Pueraria mirifica, a member of the Leguminoseae family, is an herb indigenous to Thailand and has been researched extensively for its beneficial effects in the treatment of menopausal symptoms. Puerarin, the main isoflavone component of Pueraria mirifica, modulates estrogen receptor expression and could be a safe alternative for the treatment of estrogen dependent conditions. Pueraria also contains the phytoestrogen miroestrol, which functions as a selective estrogen receptor modulator by competitively binding to estrogen and blocking excessive estrogen receptor stimulation. Pueraria root extract has no known side effects and no known drug interactions have been reported. Its beneficial effects on alleviating menopausal symptoms include the reduction of bone loss and hot flashes and the improvement of blood lipid profiles, which could lead to protection from cardiovascular disease. Results of clinical trials have suggested that Pueraria may be a safe alternative to traditional drugs because of its beneficial effects on bone density, genitourinary function and cardiovascular health without the side effects or risks associated with hormone replacement therapy.
AARM REFERENCE REVIEWS:
These are AARM reference reviews in which clinicians can obtain a quick overview of understanding with respect to how herbs, nutrients, and hormones can be used effectively in clinical practice. The dosages recommended are based on therapeutic results. Side effects that have not been seen in clinical experience or found in clinical studies but only been theorized have been identified and depicted as Unsubstantiated Theoretical Concerns.
Since many nutrients and herbs on the market have not gone through double-blind studies but have been used extensively in clinical settings for hundreds, and for some thousands of years, these reference reviews have attempted to give a unified opinion on how to use these herbs effectively. The opinions expressed are from different professors and experts in the field of nutritional and botanical medicine. Some information is based on personal opinions and can not be quantified as fact. However, if clinicians only restricted themselves to what is fully proven by double-blind studies, the art of healing and restoring health with nutrients and herbs would be lost.
Pueraria mirifica is a Leguminoseae family herb that thrives in warm moist climates around the world. Pueraria mirifica is indigenous to Thailand, where it known by the name Kwao Kruea Khao. It has been the subject of numerous recent clinical investigations for possible benefits to menopausal women.
Pueraria mirifica contains the isoflavones puerarin and daidzein and the related phytoestrogen miroestrol. Miroestrol and deoxymiroestrol, like other phytoestrogens, act as Selective Estrogen Receptor Modulators (SERMs). As such, these compounds selectively bind to estrogen receptors and act as agonists or antagonists depending on the tissue and the physiologic circumstances. For instance, miroestrol competes with estrogen and blocks the excessive stimulation of estrogen receptors often seen with breast or endometrial cancer. On the other hand, these phytoestrogens act as estrogen agonists to support bone density, promote cardiovascular health, and to alleviate menopausal symptoms.
Pueraria root extract is typically recommended in the treatment of menopause-related hot flashes, at a dose range of 200 mg containing 150 mcg Miroestrol twice per day. Symptom resolution of hot flashes often occurs within a few weeks of therapy.
Pueraria root extract has no known side effects at commonly prescribed doses. There are no confirmed drug interactions found in any clinical trial or quantitative systematic review.
PUERARIA SPECIES CONTAIN THE ISOFLAVONE PUERARIN
Pueraria, among other legumes, contains isoflavones known to support bone density and the vascular system. Puerarin, the major isoflavone in Pueraria, has been shown to be readily absorbed and quickly eliminated. Accordingly, dosing this herb three or more times daily might be advised, to perpetuate blood levels and maintain constant physiologic support of hormonal functions. In contrast to phytoestrogens such as genistein and daidzein, which may stimulate estrogen receptors in cells that are already over-expressing estrogen receptors (e.g. in estrogen-dependent cancers), puerarin has been shown to decrease estrogen receptor over-expression. Puerarin may thus be considered a safer option in the treatment of estrogen dependant conditions and estrogen dependent cancers.
PUERARIA ALLEVIATES MENOPAUSAL SYMPTOMS
Pueraria mirifica has been shown to alleviate vasomotor and other menopausal symptoms. The herb reduces FSH and LH levels in menopausal monkeys suggesting that an estrogen-like effect exerts negative feedback to pituitary gonadotrophin release. FSH and LH levels returned to pretreatment levels upon cessation of the Pueraria supplementation. Pueraria mirifica has also been found to decrease serum parathyroid hormone and calcium levels in aged monkeys suggesting reduced bone loss. Flavones from Pueraria roots were found to prevent uterine atrophy and prevent increases in total cholesterol and triglycerides that typically follow rapid declines in system-wide estrogen levels. This study also showed that Pueraria limits the increase in abdominal fat stores that occur in ovariectomized menopause animal models. A human clinical study demonstrated that Pueraria lobata, a close but less potent relative of Pueraria mirifica, improves cognitive parameters and attention span compared to placebo.
