Written by Chrystal Moulton, Science Writer. ERr731® or Siberian rhubarb extract is a well-studied effective alternative treatment for managing climacteric symptoms in menopausal women, most notably reduced hot flash occurrence and improved sleep.

Menopause is a natural part of a woman’s reproductive cycle which marks the cessation of the menstrual cycle. The key hormones affecting the reproductive cycle are estrogen, progesterone, luteinizing hormone [LH], follicle stimulation hormone [FSH], anti-mullerian hormone [AMH], and testosterone.^1,2 The onset of menopause changes the behavior of these hormones. The number of ovarian follicles and granulosa cells present within ovaries causes the ovaries to produce less estrogen (specifically estradiol or E2) and progesterone. This, in turn, leads to increased levels of  FSH, LH, and estrone (E1, a different form of estrogen).^1,2 This change in hormonal behavior creates symptoms commonly associated with menopause in a gradually increasing manner. As estradiol production decreases and estrone levels rise, the first set of symptoms which generally occur are: changes in duration and consistency of periods, blood clots in menstrual blood, hot flashes, and night sweats. This is the peri-menopausal stage.^1,2 During this phase, women generally experience hot flashes, irritability, and depression, along with various other psychosexual changes.^1,2 Menopause, which is the day of complete cessation of the menstrual cycle, is diagnosed only after a full year has passed since the last period. Once verified, the post-menopausal phase begins and continues until the end of life.^1,2 The post-menopausal phase signifies an end to the reproductive cycle. Women in this phase can continue to experience menopausal symptoms for up to 9.5 years.²

Common treatment provided to menopausal women focuses on symptom management including hormone replacement as the primary therapy, as well as diet and lifestyle modification.^1-10 However, alternative treatment, in some cases, is also as effective as conventional treatment in relieving menopausal symptoms.^1,2 Among various alternative treatments that support menopausal health, Rheum rhaponticum (or rhubarb) ERr731® has demonstrated significant benefits in vasomotor symptom relief, as well as anxiety and sleep disturbance commonly experienced by women at this stage of life.^3-10

Siberian rhubarb root extract (Rheum rhaponticum) ERr731® is a standardized extract marketed in the US as Estrovera.⁸ Active components in ERr731®, rhaponticins, are highly selective agonists of the beta estrogen receptor (ER-beta).⁹ This is especially important in treating menopausal symptoms. Estradiol, the primary prescription in hormone therapy, activates not only beta estrogen receptors (ER-beta) but also alpha estrogen receptors (ER-alpha).^1,2,9 Activation of alpha estrogen receptors leads to endometrial proliferation and continued use of compounds activating the ER-alpha receptor is linked to cancer. Activation of the ER-beta receptor, however, provides symptom relief without endometrial proliferation.^1,2,9

Clinical studies have shown that supplementation with ERr731® is effective in reducing menopausal symptoms.^3-6,10 In a systematic review of 4 randomized placebo-controlled clinical trials, researchers found that supplementation with ERr731® significantly improved scores in the Menopause Rating Scale (mean difference: -15.12, p<0.001) compared to the controlled group following 12 weeks of supplementation.⁷ The effective dose for ERr731® is 4mg daily. It is prescribed as an enteric coated tablet for management of sleep disturbances, hot flashes, flush, and headaches associated with menopause.^3-10

In a 96-week multicenter clinical trial, women supplemented with ERr731® experienced a reduction in hot flashes/sweating from 3.6 to 1.2 episodes per day, with no reported adverse side effects.⁶ Researchers in this study also reported no changes in gynecological or laboratory findings in women supplemented ERr731® compared to placebo. Furthermore, no severe adverse events were reported in the ERr731® group during the 96 week trial.⁶ A more recent safety study reviewing post market safety reports from 1993 until 2014 found 124 adverse events reports submitted in Germany and 79 reported in North America.⁸ The main complaints across both regions were hypersensitivity (i.e rash, itching), GI symptoms (diarrhea, abdominal discomfort), and nervous system complaints (i.e. headaches, drowsiness, etc). In North America, also, about 28% of consumers [n=22] reported no effect of ERr731® supplementation on menopausal symptoms, while 0.9% [n=2] reported no effect in Germany. Overall, of 6.7 million doses sold per year between 2009-2014, there were 5.9 reports of adverse events annually in Germany. In North America, 14.6 product complaints per 2.4 million doses sold per year.⁸ Such post market evaluation of consumer complaints provides a clear picture of the safety of ERr731® in treatment of menopausal symptoms.

In all, ERr731® or Siberian rhubarb extract is a well-studied effective alternative treatment for managing climacteric symptoms in menopausal women. ERr731® is as effective as hormone therapy in reducing hot flashes and flush without affecting the endometrial lining and increasing the risk of cancer. As such, Siberian rhubarb remains an effective and safe treatment for long-term use in management of menopausal symptoms.

Posted September 4, 2026.

Chrystal is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Chicago.

References:

1. Faubion DSS. The New Rules of Menopause. 2023.
2. Haver MC. The new menopause: Navigating your path through hormonal change with purpose, power, and facts. Rodale Books; 2024.
3. 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. Sep–Oct 2006;13(5):744–59. doi:10.1097/01.gme.0000240632.08182.e4
4. 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. Mar–Apr 2007;14(2):270–83. doi:10.1097/01.gme.0000251932.48426.35
5. 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. Jan–Feb 2009;15(1):24–34.
6. Hasper I, Ventskovskiy BM, Rettenberger R, Heger PW, Riley DS, Kaszkin-Bettag M. Long-term efficacy and safety of the special extract ERr 731 of Rheum rhaponticum in perimenopausal women with menopausal symptoms. Menopause. Jan–Feb 2009;16(1):117–31. doi:10.1097/GME.0b013e3181806446
7. Dubey VP, Sureja VP, Kheni DB. Efficacy evaluation of standardized Rheum rhaponticum root extract (ERr 731 (®)) on symptoms of menopause: A systematic review and meta-analysis study. J Biomed Res. Apr 18 2024;38(3):278–286. doi:10.7555/jbr.37.20230219
8. Chang JL, Montalto MB, Heger PW, Thiemann E, Rettenberger R, Wacker J. Rheum rhaponticum Extract (ERr 731): Postmarketing Data on Safety Surveillance and Consumer Complaints. Integr Med (Encinitas). Jun 2016;15(3):34–9.
9. Wober J, Möller 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. Nov–Dec 2007;107(3-5):191–201. doi:10.1016/j.jsbmb.2007.04.002
10. Heger PW, Meinert I, Hotz D. The special extract ERr 731(®) from the root of rhapontic rhubarb (Rheum rhaponticum): efficacy in headache/migraine and further climacteric complaints in women in the perimenopause. Front Pharmacol. 2026;17:1831343. doi:10.3389/fphar.2026.1831343