I have seen the confused and exhausted faces of women standing in the supplement aisle many times. And honestly, it is understandable.
Menopause is not a comfortable experience. The decline in estrogen causes the body to undergo change. And you feel them. Hot flashes out of nowhere, the night sweats and sleepless nights.
Prescription medications can seem intimidating. The thought of side effects can make you hesitant to try them. So why not check out the supplement aisle?
But once there, the choices can be overwhelming. Rows of pink bottles promise “Menopause Support and Relief” and “Hormone Balance” in bold letters. The products seem to offer a natural solution to your symptoms but with so many brands and formulations available, it can be exhausting to figure out which one to pick.
Guidance to know if these supplements actually work as they claim is not something you get at the shelf. It is important to understand the scientific evidence behind the promises and the potential risks before reaching for the bottle.
Understanding the Evidence
Before exploring the evidence for various supplements, it is important to know about placebo responses in menopause related hot flash trials. A placebo is an inactive pill that is similar to the supplement but doesn’t include any active ingredient. In menopause trials, women in the placebo group often report fewer hot flashes. This might sound confusing as they are taking a pill with no active ingredient. However, studies suggest that the women’s expectation of the treatment can affect their perception and reporting of hot flash symptoms.
With this in mind, we will look at 7 common supplements marketed for menopause symptoms. We will look at some of the evidence behind them and potential safety concerns.
1. Soy
Soy is a common food item originally cultivated in Asia but currently produced in the United States. Soy is available in dietary supplements. Soy supplements may contain isoflavones which are structurally similar to the hormone estrogen. The supplements are promoted for high cholesterol and blood pressure, diabetes and symptoms of menopause.
One important distinction when discussing soy is the difference between soy foods and soy isoflavone supplements. Soy foods contain various amounts of isoflavones along with proteins and other nutrients. On the other hand, soy isoflavone supplements contain concentrated amounts of these compounds. Due to these differences, soy foods are not directly interchangeable with soy supplements. The evidence we will be looking at are specifically for concentrated supplements. For the food side of that distinction, see our guide to the 5 most powerful hormone-balancing foods.
What Does the Evidence Say?
A 2012 Meta-analysis that looked at 19 trials concluded that soy isoflavones significantly reduced hot-flash frequency by approximately 20.6% and severity by 26.2% compared with placebo. Another Meta-analysis in 2016 that looked at various plant based therapies also concluded soy isoflavones were associated with statistically significant, but modest, improvements in hot flashes and vaginal dryness. It did not significantly reduce night sweats.
- Soy isoflavone supplements are generally safe during short-term use. Evidence is limited for long term safety of Soy Isoflavone supplements.
- People with soy allergy should avoid soy derived Isoflavone supplements.
- Safety of Soy isoflavone supplements in people with hormone sensitive cancer or taking hormone-based treatments is not certain. Consult with a health care provider before starting.
2. Red clover
Red clover is a legume that contains substances called isoflavones that are structurally similar to estrogen. It is also available as a dietary supplement. It is promoted for menopausal symptoms including hot flashes, night sweats and hormonal balance.
What Does the Evidence Say?
A 2016 systematic review and meta-analysis found that women taking red clover experienced approximately two fewer hot flashes per day compared to the placebo group, but the result was not statistically significant.
- Red clover extracts are generally well tolerated with safety reported in clinical studies as long as 2 years. Long-term safety is limited.
- Consult with your health care provider if you have hormone-sensitive cancers or receive hormone-based treatments as safety has not been established in these groups and use of red clover.
3. Evening Primrose Oil
Evening primrose oil dietary supplements are derived from the evening primrose plant. It contains essential fatty acids like omega-6 fatty acids and gamma-linolenic acid. These are involved in different processes in the body that influence inflammation and other physiological processes. They are marketed for premenstrual syndrome as well as menopause symptoms including hot flashes.
What Does the Evidence Say?
A 2024 systematic review found that women who took evening primrose oil for less than 6 months reported less severe hot flashes compared to placebo. However, there was no significant difference in the frequency and duration of hot flashes between the groups.
Another 2025 systematic review and meta-analysis including six randomized controlled trials involving 450 women found that the group taking evening primrose oil had an average decrease in the number of hot flashes per day compared to the placebo group but the result was not statistically significant.
- Evening Primrose oil is generally well tolerated short term in adults but long-term safety has not been studied.
4. St. John’s wort
St. John’s Wort is an herbal supplement commonly marketed for mood support and mild depression. It is also promoted for some menopause symptoms including hot flashes and night sweats.
What Does the Evidence Say?
The research has limited and mixed results for the efficacy of St. John’s wort for hot flashes. A clinical trial with 47 women found no statistically significant reduction in hot flashes in women taking St. John’s wort versus placebo. Even though there is evidence for the use of St. John’s wort for mood changes and depression, there is limited evidence for its benefits especially in menopause related mood changes, mental health and sleep disturbances.
- St. John’s wort can interact with many prescription medications. Check with your health care provider or pharmacist before starting.
