Up to 75% (1) of women going through menopause report using supplements or alternative therapies for menopause symptoms.
In a survey of 500 participants (2) at UIC Chicago, about 70% of patients taking plant based dietary supplements for menopausal symptoms had not told their doctors. There is a general idea out there that because these products are “all natural” they are safer somehow, which is not always true.
As a primary care doctor, I often see patients who are interested in knowing more about alternative medicines/supplements or already taking them particularly for bothersome symptoms like hot flashes.
One thing we know for sure is the placebo effect can play a large role in reducing hot flash frequency and severity (3) which can make it even more difficult to see if supplements are helpful.
In general, there is no hard evidence for any herbal/botanical/dietary supplements and when evaluating whether to take a supplement or not, generally we should weigh its effectiveness (compared to a placebo) with any safety concerns. Some of the more common herbal supplements that are mentioned in conversation or in online forums are Black Cohosh, Red Clover, Ginseng, Primrose oil, Flaxseed, and St. John’s wort.
Black cohosh, while generally safe, does not have any strong evidence supporting its use. While there haven’t been reports of any major adverse effects, it is probably best for patients with a history of breast cancer to avoid this since there is some possibility that it could stimulate breast tissue in a mechanism like estrogen. Ashwagandha is in the same boat of being generally safe without good evidence of true benefit though there are some small studies where patients reported improvement.
Red clover, Primrose oil, and Ginseng have no real evidence either way. St. John’s wort also has little evidence supporting its use and it is generally safe in small doses. However, St John’s wort and Red Clover have many drug interactions with medications like blood thinners, so it is particularly important to report use to your doctors.
Some of the other commonly mentioned supplements are often found in our usual diet. Foods like soy, flaxseed, lentils, and some fruits and vegetables have plant-derived estrogens called “phytoestrogens,” which can also be found in the form of Isoflavone in stores. These phytoestrogens have no reported benefit and since they may also stimulate breast tissue, anyone with a history of breast cancer should avoid them too.
Only supplementation with Calcium (found in dairy products) and Vitamin D (found in fish and fortified milks and cereals) has been shown to help prevent post-menopausal bone density loss, though not particularly with hot flashes.
The bottom-line is that there is no robust evidence for any herbal or plant-based supplements in treating menopausal symptoms, whether due to lack of controlled trials or due to lack of significant results in small trials. Since most of them are safe in small doses, ultimately, they may be worth a try for the right candidate. However, some can have interactions with other medications, and some may increase risk of breast cancer because of the effect of stimulating estrogen. The main thing to keep in mind is to report usage to your doctors to make sure they are safe in your specific situation.
- https://www.uptodate.com/contents/menopausal-hot-flashes/abstract/104,105
- https://pubmed.ncbi.nlm.nih.gov/12544679/
- https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1204163/full