PUERARIA MAY SUPPORT GENITOURINARY INTEGRITY
Loss of integrity of the vaginal and uroepithelial mucosal membranes is a common occurrence in and after menopause and can lead to vaginal dryness, dyspareunia, and an increased tendency to bladder infections and urinary incontinence. Since pharmaceutical grade hormones often have tremendous side effects on the entire body including increased risk for breast and endometrial cancer, as well as damaging effects on vasculature, there is an ongoing search for herbal, nutritional, and other alternative medications that maintain urinary and vaginal epithelium. Animal studies have shown Pueraria mirifica to have a supportive effect on the urinary and vaginal mucosal tissues in a manner similar to, but less powerful than estradiol. Pueraria has been shown to have beneficial effects on the vaginal mucosa, improving vaginal pH, dryness, and dyspareunia as well as achieving measurable estrogen-like effects on atrophic vaginal epithelia.
PUERARIA MAY IMPROVE BLOOD LIPIDS
Menopause negatively impacts lipid metabolism as evidenced by increased occurrence of cardiovascular disease and worsening lipid profiles. Prior to menopause, women display less heart disease compared to men, but postmenopausally there is a marked change and women and men display nearly equal incidence of atherosclerosis and other cardiovascular diseases. Blood pressure, insulin resistance, and lipid profiles quickly alter to equal that seen in the male population. Soy isoflavones and other plants in the legume family have been reported in numerous studies to offer a protective effect on the vasculature and slow the detrimental changes to lipids and metabolism seen post-menopause.
Postmenopausal women given Pueraria mirifica for two months had improved lipid profiles compared to a placebo control group. HDL increased 34% while LDL decreased 17% in the group receiving the Pueraria. Individual phytoestrogens were examined and miroestrol and coumestrol were both reported to act on both alpha and beta estrogen receptors while daidzein and genistein were more active on beta estrogen receptors. The researchers proposed that Pueraria phytosterol constituents enabled gene transcription in a manner that benefited lipid metabolism. Other studies have not been able to demonstrate improved blood lipids with the use of Pueraria and further investigations are warranted.
CLINICAL TRIALS SHOW PUERARIA OFFERS HORMONAL SUPPORT WITHOUT OVER-STIMULATING THE BREASTS AND ENDOMETRIAL LINING
Another double-blind, placebo controlled human clinical trial administered several dosage strengths of Pueraria versus a placebo medication to postmenopausal women aged 45 to 60 and measured the effects on blood lipids, bone alkaline phosphatase, endometrial thickness, and breast parameters. Liver and renal blood parameters were also assessed to rule out any possible organ toxicity caused by the herb. After 24 weeks the groups receiving the Puerariashowed a significant decrease in bone alkaline phosphatase suggesting a reduction in bone resorption and turnover. No measurable changes were seen in the breasts or the endometrium in any group, suggesting that Pueraria does not have a proliferating effect on the uterine lining or breast tissue as do pharmaceutical grade estrogens.
Another clinical pilot study found that Pueraria mirifica at either 50 mg or 100 mg a day for six months reduced perimenopausal symptoms of hot flashes and night sweats. Serum estradiol increased slightly with no detectable changes in FSH or LH levels. A larger follow up clinical trial compared the effects of Pueraria mirifica to conjugated equine estrogen, with and without medroxyprogesterone. There were no significant differences between treatment groups with respect to climacteric symptoms, and all participants reported some relief of vasomotor, urogenital, and psychological symptoms. There were no significant differences in FSH, LH, or serum estradiol levels between the groups, indicating that Pueraria was as effective as conventional pharmaceutical therapy.
PUERARIA AS A SAFE ALTERNATIVE HORMONE REPLACEMENT THERAPY
Due to its numerous benefits Pueraria mirifica is considered a safe alternative to improve bone density, genitourinary epithelium, blood lipids, inflammatory markers, and general menopausal symptoms. Pueraria may be considered an effective alternative to pharmaceutical hormone replacement therapy. Furthermore, research is suggesting the safe application of Pueraria in cases of hormonal excess, hormone-dependent cancers and genetic over-expression of estrogen receptors (Fig 1), lending the plant wide utility in the general population.
