This post was written by Le Pham, PharmD, Parkview Health.
Menopause is the absence of menstrual periods in women for at least twelve consecutive months. It most often occurs as a natural part of aging, but it can also happen due to ovarian surgery, chemotherapy or certain medications that affect hormone production.
While menopause cannot be cured, its symptoms can be managed through healthy habits, hormone therapy and non-hormonal options, including vitamins and certain plant-based supplements. In this post, we'll examine popular herbal remedies for addressing menopause symptoms and review current research on their effectiveness.
Plant-based supplements for menopause
Herbal supplements have been used for centuries in traditional medicine worldwide. Today, they are readily available and don't require a prescription, making them more accessible than traditional medicines. However, the US Food and Drug Administration (FDA) does not strictly regulate herbal supplements. The quality and strength of these products can vary among brands, and some may interact with other prescription or over-the-counter medications.
That being said, several herbal products have been used traditionally to help relieve symptoms associated with menopause. If you are considering taking any supplement, it is essential to consult a healthcare provider to ensure the product is safe and effective for you.
Black cohosh
Black cohosh is an herb that is native to the eastern United States and Canada. Indigenous people have used the underground stems and roots to make medicine since as early as the late 19th century.
The exact mechanism by which black cohosh may improve menopausal symptoms is not fully understood. Studies have found that black cohosh may help alleviate vasomotor symptoms, such as hot flashes and night sweats. However, the herb does not appear to improve mood-related symptoms, including anxiety and depression, significantly. Moreover, it can also lessen joint pain and stiffness. Overall, the strongest evidence for its potential benefit remains in the management of vasomotor symptoms, although study results have been mixed.
Black cohosh is usually safe to consume, though some people may experience side effects like headaches, dizziness, nausea, and vomiting. Rarely, it may harm the liver, so patients who have liver problems should talk to their provider before taking black cohosh.
Phytoestrogens
Phytoestrogens are the plant compounds that act like estrogen in the body (phyto in Greek means plant). Because they look like estradiol, the main form of estrogen, they can mimic some of its effects. There are two major types of phytoestrogens.
Isoflavones:
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soybeans and soy products (tofu, soy milk, edamame)
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legumes (lentils, chickpeas, peas, beans)
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nuts (almonds, peanuts, sunflower seeds)
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fruits (strawberries, raspberries)
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vegetables (asparagus, broccoli, Brussels sprouts)
While vegetables do contain isoflavones, the amounts vary and are typically not significant. The majority of isoflavones come from soybeans and soy products.
Lignans:
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seeds (flaxseed, sesame, pumpkin, sunflower)
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whole grains (wheat, barley, rye, oats, rice)
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red clover (legume family)
Multiple studies have shown that soy-based products and red clover may help reduce the frequency of hot flashes, but research on flaxseed has yielded mixed results. Other small studies suggest phytoestrogens may help prevent bone loss after menopause, but the results are mixed, and more data is needed.
Adding phytoestrogens to the diet is usually safe and healthy. Studies show soy causes few side effects, but eating too much can cause bloating, constipation or nausea.
Patients with or at risk of estrogen-dependent cancers such as breast cancer, ovarian cancer and uterine cancer should talk to their healthcare provider before taking soy-based supplements. This also includes those who have a family history of cancers or who have been taking estrogen-only therapy for a long time.
Phytoestrogens can also affect the absorption of thyroid medications, so it is recommended to separate the timing of these medications and supplements to avoid potential interaction.
Calcium and vitamin D
Calcium helps keep bones strong and prevents bone loss. Postmenopausal women should consume a combined 1,200 mg of calcium daily from food and supplements.
Vitamin D helps calcium absorption and supports bone health. Most adults need 600-800 IU per day, but patients with low vitamin D (confirmed via blood test) may need a higher dose, typically 50,000 IU administered once a week.
Many multivitamins for postmenopausal women include calcium, vitamin D and other nutrients. Check the nutrition label on the bottle. While calcium is important for bone health, ingesting more than 2000 mg of calcium a day, is too much and can cause kidney stones, constipation or upset stomach. Calcium can also reduce the absorption of some medications, such as iron supplements, thyroid hormones or water pills.
If your diet and multivitamins already provide enough calcium and vitamin D, it is not necessary to take extra vitamin D and calcium supplements separately.
Additional considerations
Herbal products like dong quai, evening primrose oil, DHEA, and mixed herbal blends are often marketed to alleviate menopause symptoms. However, there is not enough strong evidence to support their effectiveness. In 2023, The Menopause Society stated that supplements should not be used to treat hot flashes because of poor study quality and limited safety data. So far, only calcium and vitamin D have clear guidance on safety and effective use.
Final thoughts
The decision to take supplements should be a discussion between the providers and their patients. Patients who wish to try a supplement should choose a single-ingredient product rather than a combination formulation. This allows patients and their healthcare providers to better evaluate effectiveness and to monitor potential drug interactions.
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References
Clinical Implications of Herbal Supplements in Conventional Medical Practice: A US Perspective
Exploring the Efficacy and Safety of Black Cohosh (Cimicifuga racemosa) in Menopausal Symptom Management
Mayo Clinic and North Central Cancer Treatment Group hot flash studies: a 20-year experience
Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review
Evaluation of Clinical Meaningfulness of Red Clover (Trifolium pratense L.) Extract to Relieve Hot Flushes and Menopausal Symptoms in Peri- and Postmenopausal Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int.
Association of Physical Activity and Fracture Risk Among Postmenopausal Women
The 2023 nonhormone therapy position statement of The North American Menopause Society
