Menopause Supplements: What the Evidence Actually Shows

What are menopause supplements?

"Menopause supplements" is a broad label for over-the-counter products marketed for hot flashes, sleep, mood, weight or "hormone balance." They usually contain one or more of these:

• Herbs and plant extracts: black cohosh, red clover, dong quai, sage, evening primrose oil, ashwagandha, maca.
• Phytoestrogens: soy isoflavones, flaxseed lignans, equol.
• Vitamins and minerals: vitamin D, calcium, magnesium, B vitamins.
• Other products: probiotics, omega-3s, DHEA, wild yam creams.

In the US, dietary supplements don't need FDA approval for safety or effectiveness before they're sold. Manufacturers are responsible for their own products, and quality can vary between brands and even between batches (FDA).

Do menopause supplements work for hot flashes?

Hot flashes and night sweats are the most common reason women try supplements, so that's where the most research is. The overall picture is disappointing. In its 2023 review of non-hormonal treatments, The Menopause Society (formerly NAMS) did not recommend supplements or herbal remedies for hot flashes, citing a lack of consistent evidence. It also did not recommend soy foods, soy extracts or equol (The Menopause Society, 2023). The Endocrine Society's guideline reached a similar conclusion about botanicals (Stuenkel et al., 2015).

Popular menopause supplement ingredients: what the research shows

Black cohosh

Black cohosh is the most-studied herb for menopause. A Cochrane review of 16 randomized trials with more than 2,000 women found no significant difference between black cohosh and placebo for hot flash frequency or menopausal symptom scores, while hormone therapy was clearly more effective (Leach and Moore, 2012). There have been rare reports of liver damage in people taking black cohosh products (NCCIH). Stop and contact a clinician if you notice dark urine, yellowing skin or eyes, or abdominal pain.

Soy isoflavones

A meta-analysis of 17 trials found that soy isoflavone supplements reduced hot flash frequency by about 21% and severity by about 26% compared with placebo, with considerable variation between studies (Taku et al., 2012). The Menopause Society's later review judged the evidence too inconsistent to recommend them. Some people's gut bacteria convert soy compounds into equol, which may explain why responses differ. Whole soy foods are a healthy source of protein whatever their effect on hot flashes.

By the numbers

Soy isoflavone supplements vs placebo

~21%fewer hot flashes with soy isoflavone supplements than with placeboSource: Taku 2012

~26%lower hot flash severity than with placebo, with wide variation between studiesSource: Taku 2012

Red clover, dong quai, evening primrose oil and sage

These are common in multi-ingredient blends. Trials are small and results inconsistent, and none has convincing evidence for hot flashes. Dong quai and red clover may affect bleeding, so take extra care if you use blood thinners.

Wild yam and "natural progesterone" creams

Wild yam contains diosgenin, which can be turned into progesterone in a lab but not by the human body. Over-the-counter wild yam creams don't provide progesterone and don't protect the uterine lining if you're taking estrogen.

DHEA

DHEA is a hormone precursor that the body can convert into estrogen and testosterone. Oral DHEA hasn't been shown to reliably improve menopause symptoms and can cause acne, hair growth and other side effects. A prescription vaginal form (prasterone) is FDA-approved for painful sex due to menopause. See DHEA for women.

Supplements for bone, sleep and mood

Vitamin D and calcium

Bone loss speeds up after menopause. Calcium and vitamin D are essential nutrients, and supplements make sense if your diet or sun exposure falls short. Many women can get enough calcium from food (dairy, fortified plant milks, tofu set with calcium, canned fish with bones). For vitamin D, the recommended intake for most adults up to age 70 is 600 IU per day, and 800 IU after 70 (NIH Office of Dietary Supplements). More isn't better; very high doses can cause harm. Ask your clinician whether a blood test or bone density scan makes sense for you.

Magnesium

Magnesium is often marketed for sleep. Evidence that it helps sleep in people who aren't deficient is limited. See magnesium for sleep for a closer look.

Probiotics

Probiotics don't treat hot flashes, but specific strains have evidence for IBS symptoms, and one has early evidence for bone loss. See probiotics for perimenopause.

Supplements for weight

No supplement has good evidence for treating menopause weight gain. Strength training, protein, sleep and medical care when appropriate are the evidence-based options; see menopause weight gain.

How to choose a supplement safely

1. Check with your clinician or pharmacist first, especially if you take prescription medications, have liver or kidney disease, or have had breast cancer or another hormone-sensitive cancer.
2. Look for third-party testing such as USP or NSF marks, which confirm the product contains what the label says.
3. Prefer single ingredients with clear doses over proprietary blends, so you know what's working or causing side effects.
4. Be skeptical of big claims. "Balances hormones," "melts belly fat" or "clinically proven" without named studies are red flags.
5. Try one thing at a time for a set period, such as eight to twelve weeks, and keep a symptom log. Stop if there's no clear benefit.

What works better than supplements for hot flashes?

Hormone therapy is the most effective treatment for hot flashes and night sweats, and The Menopause Society says it should be considered for appropriate women within 10 years of their final period (The Menopause Society, 2022). For women who can't or prefer not to use hormones, effective non-hormonal options include cognitive behavioral therapy, clinical hypnosis, certain SSRIs and SNRIs, gabapentin, oxybutynin and fezolinetant (Veozah), an FDA-approved non-hormonal medication (The Menopause Society, 2023). Our guide to hot flashes compares these options.

Amie HRT+ is a compounded cream that combines estradiol and progesterone, with the strength chosen by a licensed clinician. It is not FDA-approved. A clinician reviews your health history, including any history of breast cancer, blood clots, stroke or heart disease, and decides whether it's appropriate. FDA-approved hormone therapy and non-hormonal medications are also available through your own doctor.

The bottom line