Actaea racemosa L. Is More Effective in Combination with Rhodiola rosea L. for Relief of Menopausal Symptoms Original paper

What was studied?

This randomized, double-blind, placebo-controlled clinical trial evaluated the efficacy and safety of a novel herbal preparation, Menopause Relief EP® (RR-BC), combining extracts of Actaea racemosa (black cohosh, BC) and Rhodiola rosea (RR), in relieving menopausal symptoms. The study compared this combination against two doses of black cohosh alone and placebo over 12 weeks. The primary outcomes were improvements in menopausal symptom severity assessed by the Kupperman Menopausal Index (KMI) and Menopause Rating Scale (MRS), with secondary endpoints including quality of life (QoL) measured by the Utian Quality of Life (UQOL) scale. Safety and adverse events (AEs) were also monitored.

Who was studied?

The study enrolled 220 menopausal women aged 40–82 years (median 52 years) diagnosed with menopausal complaints confirmed by elevated FSH and low estradiol levels. Participants were randomized evenly into four groups (RR-BC combination, low-dose BC, high-dose BC, and placebo). Patients had moderate menopausal symptoms as measured by baseline KMI and MRS scores. Women with hormone therapy, psychological disorders, or other conditions likely to interfere with outcomes were excluded. Ninety percent completed the study per protocol, with treatment compliance exceeding 90% across groups.

Most important findings

The RR-BC combination significantly reduced menopausal symptom severity, as shown by a 71.2% decrease in KMI scores after 12 weeks, outperforming both low-dose and high-dose BC groups and placebo. Similarly, MRS scores decreased by 67.7% with RR-BC versus 49.9% and 60.0% for the BC groups. Quality of life, particularly in emotional and physical health domains, improved significantly more with RR-BC than with BC or placebo. The RR-BC group also experienced significant improvements in sexual activity. Safety analysis showed no significant difference in adverse event frequency or severity between groups, with no serious adverse events reported. The data support a synergistic or additive effect of Rhodiola when combined with black cohosh, enhancing relief from psychological and somatic menopausal symptoms. Although the study did not directly assess microbiome changes, both plants have known adaptogenic and neuroprotective properties that may indirectly influence microbiome-associated inflammation and hormonal regulation, which are relevant to menopause symptomatology.

Key implications

This trial demonstrates that combining Rhodiola rosea with Actaea racemosa provides superior symptom relief and quality of life improvements for menopausal women compared to black cohosh alone, with excellent safety and tolerability. The combination’s enhanced effect on emotional health and sexual function suggests it addresses neuropsychological symptoms effectively, likely via adaptogenic and estrogen-modulating mechanisms. These findings encourage further investigation of combined botanical therapies in menopause, including exploration of their impact on the microbiome and inflammatory pathways. This approach offers a promising alternative or adjunct to hormone replacement therapy, especially for women seeking non-hormonal, plant-based interventions with favorable safety profiles.