Jack Harley, Therapeutic Neuroscience at Oxford University
reviewed by Dr Michael Yapko
Thursday, September 16, 2021
Jack Harley, Therapeutic Neuroscience at Oxford University
Thursday, September 16, 2021

Menopause supplements: Do they actually work?

Contents

Menopause supplements are big business. Each year around 64% of women in the US use supplements to improve their well-being, sleep better, strengthen bones and reduce hot flashes (among other things). As a treatment for menopause symptoms, they seem like a no-brainer⸺they're natural, easy to find in any drug store, supermarket or health shop, and seem to be a no-risk option. But are they too good to be true?

Natural supplements for menopause

Plants, roots, herbs, and flowers have been used as medicine for thousands of years to manage everything from croup in babies to menopause symptoms in women.
The modern era is no different. In shops, shelves and shelves are dedicated to supplements⸺the power of nature bottled as tablets, powder, cream, or tea.
For women going through menopause, these natural remedies are an appealing choice, either to take in addition to hormone replacement therapies (HRT), or instead of HRT.
Supplements come with big claims about reducing menopause symptoms⸺but keep in mind over-the-counter menopause supplements are not regulated in the same way as prescription drugs but may carry adverse side effects.

Just because menopause supplements are derived from natural substances does not make them risk-free.

The role of phytoestrogens

The most common menopause symptoms, such as hot flashes, increased weight, mood swings, and increased facial hair, are associated with falling levels of the hormone estrogen. Many menopause supplements seek to naturally replace this hormone through phytoestrogens⸺a natural compound that mimics the effect of estrogen.

There is good news, bad news, and uncertain news about phytoestrogens.

The good news is; some studies have shown that phytoestrogen lowers occurrences of hot flashes and the risk of osteoporosis, heart disease, and breast cancer.

However, that doesn't mean they are the miracle cure-all.

Alternative studies have shown that phytoestrogens don't help improve menopause symptoms and may increase the risk of certain cancers. Overall, more research needs to be done to understand the full effects and potential risks of phytoestrogens on the body.

It's always important to speak to your doctor about phytoestrogens before buying them because they can interact with certain medications and are not appropriate for everyone. It's a confusing situation, so it's better to be informed than just believe the label on the bottle.

With that in mind, let's look at some of the more popular menopause supplements.

Black cohosh

Black cohosh (Actaea racemosa) is a flowering plant native to eastern North America and contains phytoestrogens. Menopause supplements containing an extract from the root of the black cohosh herb are often marketed as relieving symptoms of menopause such as hot flashes, night sweats, vaginal dryness, and mood swings.

You might also come across black cohosh in Chinese medicine as a herbal supplement called Sheng Ma.

Out of all menopause supplements, this is the one most thoroughly researched.  

Some studies have supported the use of black cohosh, finding it safe and effective for treating menopausal symptoms. But not everyone agrees, and a number of reviews have concluded there is insufficient evidence to support its use.

Part of the problem may be quality control, with some supplements being found to contain the wrong herb.

Side effects of this supplement are uncommon but can include mild nausea, upset stomach, and rashes.

While this may be one of the more promising menopause supplements on the market, more research needs to be done to confirm black cohosh's effectiveness and long-term safety.

Red clover extract

Red clover (Trifolium pratense) is a dark flowering plant used in traditional medicine and native to Europe, Asia, and northwest Africa and also contains phytoestrogens.

So far studies into red clover as a menopause supplement have been mixed. Red clover extract showed promise in one review of 11 clinical trials, and another showed it improved general quality of life, but at the same rate as the placebo.

No serious adverse effects have been reported, but mild symptoms such as nausea and headaches occasionally occur. Due to the lack of long-term safety of this supplement, it is not recommended that you take it for more than one year or without consulting your doctor.

Red Clover flower

Evening primrose oil

Evening primrose oil is made from the evening primrose plant (Oenothera biennis), native to central and eastern North America.

You may be familiar with evening primrose as a supplement that eases period pain when used with vitamin E.

A recent review of several studies suggested that evening primrose oil was no more beneficial than placebo at reducing symptoms. Another study showed black cohosh was a more effective supplement. Once again, more research is needed.

Evening primrose is generally safe for adults to consume. However, it is worth noting that evening primrose oil may interact with HIV drugs, and you should consult your local doctor if you are currently taking other medications.

Evening Primrose flower

Valerian root

Taken in the form of a tea or tablet, valerian root (Valeriana officinalis) has been shown to help promote better sleep. But be careful⸺in a small number of people it can actually promote wakefulness!

There are some early signs that valerian root may help reduce hot flashes. One study of 68 women demonstrated that those who took valerian capsules three times a day for eight weeks experienced a reduced number of hot flashes.

