Efficacy of Labisia pumila and Eurycoma longifolia standardised extracts on hot flushes, quality of life, hormone and lipid profile of peri-menopausal and menopausal women: a randomised, placebo-controlled study

  • Sasikala M. Chinnappan Biotropics Malaysia Behad
  • Annie George Biotropics Malaysia Berhad, Section U1Hicom Glenmarie, Industrial Park Shah Alam, Selangor, Malaysia
  • Malkanthi Evans KGK Science, London, ON, Canada
  • Joseph M. Anthony KGK Science, London, ON, Canada
Keywords: Eurycoma longifolia, menopausal symptoms, hot flush


Background: Interest in herbal medicines and non-hormonal therapies for the treatment of menopausal symptoms has increased since the publication of adverse effects of estrogen replacement therapy. Vasomotor symptoms are the most characteristic and notable symptoms of menopause.

Objective: To investigate the changes in the frequency and severity of hot flush and associated vasomotor symptoms experienced by peri-menopausal and menopausal women supplemented with the herbal formulation (Nu-femme™) comprising Labisia pumila (SLP+®) and Eurycoma longifolia (Physta®) or placebo.

Design: Randomised, double-blind, placebo-controlled, 24-week study enrolled 119 healthy women aged 41–55 years experiencing peri-menopausal or menopausal symptoms and supplemented with Nu-femme™ or placebo. The primary endpoint was comparative changes between treatment groups in the change in the frequency and severity of hot flushes. The secondary objectives were to assess the changes in the frequency and severity of joint pain, Menopause Rating Scale (MRS) and Menopause-Specific Quality of Life (MENQOL) questionnaire domain scores. Concentrations of serum hormone, lipid profile, bone markers, sleep quality and vitality were also studied as secondary objectives.

Results: At week 12, significant (P < 0.01) improvements in hot flush symptoms were observed in Nu-femme™ and placebo groups. Even though there was no significant difference between groups, higher percentage of improvement, 65%, was seen in Nu-femme™ compared to 60% in placebo. Significant improvements (P < 0.001) in MRS and MENQOL scores at weeks 12 and 24 were observed in both groups, respectively. Luteinising hormone and follicle-stimulating hormone levels were significantly reduced (P < 0.05) at weeks 12 and 24, respectively, compared to baseline in the Nu-femme™ group, with no significant changes observed in the placebo group. There were significant (P < 0.05) reductions in serum low-density lipid and triglycerides levels at week 12 in Nu-femme™ group, but no changes seen in placebo group. At the end of week 24, changes in haematology and clinical chemistry parameters remained within normal clinical ranges in both groups.

Conclusion: Herbal formulation consists of L. pumila and E. longifolia (Nu-femme™) may support reduction in hot flushes and improvements in hormone and lipid profile in healthy peri-menopausal and menopausal women.


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  1. Davis SR, Lambrinoudaki I, Lumsden M, Mishra GD, Pal L, Rees M, et al. Menopause. Nat Rev Dis Primers 2015; 1: 15004. doi: 10.1038/nrdp.2015.4

  2. Williams RE, Levine KB, Kalilani L, Lewis J, Clark RV. Menopause-specific questionnaire assessment in US population-based study shows negative impact on health-related quality of life. Maturitas 2009; 62(2): 153–9. doi: 10.1016/j.maturitas.2008.12.006

  3. Heinemann LA, Potthoff P, Schneider HP. International versions of the Menopause Rating Scale (MRS). Health Qual Life Out 2003; 1(1): 28. doi: 10.1186/1477-7525-1-28

  4. Woods NF, Mitchell ES. Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women’s lives. Am J Med 2005; 118(Suppl 12B): 14–24. doi: 10.1016/j.amjmed.2005.09.031

  5. McKinlay SM, Brambilla DJ, Posner JG. The normal menopause transition. Maturitas 1992; 14(2): 103–15. doi: 10.1016/0378-5122(92)90003-M

  6. Dibonaventura MD, Chandran A, Hsu MA, Bushmakin A. Burden of vasomotor symptoms in France, Germany, Italy, Spain, and the United Kingdom. Int J Womens Health 2013; 5: 261–9. doi: 10.2147/IJWH.S39027

  7. Genazzani AR, Schneider HPG, Panay N, Nijland EA. The European Menopause Survey 2005: women’s perceptions on menopause and post-menopause hormone therapy. Gynecol Endocrinol 2006; 22(7): 369–75. doi: 10.1080/09513590600842463

  8. Sussman M, Trocio J, Best C, Mirkin S, Bushmakin AG, Yood R, et al. Prevalence of menopausal symptoms among mid-life women: findings from electronic medical records. BMC Women’s Health 2015; 15: 58. doi: 10.1186/s12905-015-0217-y