5. Vitamin E
Vitamin E is a fat-soluble compound that has antioxidant properties. It is naturally found in foods and also sold as a dietary supplement. It is marketed for menopause symptoms including hot flashes and night sweats.
What Does the Evidence Say?
A 2007 clinical trial with 51 women reported that taking 400 IU of vitamin E daily for four weeks resulted in reduced frequency and severity of hot flashes compared to placebo. However, the study was too small and had questionable methodology and reporting to conclude the benefits. Another 2022 systematic review found no statistically significant reduction in hot flash frequency in women taking Vitamin E compared to placebo.
- Vitamin E is generally tolerated and safe when taken at the recommended dose.
- Vitamin E can interfere with blood clotting. This is particularly concerning if you take blood thinning medications or have blood disorders. Consult with your health care provider before starting.
6. Magnesium
Magnesium is a mineral essential for normal muscle and nerve function as well as bone health. It is also marketed as a dietary supplement for menopausal symptoms including hot flashes, bone health and sleep disturbances.
What Does the Evidence Say?
A randomized clinical trial with 289 women found that there was not a statistically significant difference in frequency and severity of hot flashes between women taking magnesium versus placebo.
- Magnesium is generally safe and tolerated when taken in the recommended amounts. Excessive intake can result in serious complications especially in people with decreased kidney function.
- Magnesium can interact with certain prescription medications including antibiotics and affect absorption.
7. Black cohosh
Black cohosh is a plant native to North America. It is sold in various forms as dietary supplements. It is most commonly used for menopausal symptoms, including hot flashes, night sweats and vaginal dryness.
What Does the Evidence Say?
A 12-month clinical trial with 351 women found that black cohosh did not significantly reduce hot flashes or night sweats compared with placebo. Another trial reported similar findings with some women experiencing higher intensity hot flash symptoms while taking black cohosh. Larger reviews also reached the same conclusion. A 2012 Cochrane review with 2027 women reported there was not sufficient evidence to support the use of black cohosh for menopausal symptoms. A 2016 systematic review also did not find any statistically significant improvement in hot flashes compared with placebo.
- Black Cohosh is generally well tolerated with few reported side effects. There is limited evidence for long term safety.
- It is not known to have clinically significant drug interactions but further studies are needed.
- Black Cohosh has been associated with rare reports of liver injury. It is advised to avoid use in people with liver conditions.
Supplement Safety Considerations
Even though supplements are marketed as natural alternatives to prescription medications, “natural” does not always translate to safe or risk-free. Some supplements can interact with prescription medications or worsen existing health conditions.
If you have breast cancer or history of breast cancer: Some supplements contain chemicals with estrogen type effects. This can be especially concerning for women with hormone-sensitive cancers, women on tamoxifen or other hormone related treatments.
If you have blood disorders or take blood thinners: Certain supplements like Vitamin E can interact with anticoagulants like warfarin, Apixaban and Xarelto or antiplatelets such as clopidogrel or aspirin. These interactions may interfere with blood clotting and increase the risk of bleeding.
If you have a liver condition – some supplements like black cohosh have been associated with rare reports of liver injury. Consult with your healthcare provider before taking them.
If you take antidepressants – supplements like St. John’s wort can interact with some antidepressants increasing the risks for serious complications. Discuss with your provider before starting.
Other Options
Even though there is mixed and limited evidence for menopause supplements, several treatments have stronger scientific evidence. According to The Menopause Society’s position statement, menopausal hormone therapy is the most effective treatment for menopause related symptoms like hot flashes and night sweats, even though it is not appropriate for everyone. For women who cannot or prefer not to receive hormone-based treatments, non-hormonal prescription medications like SSRIs or SNRIs as well as gabapentin have demonstrated benefits in clinical trials. There is also some evidence supporting the use of cognitive behavioral therapy in managing hot flash and night sweats. Fezolinetant is a newer nonhormonal prescription medication approved to reduce the frequency and severity of menopause related hot flashes. It can cause a rare but serious liver injury and requires liver blood testing before and during treatment. Alongside treatment, the day-to-day measures that actually have support behind them are collected in our hot flash survival kit.
If you and your provider decide hormone therapy fits
Gala offers menopause care online, starting at $69 a month with no insurance needed. Board-certified providers in your state review your intake and can prescribe bioidentical estradiol, progesterone or vaginal estradiol, or a non-hormonal option when hormones aren't right for you.
Affiliate link: The Greenest may earn a commission if you sign up.
Finding What Works for You
Menopause affects every woman differently. The management of menopause symptoms is unique to every woman and treatment should be tailored to individual symptoms and preferences. Discussing the available options, whether it be supplements or prescription medications, with your healthcare provider can help you address your concerns and find the approach that works for you. It is also worth walking into that appointment with your numbers for blood pressure, bone density and cholesterol in hand, since menopause shifts several of them.
Selam Melka, PharmD, is a pharmacist with more than ten years of experience in clinical pharmacy and acute care.
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