Herbs That May Assist

Rehmannia
Rehmannia glutinosa, root
Asiatic cornelian cherry
Cornus officinalis, fruit
Chinese yam
Dioscorea oppositifolia, rhizome
Zizyphus
Ziziphus jujuba var. spinosa, seed
Tree peony
Paeonia suffruticosa, root bark
Poria
Poria cocos, fruiting body
Water plantain
Alisma orientale, rhizome
Anemarrhena
Anemarrhena asphodeloides, rhizome dry

Actions

• Increases oestrogen
• Decreases FSH and LH
• Promotes serotonin and GABA activity
• Supports hypothalamus-pituitary-adrenal (HPA) axis
• Reduces vasodilatory response of hot flushes

Clinical Applications

• Menopausal symptoms

Oestrogen Lifting Herbs is a blend of traditional Chinese medicine (TCM) herbs, which can offer effective relief from menopausal symptoms like hot flushes and night sweats. This formula includes the clinically trialled blend, Rehmannia Six, designed to nourish ‘kidney yin' energy to mitigiate menopausal symptoms in TCM. In addition to Rehmannia Six, Oestrogen Lifting Herbs features two other key TCM herbs: zizyphus and anemarrhena. These herbs are effective in addressing various menopausal symptoms, including anxiety, insomnia, and night sweats. Together, the ingredients in Oestrogen Lifting Herbs are formulated to support reproductive, adrenal, and neurotransmitter functions, which are often disrupted during menopause.

Background Information

Menopause takes place over an 8-to-10-year period in three stages, perimenopause, menopause, and post menopause.[1,2] Several factors can influence the onset of menopause, including genetics and lifestyle factors. It may also occur in response to surgery (i.e., total hysterectomy). As women transition through each stage, of oestrogen and progesterone levels can fluctuate and become erratic, which can lead to menopausal symptoms. These symptoms can range from mild to severe and impact a woman’ quality of life over several months or years.[3]

Beyond oestrogen and progesterone, other hormones can influence perimenopausal symptoms. A drop in dehydroepiandrosterone (DHEA) by up to 60% during menopause can significantly impact overall oestrogen activity,[4,5] as DHEA can be converted to oestrogen via aromatase enzymes. Suboptimal DHEA levels affect its natural oestrogen-supporting role. Moreover, excess hypothalamic-pituitary-adrenal (HPA) axis activity, resulting in elevated cortisol production, is also linked to the severity of menopausal symptoms.[6,7]

Hormonal interplay and common perimenopausal symptoms

Hot flushes, common in perimenopause, are linked to changes in the nervous system’s temperature-regulating circuits. The withdrawal of oestradiol during perimenopause narrows the thermoregulatory zone, causing low tolerance to temperature changes and triggering an overheating response. By gently modulating ovarian hormones and key neurotransmitters—noradrenaline, GABA, and serotonin—the thermoneutral tolerance zone can be stabilized. Lowering noradrenaline and supporting GABA and serotonin can help raise the thermoneutral threshold, reducing hot flushes.[6,7]

The transition to menopause is associated with increased urinary cortisol levels, with severe hot flushes linked to high cortisol levels.[8] This may result from heightened stress during menopause, which can also reduce DHEA production and interfere with GABA, serotonin, and noradrenaline. In women with severe perimenopausal flushing, spikes in corticotropin-releasing hormone (CRH) activate mast cell degranulation, driving vasodilation.[6,9-12] This suggests that reducing excessive HPA activation may help manage climacteric symptoms.

'Yin Deficiency' Theory and Hormonal Patterns in Menopause

These hormonal changes, through the lens of Traditional Chinese Medicine (TCM), are described as ‘Yin deficiency of the kidney,’ which manifests as insufficient fluids and blood, resulting in a lack of moisture within the body.[13,14] This understanding aligns with the changes that occur during the menopausal transition. Interestingly, stress and cortisol are considered to represent an imbalance toward ‘Yang excess’ (the opposite of Yin deficiency), while DHEA is considered Yin. Therefore, kidney Yin deficiency can be seen as a relative cortisol excess and low DHEA, consistent with the physiological understanding of menopause.[13,14]

Supporting this theory, a study involving 23 symptomatic menopausal women evaluated by nine TCM practitioners found that 81% of consultations resulted in a diagnosis of kidney Yin deficiency. This suggests that most symptomatic menopausal women could benefit from therapies enhancing kidney ‘essence.[12,14]

