Hibiscus for Health in the Menopausal Transition
Hibiscus calyx makes an amazingly full-bodied, sour red tea that can be drunk as a cool summer refresher or from a steaming mug in the winter. This article addresses the specific benefits that hibiscus flower can provide for women as we move into and through the transitional years and enjoy the third trimester of life.
There are many species of Hibiscus out there, but the two main varieties available to us are:
Hibiscus rosa-sinensis (“Chinese rose” from East Asia)
Hibiscus sabdariffa (“roselle” African, Caribbean)
Hibiscus can be incredibly beneficial for perimenopausal and menopausal women who are navigating the hormonal shift from estradiol to estrone. Estradiol is the primary form of estrogen found in women during the ‘reproductive years.’ It is largely produced in the follicles of the ovaries. Here, androstenedione is created and then converted into estrone. Estrone is then converted to the more potent estradiol.
Androstenedione -> Estrone -> Estradiol
After menopause, we are freed from the energetic costs of the menstrual cycle and can use our power for other creative activities. The more mild version of estrogen, estrone, is enough to maintain our health. It can also be converted into estradiol for specific needs. Estrone is produced in adipose tissue (fat) and by the adrenal glands (on top of the kidneys).
Hibiscus calyx makes a very sour tea and in some places, it is simple referred to as “sour tea.” In Traditional Asian Medicine, the sour flavor is associated with the wood phase of the seasonal cycle. This phase can be seen in the Springtime season and the early morning hours. In the life cycle, it is associated with childhood. Sourness is a flavor that represents new growth. We can think of it as a pre-ripe state as we know that unripened fruit is often very sour.
In her 2009 thesis, Kristen Marie Gentile gets curious about the assignment of menopausal women to Ancient Greek temples as priestesses. She says that a post-menopausal identity was likened with youth; so much so that young women and older women were able to act as ritual agents, as priestesses.
In this same way, we can think about using the sour flavor to help bring us back to a "beginner” state. It reduces accumulations through its astringent properties. Astringent means there is an action of constriction of the tissues that helps to rid them of accumulation. (If you’ve ever prepared fresh liver for cooking by squeezing some lemon on it, you will see the liver starts to release old fat and blood that can be washed away before eating).
The metal phase correlates with the autumn season and is generally related with these post-reproductive years. The autumn season is characterized by an expansion outwards, more heat and more dryness. It is the fullest expression of the year and is a time of growth (and accumulation). We harvest during this time.
Spring and autumn are seasons of balance and they are opposites, working to find a harmony with each other. In our bodies, if the autumnal gesture becomes imbalanced, we can see signs of excessive heat and dryness. It can also mean more accumulation (lipids building up in our blood, atherosclerotic plaques building up in our vessels, old blood and lymphatic fluids stagnating in the spleen and liver, accumulation of visceral fat, etc).
To counteract this, we can use the sour flavor in a way that modern people might say, “reverses aging.”
Nutrition-Based Alternative to Hormone Replacement Therapy
A 2023 animal study showed that hibiscus calyx extract binds to a very specific estrogen receptor (ERα) and promoted improved memory when the animals had their ovaries removed. The researchers declared hibiscus as a “nutrition-based alternative to hormone replacement therapy” that can be used without the risk of pharmaceutical estradiol (Lorenzana-Martínez et al).
2. Reduced Cardiovascular Disease Risk
Cardiovascular disease (CVD) includes heart attack (ischemic heart disease) as well as stroke. The known risk factors for CVD are high blood pressure (hypertension), high blood sugar and diabetes and high cholesterol levels (especially high LDL and low HDL). Obesity is often included as a risk factor, but this comes with a significant level of bias.
While there may be some vasomotor benefits to hormone replacement therapy (HRT) in early perimenopause, a 2017 Cochrane review looking at menopausal women over 60 found that “women taking continuous combination menopausal hormone therapy had increased risk of ischemic heart disease, venous thromboembolism, stroke, breast cancer, biliary disease and death from lung cancer” (Jamrozik et al., 2022; Marjoribanks et al., 2017).
It’s important that we find safer ways to navigate the temporary discomfort of the vasomotor symptoms (hot flashes, night sweats) we experience during this life change.
A 2022 meta-analysis and systematic review (Ellis et al.) looking at 17 studies on Hibiscus sabdariffa and its effects on the risk factors of cardiovascular disease showed that hibiscus has significantly positive effects. A 2013 review of human and animal research (Hopkins et al., 2013) found the same.
High doses (>1g per day) were able to significantly lower systolic BP (top number) and it appears to lower diastolic BP (bottom number) as well. People will higher BP when starting hibiscus had the greatest reduction in BP. The average reduction in systolic blood pressure was 8.8mmHg. (We know a decrease of 2 - 5 mmHg reduces the risk of death associated with hypertension, so this is very meaningful!)
Doses of 500 - 1000mg per day significantly lowered low-density lipoprotein (LDL), often called “bad cholesterol.” A low dose of hibiscus (100mg) had a better effect of lowering cholesterol in people with metabolic syndrome than a high dose did.
A combination of the DASH diet and use of hibiscus was more effective than the DASH diet alone in reducing both systolic and diastolic BP.
People who took 10g of hibiscus per day had similar reductions in both systolic and diastolic BP as those taking 50mg of the pharmaceutical drug, captopril (an ACE inhibitor).
In animals, hibiscus was equally as effective at reducing blood glucose levels as the Type II Diabetes drug gilbenclamide.
A small study with 46 participants showed that in combination with nonmedical treatment advice, two cups of hibiscus tea each morning was able to significantly lower systolic BP (by ~8pts) in patients with Stage I hypertension in one months time.(Jalalyazdi et al., 2019).
