Ginseng is an herbal remedy that is widely used in East Asian countries and is used to treat a spectrum of illnesses, including cancer and cardiovascular disease (CVD).  A recent randomized, double-blind, placebo-controlled study explored the use of red ginseng (RG; Panax ginseng) for the treatment of menopausal symptoms.  (Red ginseng is one of the most popular forms of ginseng and is obtained by steaming and drying unpeeled 6-year-old raw white ginseng.)
Postmenopausal women between the ages of 45 and 60 years  (n=72) were randomized to receive either red ginger (3 g of RG, including 60 mg of ginsenosides, per day) or placebo for 12 weeks. Changes in menopausal symptoms were assessed using the Kupperman index and the menopause rating scale.  In addition, cardiovascular risk factors (lipid profiles, high-sensitivity C-reactive protein, and carotid intima-media thickness) and serum estradiol levels were measured.
Significant improvements in the Kupperman index and in the menopause rating scale scores were observed in the RG group compared with the placebo group.  In addition, total cholesterol and low-density lipoprotein cholesterol significantly decreased in the group receiving RG.  Serum estradiol levels were not influenced by RG.This study demonstrates that red ginseng has beneficial effects on both menopausal symptoms and cardiovascular risk factors in postmenopausal women.  RG has physiologically active components that are absent in raw white ginseng and is therefore superior to traditional ginseng. The authors suggest that the beneficial effects of RG are due to the phytoestrogens they contain.  These plant-like estrogens have chemical structures and functions similar to those of human estrogen.

This study indicates that red ginseng may be attractive option for postmenopausal women who have menopausal symptoms, especially those with elevated cardiac risk factors.  Compared to the data on the effects  of soy products, black cohosh, and other herbal remedies on menopausal symptoms, these findings are relatively robust.

However, certain questions remain.  Although red ginseng has been used for over 2000 years, do we have enough data regarding its safety?  The authors suggest that red ginseng might be an attractive option for women who cannot take estrogen; however, it is clear that phytoestrogens are biologically active and, at the cellular level, act like estrogen.  Presumably, phytoestrogens also carry some risk given their estrogen-like activities, yet this is an area that has not been well-studied.

Women with breast cancer and menopausal symptoms often turn to alternative treatments.  In this population, estrogen replacement therapy is avoided.  Are phytoestrogens a safer option?  While there have been some epidemiologic studies that have suggested that women with diets high in phytoestrogens (e.g., Asian women) are at lower risk for breast cancer, the data are inconsistent and it remains unclear whether phytoestrogens are protective or whether they may increase the risk of adverse outcomes related to breast cancer risk.

Ruta Nonacs, MD PhD

Kim SY, Seo SK, Choi YM, et al. Effects of red ginseng supplementation on menopausal symptoms and cardiovascular risk factors in postmenopausal women: a double-blind randomized controlled trial.  Menopause. 2012;19(4):461-6.