Actions

Increases Oestrogen
A study found that Rehmannia Six significantly increased serum oestradiol levels and the number of oestrogen receptors in women with menopausal symptoms. The authors suggest that Rehmannia Six nourishes kidney yin deficiency, improving ovarian oestrogen production and response.[13]

Decreases FSH and LH
The same study showed that Rehmannia Six significantly decreased serum follicle-stimulating hormone (FSH) and luteinising hormone (LH). Similar improvements in hypothalamic-pituitary-ovarian (HPO) function were observed in ageing female mice, including increased ovarian weight, serum oestradiol levels, and oestrogen receptor-alpha expression, along with reduced LH levels.[15]

Promotes Serotonin and GABA Activity
Zizyphus and its constituents, such as sanjoinine A, have demonstrated potent GABAergic actions, reducing anxiety and improving sleep in animal models. Sanjoinine A increases GABA synthesis and receptor levels,[17-19] while spinosin, another bioactive constituent, enhances the hypnotic effect via serotonergic action.[20]

Sarsasapogenin, a component of Anemarrhena asphodeloides, has shown antidepressant activity in animal models, increasing serotonin levels in the hypothalamus and hippocampus. Rehmannia glutinosa also exhibits a significant sedative effect on the central nervous system.[21]

Supports HPA Axis
In Western herbal medicine, Rehmannia is considered an adaptogen that protects the body during stress. In TCM, it nourishes Yin and tonifies the kidneys, suggesting similar uses. Rehmannia may help with excess HPA activation and imbalanced cortisol/DHEA ratios in menopausal women.[13]

Reduces Vasodilatory Response of Hot Flushes
Research indicates that excessive nitric oxide (NO) release is involved in menopausal hot flushes.[22] Animal models show that saponins from Cornus officinalis reduce pathological vasodilation by attenuating NO release.[22] Other herbs like Paeonia suffruticosa, Poria cocos, and Alisma orientale also inhibit NO production,[16,23,24] potentially reducing hot flushes.

Clinical Applications

Menopausal Symptoms
A randomised controlled trial of Rehmannia Six showed significant benefits for peri-menopausal women. Twenty-two women with climacteric syndrome were given either the herbal formula or a placebo for two months. The treatment group experienced significant improvements in menopause symptoms, increased oestradiol levels, and reduced FSH and LH levels, approaching premenopausal levels. The number of oestrogen receptors on peripheral blood leucocytes also increased significantly. No significant changes were observed in the placebo group.[13]

Summary of Ingredients

Ingredient and Dose	Duration of Studies	Sample of Results
Rehmannia six combination; traditional dose	8 weeks	The treatment group experienced significant improvements in menopause symptoms, increased oestradiol levels, and reduced FSH and LH levels, approaching premenopausal levels

Safety Information

Disclaimer: In the interest of supporting Healthcare Practitioners, all safety information provided at the time of publishing is in accordance with Natural Medicine Database (NATMED PRO), renowned for its professional monographs which include a thorough assessment of safety, warnings, and adverse effects.

For further information on specific interactions with medications, please contact Clinical Support on 1800 777 648, or via email, anz_clinicalsupport@metagenics.com

Pregnancy and Lactation

• Insufficient reliable information available; avoid using.[25]

Contraindications

• None of note[25]

