3), 34–39.
8. Hasper, I., Ventskovskiy, B. M., Rettenberger, R., Heger, P. W., Riley, D. S., & Kaszkin-Bettag, M. (2009). Long-term efficacy and safety of the special extract ERr 731 of Rheum rhaponticum in perimenopausal women with menopausal symptoms.Menopause (New York, N.Y.), 16(1), 117–131.
9. Heger, P. W., Hotz, D., Kalder, M., & Kostev, K. (2025). Association between Extract Rheum rhaponticum 731 (ERr 731) prescription and subsequent breast cancer.Breast cancer research and treatment, 212(1), 139–148.