Rhodiola Rosea and the Energy Shift of Menopause

“Pause menopause with Rhodiola rosea” is the title of a 2016 research paper, which proposes that this adaptogenic herb might help women through the menopause transition.

“Pause menopause” carries the dominant narrative: that menopause is a malfunction to be halted, and that a remedy works by acting on menopause itself. That’s the story most of us have heard. But if you look deeper, the picture becomes clear. Menopause isn’t a disease to be paused — it’s a natural transition. The symptoms women suffer aren’t menopause itself; they’re the result of the body’s natural shifts becoming blocked — and in Rhodiola’s case the relevant one is the Energy Shift: the stage where the brain struggles to change fuel and the stress response fires on a loop. Rhodiola doesn’t pause menopause. What it can do is help unblock that Energy Shift — which is exactly why it eases the symptoms it does.

That’s also why Rhodiola has become one of the supplements I most often recommend in my clinic: not as an oestrogen booster, but because it can help stabilise cortisol and the stress response, and because so many women find it improves their memory, mental clarity, cognitive speed, energy and mood. For some, as the authors note, it can also improve libido and sexual function.

So this note sets out what Rhodiola actually is, how it works, what the evidence does and doesn’t support — and the question I’m asked most: how it sits alongside HRT.

What Rhodiola rosea is

Rhodiola rosea is a herb that grows in cold, high-altitude regions like Siberia and the Arctic, used for centuries as a tonic for stamina and resilience. In modern terms it’s classed as an adaptogen: a plant whose active compounds — chiefly rosavins and salidroside — appear to help the body adapt to physical and psychological stress, rather than acting on any one organ in a single, drug-like way.

The most important thing to understand up front is what Rhodiola is not. It is not a hormone, and taking it does not top up your oestrogen. Its central role is in how the body handles stress and energy — which is precisely why it’s relevant to menopause, where a falling oestrogen makes the stress system far more reactive than it used to be.

How it works

There are two strands to Rhodiola’s action, and they’re very different in how well evidenced they are.

The first, and best supported, is its effect on the stress response. Menopause makes the hypothalamic–pituitary–adrenal (HPA) axis — the body’s cortisol-control system — more volatile, which is part of why the middle of the transition can feel so wired, exhausted and foggy. Rhodiola appears to blunt the erratic cortisol surges and steady that system; in one placebo-controlled trial it reduced the cortisol response on waking. This is the mechanism I see matter most clinically, and it maps directly onto the Energy Shift — the stage driven by an over-firing stress response and a brain short of fuel.

The second strand is the SERM proposal – where Rhodiola is proposed to act as a Synthetic Selective Estrogen Receptor Modulator. In the test tube, compounds in Rhodiola bind to oestrogen receptors (both ERα and ERβ). But binding is not the same as switching a receptor on — and when Rhodiola was given by mouth to animals, it produced none of the signals you’d expect if it were acting like oestrogen. The hypothesis is that it might interact with oestrogen receptors in a tissue-selective way, and also work “downstream” through cellular signalling pathways, to offer some of oestrogen’s protective effects without behaving like oestrogen in the blood. It’s biologically plausible and genuinely interesting — but it remains a hypothesis awaiting proper human study.

What it can help with

The strongest evidence — and the reason I use it — is for the stress-and-energy cluster: several placebo-controlled trials report improvements in stress-related fatigue, low mood, and mental performance such as concentration and mental clarity. Many of these trials were in stressed or younger adults rather than menopausal women specifically, so I’m extrapolating from a real but not menopause-specific signal. Clinically, it’s often where I see the quickest wins: more morning energy, less of the wired-but-tired feeling, clearer thinking.

The research then sets out a wider set of proposed, longer-term effects — neuroprotective, cardiovascular-protective, bone-protective and anti-stress properties — drawn largely from cell and animal studies, often of salidroside rather than the whole herb. I treat these as mechanisms researchers are actively exploring, not as established benefits: Rhodiola has not been shown to prevent or treat osteoporosis, heart disease or cancer, but the direction of this early work is encouraging.