References

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2. Burger HG. The endocrinology of the menopause. Maturitas. 1996 Mar;23(2):129-36. doi: 10.1016/0378-5122(95)00969-8.
3. Santoro N. The menopausal transition. Am J Med. 2005 Dec 19;118(12):8-13.
4. Labrie F, Bélanger A, Bélanger P, et al. Androgen glucuronides, instead of testosterone, as the new markers of androgenic activity in women. J Steroid Biochem Mol Biol. 2006;99(4-5):182-188. doi:10.1016/j.jsbmb.2006.02.004
5. Labrie F, Labrie C. DHEA and intracrinology at menopause, a positive choice for evolution of the human species. Climacteric. 2013;16(2).
6. Archer DF, Sturdee DW, Baber R, et al. Menopausal hot flushes and night sweats: where are we now? Climacteric. 2011;14(5):515-28.
7. Freedman RR, Woodward S, Sabharwal SC. Alpha 2-adrenergic mechanism in menopausal hot flushes. Obstet Gynecol. 1990;76(4).
8. Wood NF, Carr MC, Tao EY, Taylor HJ, Mitchell ES. Increased urinary cortisol levels during the menopausal transition. Menopause. 2006;13.
9. Meldrum DR, DeFazio JD, Erlik Y, et al. Pituitary hormones during the menopausal hot flash. Obstet Gynecol. 1984;64.
10. Clifton VL, Crompton R, Read MA, Gibson PG, Smith R, Wright IM. Microvascular effects of corticotropin-releasing hormone in human skin vary in relation to estrogen concentration during the menstrual cycle. J Endocrinol. 2005;186(1).
11. Yakubo K, Makino T, Takayama S, Sakai A, Iizuka R. [Endocrinological analysis of climacteric symptoms and gonadal dysfunction by CRF test]. Nihon Sanka Fujinka Gakkai Zasshi. 1990;42(6).
12. Cagnacci A, Cannoletta M, Caretto S, Zanin R, Xholli A, Volpe A. Increased cortisol level: a possible link between climacteric symptoms and cardiovascular risk factors. Menopause. 2011;18(3).
13. Zhang JP, Zhou DJ. [Changes in leucocytic estrogen receptor levels in patients with climacteric syndrome and therapeutic effect of liuwei dihuang pills]. Zhong Xi Yi Jie He Za Zhi. 1991;11(9).
14. Zell B, et al. Diagnosis of symptomatic postmenopausal women by traditional Chinese medicine practitioners. Menopause. 2000;7(2).
15. Ma Y, Zhou WX, Cheng JP. [Study on effect and mechanism of liuwei dihuang decoction in modulating hypothalamus-pituitary- ovary axis in senescence accelerated mice model.] Zhongguo Zhong Xi Yi Jie He Za Zhi. 2004;24(4). [article in Chinese] – abstract only.
16. Matsuda H, Kageura T, Toguchida I, Murakami T, Kishi A, Yoshikawa M. Effects of sesquiterpenes and triterpenes from the rhizome of Alisma orientale on nitric oxide production in lipopolysaccharide-activated macrophages: absolute stereostructures of alismaketones-B 23-acetate and -C 23-acetate. Bioorg Med Chem Lett. 1999;9(21).
17. Han H, Ma Y, Eun JS, et al. Anxiolytic-like effects of sanjoinine A isolated from Zizyphi Spinosi Semen: possible involvement of GABAergic transmission. Pharmacol Biochem Behav. 2009;92(2).
18. Peng WH, Hsieh MT, Lee YS, et al. Anxiolytic effect of seed of Zizyphus jujuba in mouse models of anxiety. J Ethnopharmacol. 2000;72(3).
19. Liao JF, Jan YM, Huang SY, et al. Evaluation with receptor binding assay on the water extracts of ten CNS-active Chinese herbal drugs. Proc Natl Sci Counc Repub China B. 1995;19(3).
20. Wang LE, Bai YJ, Shi XR, et al. Spinosin, a C-glycoside flavonoid from semen Zizhiphi Spinozae, potentiated pentobarbital- induced sleep via the serotonergic system. Pharmacol Biochem Behav. 2008;90(3).
21. Ren LX, Luo YF, Li X, Wu YL. Antidepressant activity of sarsasapogenin from Anemarrhena asphodeloides Bunge (Liliaceae). Pharmazie. 2007;62(1).
22. Hubing KA, Wingo JE, Brothers RM, Del Coso J, Low DA, Crandall CG. Nitric oxide synthase inhibition attenuates cutaneous vasodilation during postmenopausal hot flash episodes. Menopause. 2010;17(5):978-82.
23. Ding L, Jiang Z, Liu Y, Chen L, Zhao Q, Yao X, Zhao F, Qiu F. Monoterpenoid inhibitors of NO production from Paeonia suffruticosa. Fitoterapia. 2012;83(8):1598-603.
24. Cai TG, Cai Y. Triterpenes from the fungus Poria cocos and their inhibitory activity on nitric oxide production in mouse macrophages via blockade of activating protein-1 pathway. Chem Biodivers. 2011;8(11):2135-43.
25. Natural Medicines Database. AusDi; 2024. Accessed September 20, 2024. https://ausdi.hcn.com.au/