Valerian is generally safe and can be considered a reasonable treatment option for women who are not taking hormonal therapy. However, valerian is occasionally associated with symptoms such as mild headaches or nausea.  

Ginseng

Ginseng is a very popular herb used in traditional Chinese medicine to boost immune function and heart health.

There is only limited evidence of ginseng's effectiveness in treating menopause symptoms, but it has been shown to support mood and memory.

Recent research has also shown that ginseng can even reduce the risk of cardiovascular disease, which occurs more commonly with menopause.

The potential side effects of ginseng include diarrhea, sleeping difficulty, and skin rashes. It may also interact with certain medications such as blood thinners, so it is recommended that you consult a healthcare professional prior to consumption.

Maca

Maca (Lepidium meyenii), also known as Peruvian ginseng, is an edible plant native to South America. The plant has been used for hundreds of years in traditional medicine to treat conditions such as infertility, hormonal imbalances, and menopausal symptoms.

Only a handful of studies have evaluated maca for its effectiveness in treating symptoms of menopause.

That said, some small studies have indicated that maca may be effective in treating mild depression, and boosting libido in postmenopausal women.

Although no significant side effects have been reported, the safety of this supplement has not been evaluated.

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Dong Quai

Dong Quai (Angelica sinensis) is a herb that grows in the high altitude mountains of China, Japan, and Korea.

Dong Quai has been shown to affect the levels of estrogens in animals, but there is no evidence that the same effect occurs in humans. In fact, one clinical study of over 70 women showed that Dong Quai did not improve symptoms of hot flashes or vaginal dryness.

Dong Quai should not be taken with medications that include aspirin and blood thinners, and it may increase your skin's sensitivity to the sun. Researchers recommend caution for people with estrogen-receptor-positive breast cancer who are thinking of taking Dong Quai.

St-John's-Wort

St-John's-wort has been studied extensively for its effectiveness in treating mild to moderate anxiety and depression, but studies in relation to menopause are more limited.

A 2010 study involving 100 women showed promising signs that St-John's-wort was effective in treating hot flashes, but only after eight weeks.

There are some concerns about the side effects of taking this supplement as it influences your liver enzymes. It should also be taken with caution if you are currently taking medications that interfere with serotonin levels, such as medications for anxiety, some anticancer drugs, and anticonvulsants.

Vitamin D & Calcium

Vitamin D is often taken on its own to help improve the symptoms of mild depression. When taken in conjunction with calcium, it's also thought to improve bone health.

One recent study showed that vitamin D slowed bone density loss, while calcium improved bone density.

While it may be tempting to start popping these supplements to improve your bone health, the International Osteoporosis Foundation recommends these supplements are only used for patients with a high risk of calcium or vitamin D deficiency.

Talk to your doctor before taking vitamin D supplements so they can test your vitamin D levels. Your doctor will only recommend it if you are deficient.

In the general population, calcium is thought to be more likely to cause harm than good, increasing the risk of myocardial infarction and stroke. A better alternative to calcium supplements is a healthy, balanced diet with calcium rich foods.

Soy

Soy is the Queen of the phytoestrogen rich supplements. After the Women's Health Initiative (WHI) study caused doubt about the safety of HRT, it became the darling go-to treatment for menopause symptoms.

Over the years, there have been many studies into the consumption of soy products, like milk, tofu, and beans. While some research suggests soy may help to reduce hot flashes, night sweats, and bone loss, others don't.

There are benefits and risks to increasing your intake of soy, so if you are considering increasing soy in your diet or taking any menopause supplements, make sure you discuss it first with your doctor.

The alternatives

Menopause supplements are not the only natural remedy available. One prescription-free alternative is hypnotherapy for hot flashes, which has been clinically shown to reduce hot flashes by 80% and improve sleep quality in menopausal women.  

Hypnotherapy is recommended by the North American Menopause Society as a first line treatment for menopausal hot flashes. It has also been shown to improve sleep quality and reduce anxiety during menopause.

While hypnotherapy isn't available at your local drugstore, it is easy to find through your phone, with an at-home hypnotherapy app, developed by leading clinicians.

The Wrap Up

Although hormonal therapy is considered the most effective treatment for menopause symptoms, many women prefer natural alternatives. Herbs such as black cohosh and red clover are popular and may relieve symptoms such as hot flashes, sleeping difficulties, and mood swings. However, most supplements for menopause are only weakly supported by scientific evidence or not supported at all, and further research is needed. A natural alternative to menopause supplements is hypnotherapy for hot flashes, which has been clinically proven to reduce hot flashes, with no side effects.

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Mindset Health only uses high-quality sources, including peer-reviewed research, to support our articles. We work with experts to ensure our content is helpful, accurate and trustworthy.

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