On the question women worry about most — safety in hormone-sensitive tissue — the preliminary evidence is reassuring rather than alarming: oral Rhodiola doesn’t appear to stimulate breast or uterine tissue, and in some laboratory and animal studies its compounds actually inhibited breast-cancer-cell growth rather than driving it. The authors also note it has few side effects compared with synthetic SERMs.

That said, it isn’t for everyone, and the side effects that do occur are stimulatory, not hormonal: because it’s energising, it can occasionally cause restlessness, disturbed sleep, a more noticeable heartbeat or heightened anxiety in people sensitive to stimulants, and it shouldn’t be stacked with a lot of caffeine. At higher intake it has a mild blood-thinning effect, so anyone on anticoagulants or with a bleeding tendency should only use it under medical supervision, and there’s a theoretical caution in bipolar disorder. I don’t give doses here as a blanket recommendation — the right form and amount depend on the person, which is what an assessment is for.

Rhodiola and HRT

This is the question I’m asked most, and it’s where Dr Google is least reliable.

You may have read that Rhodiola “lowers your HRT” or reduces oestrogen by a set percentage. That overstates what the research actually shows. In the key animal study, Rhodiola given on its own produced no oestrogenic effect at all — no rise in oestradiol, no change in uterine size, no drop in luteinising hormone. When it was given alongside oestradiol, two things happened: the body’s metabolism of oestradiol increased, and circulating oestradiol dipped slightly — but that dip was not statistically significant, meaning it can’t be relied on as a real effect. The authors’ own conclusion was measured: Rhodiola did not amplify oestrogen’s action and, taken orally, is “unlikely to present an oestrogenic risk.”

So my current position is this: there’s no established, meaningful interaction between Rhodiola and HRT — but it also hasn’t been properly studied in women taking HRT. That uncertainty is exactly why, if you’re on HRT, Rhodiola (like any supplement) is something to discuss with your prescriber rather than start on your own.

Where it fits — and who I’d think twice about

In my clinic, Rhodiola earns its place as support for the stress-and-energy side of the transition — the wired-but-tired exhaustion, the foggy thinking, the flattened mood that come from a stress system running too hot. It’s not a hormone and it’s not a substitute for one; what it can do is take some of the pressure off the Energy Shift, which is often where women feel most overwhelmed. For some, better energy and clearer thinking also bring back libido and motivation as a knock-on effect.

It isn’t right for everyone, though. I’m cautious with anyone who is very anxious or sensitive to stimulants, who has a heart-rhythm problem, who takes blood-thinning medication, or who has bipolar disorder — and with anyone on HRT or other prescription medicines, where it should be considered alongside what they’re already taking, not bolted on independently. Like any tool, it works best chosen for the right person at the right stage, rather than taken because the internet recommended it.

How strong is the evidence?

The strongest evidence for Rhodiola is for stress, fatigue, mood and mental performance — and even there, many trials were done in stressed or younger adults rather than menopausal women specifically. The wider claims you’ll see — for the heart, bones and brain — rest largely on cell and animal studies, often of a single compound (salidroside) rather than the whole herb. The appealing idea that it’s a “natural SERM” is a hypothesis proposed in a 2016 review, not a settled fact, and the authors themselves call for proper human studies.

So Rhodiola’s actions are biologically plausible, well tolerated for most, genuinely useful in my experience for the stress-and-energy cluster, which to be fair most women have, and it remains one of my favourite supplements.

References

Gerbarg, P.L. and Brown, R.P. (2016) ‘Pause menopause with Rhodiola rosea, a natural selective estrogen receptor modulator’, Phytomedicine, 23(7), pp. 763–769. PMID: 26776957

Eagon, P.K. et al. (2004) ‘Rhodiola rosea exhibits oestrogenic-like activity / SERM properties’, presented at the American Association for Cancer Research (AACR) Annual Meeting. LINK