DISCLOSURE OF INTERESTS
Dr. Saunders reports personal fees related to employment or seeing patients from CCNM, the Dundas Naturopathic Centre, and from Beaumont Health Systems, Troy Hospital, MI, outside the submitted work. Dr. Winston reports personal fees from Herbalist & Alchemist, Inc, outside the submitted work. Dr. Stansbury has nothing to disclose.
- Sugiyama H, Kumamoto T, Suganami A, Nakanishi W, Sowa Y, Takiguchi M, et al. Insight into estrogenicity of phytoestrogens using in silico simulation.
- McCabe LD, et al. Antiresorptive effects of phytoestrogen supplements compared with Estradiol or Risedronate in postmenopausal women using (41)Ca methodology.
- Wattanapitayakul SK, Chularojmontri L, Srichirat S. Effects of Pueraria mirifica on vascular function of ovariectomized rabbits.
- Penetar DM, Teter CJ, Ma Z, Tracy M, Lee DY-, Lukas SE. Pharmacokinetic profile of the isoflavone puerarin after acute and repeated administration of a novel kudzu extract to human volunteers.
- Tang X, Zhu X, Liu S, Nicholson RC, Ni X. Phytoestrogens induce differential estrogen receptor beta-mediated responses in transfected MG-63 cells.
- Lamlertkittikul S, Chandeying V. Efficacy and safety of Pueraria mirifica (Kwao Kruea Khao) for the treatment of vasomotor symptoms in perimenopausal women : Phase II study.
- Trisomboon H, Malaivijitnond S, Watanabe G, Cherdshewasart W, Taya K. The estrogenic effect of Pueraria mirifica on gonadotrophin levels in aged monkeys.
- Trisomboon H, Malaivijitnond S, Suzuki J, Hamada Y, Watanabe G, Taya K. Long-term treatment effects of Pueraria mirifica phytoestrogens on parathyroid hormone and calcium levels in aged menopausal cynomolgus monkeys.
- Wang J, Guo Y, Niu J, Liu J, Wang L, Li P. Effects of Radix Puerariae flavones on liver lipid metabolism in ovariectomized rats.
- Cherdshewasart W, Subtang S, Dahlan W. Major isoflavonoid contents of the phytoestrogen rich-herb Pueraria mirifica in comparison with Pueraria lobata.
- Woo J, Lau E, Ho SC, Cheng F, Chan C, Chan ASY, et al. Comparison of Pueraria lobata with hormone replacement therapy in treating the adverse health consequences of menopause.
- Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women – Principal results from the Women’s Health Initiative randomized controlled trial.
- Manonai J, Seif C, Boehler G, Juenemann KP. The effect of Pueraria mirifica on cytologic and urodynamic findings in ovariectomized rats.
- Manonai J, Chittacharoen A, Theppisai U, Theppisai H. Effect of Pueraria mirifica on vaginal health.
- Polotsky HN, Polotsky AJ. Metabolic Implications of Menopause.
- Agrinier N, Cournot M, Ferrieres J. Dyslipidemia in women after 50: Age, menopause or both?
- Ren J, Kelley RO. Cardiac Health in Women With Metabolic Syndrome: Clinical Aspects and Pathophysiology.
- Carlson S, Peng N, Prasain JK, Wyss JM. Effects of botanical dietary supplements on cardiovascular, cognitive, and metabolic function in males and females.
- Okamura S, Sawada Y, Satoh T, Sakamoto H, Saito Y, Sumino H, et al. Pueraria Mirifica Phytoestrogens improve Dyslipidemia in Postmenopausal Women Probably by Activating Estrogen Receptor Subtypes.
- Manonai J, Chittacharoen A, Udomsubpayakul U, Theppisai H, Theppisai U. Effects and safety of Pueraria mirifica on lipid profiles and biochemical markers of bone turnover rates in healthy postmenopausal women.
- Chandeying V, Lamlertkittikul S. Challenges in the conduct of Thai herbal scientific study: Efficacy and safety of phytoestrogen, pueraria mirifica (Kwao Keur Kao), phase I, in the alleviation of climacteric symptoms in perimenopausal women.
- Chandeying V, Sangthawan M. Efficacy comparison of Pueraria mirifica (PM) against conjugated equine estrogen (CEE) with/without medroxyprogesterone acetate (MPA) in the treatment of climacteric symptoms in perimenopausal women: Phase III study.