3. Reduction in post-menopausal weight (“meno belly”)
The term “meno belly” that is going around social media right now refers to the tendency of 60-70% of women to gain 1.5 lbs per year during the decade of their 50’s (Kodoth et al., 2022). This weight gain tends to distribute around the abdomen (visceral fat) and is associated with increased stress hormones (like cortisol) and insulin resistance. However, these changes were found to be more associated with women going through ‘surgical menopause’ (ovary removal) and less problematic for folks transitioning through ‘natural menopause.’ For the latter group, a 2021 review found these changes to be “modest” (Fenton).
A 2017 review stated that,
“Despite its favorable influence on body fat distribution, menopausal hormone therapy cannot be recommended as a treatment for central obesity in midlife women”
(Kapoor et al.) because the cardiovascular risks of hormone therapy could not be justified for the loss of a few pounds.
Hibiscus is likely to reduce overall fat accumulation in the body by promoting an enzyme called AMPK. This enzyme is found in the liver, brain and skeletal muscles, as well as many other tissues. It helps to promote the oxidation of fat in the liver, stimulates the muscles to take in glucose and use up their fat stores, stops cholesterol and triglycerides from being synthesized (Lingesh et al., 2019). In general, drinking hibiscus in addition to exercising helps your body to put its resources, like fat and glucose, to use in building muscle and prevents the accumulation of those resources in the liver, adipose tissue, blood vessels, etc.
A small study from 2014 with 36 people taking hibiscus extract over 12 weeks showed that they had a reduction in serum fatty acids (blood lipids), reduction in abdominal fat, reduced fat accumulation in the liver (Chang et al., 2014). An animal study from 2022 showed that another species of hibiscus reduced insulin resistance and adipose tissue in rats on a high-fat diet (Chen et al.).
In combination with daily exercise and a healthy diet, drinking hibiscus tea can assist with preventing and reducing the modest increase in abdominal weight experienced by postmenopausal women.
4. Maintain Bone Mass and Improve Wound Healing and Skin Quality
We don’t know enough about the transition from estradiol to estrone during the menopausal change and the main focus of our current research seems to be on estradiol replacement therapy, a multi-billion dollar business. Supporting the natural menopausal shift to estrone doesn’t make pharmaceutical companies so much money. They are looking into pharmaceutical therapy with estrone sulfate as an option that might be safer for the heart than estradiol.
It does seem that the estrone being produced in our fatty tissue plays a role in preventing bone loss (Suzuki et al., 1995) which make sense, especially since estrone can be converted into estradiol if necessary. As for what hibiscus can do:
IMPROVED WOUND HEALING:
A 2007 and 2012 animal studies showed that an extract of hibiscus increased the collagen production and growth of cells at wound sites so that wounds healed much faster. The wounds were also less likely to break open (Bhaskar et al., 2012; Shivananda Nayak et al., 2007)
MAINTAINS HEALTHY BONE
Anthocyanins are the colorful, water-soluble pigments that bring the tints to many of the fruits, vegetables and herbs that we eat. Though modern science can’t explain how, contemporary researchers do know that anthocyanins help to slow the breakdown of our bone.(Mao et al., 2021).
Maori people have used a solution of the bark of Hibiscus tiliaceus L and coconut bark to soak bone fractures and sprains because they believe it repairs bone (Whistler, 1985). The people of Fiji wrapped fractures in hibiscus leaves for the same reason. (Smith).
European researcher, G. Matheson, used this indigenous medical knowledge guide their research into a topical herbal medicine for animals that he has patented. The combination of hibiscus extract and coconut oil has been shown to improve wound healing and support the cells of the skin. It also created increased bone formation in animals who have suffered fractures (Matheson, 2010).
5. Prevention of Estrogen-dependent Cancer and Cancer Recurrence
Hibiscus has robust estrogenic activity, meaning that there are many compounds in the herb that seem to have an affinity for binding to estrogen receptors. This means that they block estrogen from binding to those receptors, similar to the drug Tamoxifen that is used to help prevent recurrence of breast cancer (Laskar et al., 2023)
“Hibiscus extract is effective on breast cancer, most notably on generally resistant triple-negative breast cancer, while being selective for normal healthy cells. Hibiscus extract could supplement chemotherapeutic regimens as an adjuvant and lead to a more efficacious treatment approach to reduce chemotherapy dosages and related toxicity.” (Nguyen et al., 2019)
Contraindications and safety concerns
Overall, hibiscus is considered safe for consumption with very few side effects. If taken with pharmaceutical diuretics like hydrochlorothiazide, it could increase urination, so there may be a theoretical risk of dehydration at very high doses (Ellis et al.).
It is important to note that animal studies have also shown hibiscus calyx extract to have anti-implantation activity. It may have the ability to block conception at doses of 400mg/kg of body weight (Vasudeva & Sharma, 2008).
Because of the possible anti-implantation activity of hibiscus, it’s best for those wishing to become pregnant to refrain from large doses of hibiscus during fertile periods until we know more.
How to Add Hibiscus to Your Daily Regimen:
Easiest way - Tazo makes a tea called “Passion.” Two cups of that a day, iced or hot, would do the trick.
I make a hibiscus cooler. For this drink, I use 2.5 quarts of filtered water with a 1.5 cups of dried hibiscus flower, bring to a boil and then reduce to a simmer for 10 minutes. Allow to cool and then strain and add any honey or maple syrup to make it less sour and put in the fridge. When cooking, you can add 2 cinnamon sticks, a teaspoon of vanilla extract or any other flavor that your heart desires.
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