  9. FDA (2018). Women’s health topics menopause. Available from: https://www.fdia.gov/ForConsumers/ByAudience/ForWomen/WomensHealthTopics/ucm117978.htm [cited 3 June 2019]

  10. Moore A. Advances in menopausal therapy: the tissue-selective estrogen complex. J Am Acad Nurse Pract 2013; 25(3): 126–33. doi: 10.1111/j.1745-7599.2012.00804.x

  11. Fait T. Menopause hormone therapy: latest developments and clinical practice. Drugs in Context 2019; 8: 212551. doi: 10.7573/dic.212551

  12. Johnson A, Roberts L, Elkins G. Complementary and alternative medicine for menopause. J Evid Based Integr Med 2019; 24: 2515690X19829380.

  13. Franco OH, Chowdhury R, Troup J, Voortman T, Kunutsor S, Kavousi M, et al. Use of plant-based therapies and menopausal symptoms: a systematic review and meta-analysis. JAMA 2016; 315(23): 2554–63. doi: 10.1001/jama.2016.8012

  14. Embong WHW. Healing herbs of Malaysia. Kuala Lumpur: Federal Land Development Authority; 2007.

  15. Jamal JAHP, Miligan SR. Kacip fatimah: a Malay traditional herb for pregnant women. 1999. Available from: https://books.google.ca/books?id=RF-lnQAACAAJ [cited 15 May 2019].

  16. Norhayati MN, George A, Hazlina NH, Azidah AK, Intan Idiana H, Law KS, et al. Efficacy and safety of Labisia pumila var alata water extract among pre- and postmenopausal women. J Med Food 2014; 17(8): 929–38. doi: 10.1089/jmf.2013.2953

  17. Samy JSM, Lee KLW, Wong KM, Khoon M. Herbs of Malaysia: an introduction to the medicinal, culinary, aromatic and cosmetic use of herbs. Shah Alam, Selangor Darul Eshan, Malaysia: Marshall Cavendish Editions; 2009.

  18. Talbott SM, Talbott JA, George A, Pugh M. Effect of tongkat ali on stress hormones and psychological mood state in moderately stressed subjects. J Int Soc Sports Nutr 2013; 10(1): 28. doi: 10.1186/1550-2783-10-28

  19. Chua LS, LeeSY AbdullahNSarmidiMR . Review on Labisia pumila (Kacip Fatimah): bioactive phytochemicals and skin collagen synthesis promoting herb. Fitoterapia 2012; 83(8): 1322–35. doi: 10.1016/j.fitote.2012.04.002

  20. Burkill IH. A dictionary of the economic products of the Malay Peninsula. London, UK: Crown Agent; 1935.

  21. Bhathena SJ, Velasquez MT. Beneficial role of dietary phytoestrogens in obesity and diabetes. Am J Clin Nutr 2002; 76(6): 1191–201. doi: 10.1093/ajcn/76.6.1191

  22. Tambi MI, Imran MK, Henkel RR. Standardised water-soluble extract of Eurycoma longifolia, Tongkat ali, as testosterone booster for managing men with late-onset hypogonadism? Andrologia 2012; 44: 226–30. doi: 10.1111/j.1439-0272.2011.01168.x

  23. Jaganath IB, Ng LT. Herbs: The green pharmacy of Malaysia. Kuala Lumpur, Malaysia: Vinpress; 2000.

  24. Chinnappan SM, George A, Ashok G, Choudhary YK. Effect of herbal extract Eurycoma longifolia (Physta®) on female reproductive hormones and bone biochemical markers: an ovariectomised rat model study. BMC Complement Med Ther 2020; 20(1): 1–9.

  25. Talbott SM. Human performance and sports applications of Tongkat Ali (Eurycoma longifolia). In: Bagchi D, Nair S, CK Sen (eds) Nutrition and Enhanced Sports Performance. San Deigo, US: Academic Press; 2019 (pp. 729-734).

  26. Zhong LL, Tong Y, Tang GW, Zhang ZJ, Choi WK, Cheng KL, et al. A randomized, double-blind, controlled trial of a Chinese herbal formula (Er-Xian decoction) for menopausal symptoms in Hong Kong perimenopausal women. Menopause 2013; 20(7): 767–76. doi: 10.1097/GME.0b013e31827cd3dd

  27. Abdul Kadir A, Nik Hussain NH, Wan Bebakar WM, Mohd DM, Mohammad W, Zahiruddin WM, et al. The effect of Labisia pumila var. alata on postmenopausal women: a pilot study. Evid Based Complement Alternat Med 2012; 2012. doi: 10.1155/2012/216525 page 1-6

  28. Ghazanfarpour M, Najafi MN, Sharghi NB, Mousavi MS, Babakhanian M, Rakhshanded H. A double-blind, placebo-controlled trial of fennel (Foeniculum vulgare) on menopausal symptoms: a high placebo response. J Turk Ger Gynecol Assoc 2018; 19(3): 122. doi: 10.4274/jtgga.2017.0124

  29. Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Syst Rev 2013;12. doi: 10.1002/14651858.CD001395.pub4 page 122-127

  30. MacLennan AH, Wilson DH, Taylor AW. Hormone replacement therapies in women at risk of cardiovascular disease and osteoporosis in South Australia in 1997. Med J Aust 1999; 170(11): 524–7. doi: 10.5694/j.1326-5377.1999.tb127876.x

  31. Freeman EW, Ensrud KE, Larson JC, Guthrie KA, Carpenter JS, Joffe H, et al. Placebo improvement in pharmacologic treatment of menopausal hot flashes: time course, duration, and predictors. Psychoso Med 2015; 77(2): 167. doi: 10.1097/PSY.0000000000000143

  32. Butt DA, Deng LY, Lewis JE, Lock M. Minimal decrease in hot flashes desired by postmenopausal women in family practice. Menopause 2007; 14(2): 203–7. doi: 10.1097/01.gme.0000235370.32103.4c

  33. Kargozar R, Azizi H, Salari R. A review of effective herbal medicines in controlling menopausal symptoms. Electronic physician 2017; 9(11): 5826. doi: 10.19082/5826

  34. George A, Udani J, Abidin NZ, Yusof A. Efficacy and safety of Eurycoma longifolia (Physta®) water extract plus multivitamins on quality of life, mood and stress: a randomized placebo-controlled and parallel study. Food Nutr Res 2018; 62. doi: 10.29219/fnr.v62.1374

  35. Henkel RR, Wang R, Bassett SH, Chen T, Liu N, Zhu Y, et al. Tongkat Ali as a potential herbal supplement for physically active male and female seniors—a pilot study. Phytother Res 2014; 28(4): 544–50. doi: 10.1002/ptr.5017

  36. Wheater G, Elshahaly M, Tuck SP, Datta HK, van Laar JM. The clinical utility of bone marker measurements in osteoporosis. J Transl Med 2013; 11(1): 201. doi: 10.1186/1479-5876-11-201

  37. Oncken C, Prestwood KM, Cooney JL, Unson C, Fall P, Kulldorff M, et al. Effects of smoking cessation or reduction on hormone profiles and bone turnover in postmenopausal women. Nicotine Tob Res 2002; 4(4): 451–8. doi: 10.1080/1462220021000018399

  38. Jayusman PA, Mohamed IN, Alias E, Dom SM, Shuid AN. Effects of standardized quassinoid-rich Eurycoma longifolia extract in a rat model of osteoporosis due to testosterone deficiency: a densitometric, morphometric and biomechanical study. J Xray Sci Technol 2018; 26(4): 643–56. doi: 10.3233/XST-17366

  39. Rehman S, Choe K, Yoo H. Review on a traditional herbal medicine, Eurycoma longifolia Jack (Tongkat Ali): its traditional uses, chemistry, evidence-based pharmacology and toxicology. Molecules 2016; 21(3): 331. doi: 10.3390/molecules21030331

  40. Fathilah SN, Abdullah S, Mohamed N, Shuid AN. Labisia pumila prevents complications of osteoporosis by increasing bone strength in a rat model of postmenopausal osteoporosis. Evid Based Complement Alternat Med 2012; 2012. doi: 10.1155/2012/948080 page 1-8

  41. Effendy N, Shuid A. Time and dose-dependent effects of Labisia pumila on bone oxidative status of postmenopausal osteoporosis rat model. Nutrients 2014; 6(8): 3288–302. doi: 10.3390/nu6083288

  42. Brown WJ, Dobson AJ, Mishra G. What is a healthy weight for middle aged women?. Int J Obes (Lond) 1998; 22(6): 520–8. doi: 10.1038/sj.ijo.0800617 page 122-127

  43. Government of Canada (2019). Available from: https://www.canada.ca/en/public-health/services/chronic-diseases/cardiovascular-disease/hypertension.html [cited 25 June 2019].

  44. Heart and Stroke Foundation (2019). How a healthy heart works. Available from: https://www.heartandstroke.ca/heart/what-is-heart-disease/how-a-healthy-heart-works [cited 25 June 2019].

How to Cite
Chinnappan, S. M., George, A., Evans, M., & Anthony, J. M. (2020). Efficacy of <em>Labisia pumila</em> and <em>Eurycoma longifolia</em&gt; standardised extracts on hot flushes, quality of life, hormone and lipid profile of peri-menopausal and menopausal women: a randomised, placebo-controlled study. Food & Nutrition Research, 64. https://doi.org/10.29219/fnr.v64.3665
Original Articles