Menopause supplements: what black cohosh and soy evidence shows

The evidence is mixed and modest. NCCIH, the NIH center for complementary health, says that many dietary supplements have been studied for menopause symptoms, but none has clearly been shown to be helpful. Black cohosh and soy isoflavones have the most research, and their results are inconsistent, with small effects at best on hot flashes.

That is not the same as saying nothing works for menopause. It means supplements sit well behind the treatments that doctors use, and some carry safety issues that sales pages tend to skip. Here is what the main health sources say ingredient by ingredient, what to watch for, and how to read a menopause offer.

What is menopause, and when do symptoms start?

MedlinePlus says you have reached menopause when you have gone 12 months without a period. The time leading up to it is called perimenopause, or the menopausal transition. It usually begins in your 40s, can last several years, and the most common age for reaching menopause is between 45 and 55. NCCIH gives an average age of 51.

During the transition, the ovaries make less estrogen and progesterone. The National Institute on Aging says symptoms can include hot flashes, night sweats, trouble sleeping, joint and muscle discomfort, pain during sex, moodiness, forgetfulness and trouble concentrating. It also notes that some women have no or only mild symptoms.

Because symptoms vary so much, so does the need for treatment. A woman with occasional warm flushes has different options from one who cannot sleep for weeks. The NIA advises women who are concerned about symptoms to talk with a doctor about lifestyle changes or medications that might help.

What do doctors recommend for hot flashes?

NCCIH describes hormone therapy, using estrogen alone or estrogen with progestin, as the most effective therapy for menopausal hot flashes. It also says hormone therapy may increase the risk of breast cancer, blood clots and other serious medical problems. So if it is used at all, it should be at the lowest dose and for the shortest time that controls symptoms. Women with certain conditions, such as breast cancer, liver disease or a history of blood clots, should not use it. NCCIH adds that non-hormonal medicines are also used, and that the FDA approved a non-hormonal treatment for hot flashes in 2013.

This is the benchmark. A supplement that promises hot flash relief should be compared with what hormone therapy and other prescribed options do, and with what the placebo groups in trials experience. Trials need a placebo group for exactly this reason, and a testimonial cannot show what would have happened without the product.

Does black cohosh work for menopause symptoms?

Black cohosh is the best-known herb for menopause. NCCIH says a substantial number of studies in people have looked at it. A 2023 review of 22 studies of products containing black cohosh extracts, alone or with other herbs, found they were potentially beneficial for overall menopause symptoms. Data on specific symptoms showed improvements in hot flashes but not in anxiety or depression. NCCIH's menopause page, which refers to an earlier 2012 review, says results have been inconsistent and that review found not enough evidence to support its use.

Safety needs attention. NCCIH says black cohosh has been used safely in studies lasting as long as a year and is generally well tolerated. But rare cases of liver damage, some serious, have been reported in people taking products labeled as black cohosh, and it is uncertain whether the herb was responsible. NCCIH also says some commercial products have been found to contain the wrong herb or unlisted mixtures. If you develop symptoms of liver trouble, such as dark urine, abdominal pain or jaundice, stop and contact a health care provider.

NCCIH also stresses that black cohosh and blue cohosh are different herbs. Blue cohosh can cause high blood pressure, high blood sugar and chest pain. It is uncertain whether black cohosh is safe for women who have had hormone-sensitive conditions such as breast or uterine cancer.

What about soy and red clover?

Soy and red clover contain isoflavones, plant compounds that are chemically similar to estrogen. NCCIH says soy isoflavone supplements or soy protein may help reduce the frequency and severity of hot flashes, but the effect may be small and research results have not been completely consistent. It also says soy isoflavones probably have a beneficial effect on bone density in postmenopausal women.

For red clover, NCCIH says studies of hot flashes have had inconsistent results, and some had a high risk of bias. For flaxseed, studies found products no more effective than placebo in reducing hot flashes.

On safety, NCCIH says soy extracts with concentrated isoflavones have been used safely for up to 6 months in studies, and soy protein supplements for up to 16 weeks. Some people are allergic to soy. Because phytoestrogen supplements may act like estrogen, they may not be safe for women who should not take estrogen. Long-term safety has not been established, so a plan to take them for years needs a doctor's input.

Are the other supplements sold for menopause worth trying?

NCCIH's summary of the remaining ingredients is short and sobering.

• Vitamin E. A few small studies suggest a small effect. In one study, women taking vitamin E averaged one fewer hot flash per day. High doses may increase bleeding risk and interact with blood thinners such as warfarin.
• DHEA. It is uncertain whether it helps, and even short-term use may have harmful effects, including liver damage.
• Dong quai. So little research exists that no conclusions can be drawn, and it may interact with warfarin.
• Evening primrose oil, ginseng, kava, melatonin and wild yam. Very little research for menopause symptoms, so no conclusions can be reached. Kava has been linked to a risk of severe liver disease.

The pattern across the list is that the research is small, and that several of these carry liver or bleeding risks. If you take prescription medicines, particularly blood thinners, check with a pharmacist before adding an herb.

How do menopause offers compare in our reviews?

Many menopause offers we review in the women's health category are not capsules at all. They are ebooks, meal plans and programs. That changes what you should check.

• The Menopause Solution review covers a $49 ebook bundle. Its caution about hormone therapy risk rests on real research, our review found, but the page misattributes it and backs its own program only with an uncheckable "95.4% success" figure.
• The Hormone Health Meal Plan review covers a $10.99 planner with no named author or size shown before you pay. We treat it as a shopping-list aid, not a way to manage symptoms.
• The Menopause D-I-WE Cooch Ball Program review covers an $88 pelvic floor program from a named founder. Its refund terms conflict between the seller's site and the checkout.

Two habits help with all of them. First, ask what the page actually cites, and whether the cited study tested the product or only a related idea. Second, read the refund terms. Our ClickBank refund guide explains how to file, and how we review shows what we look at.

What should you check before buying a menopause supplement?

1. Talk to a doctor first. Symptoms that seem hormonal can have other causes, and MedlinePlus and the NIA both point women with troublesome symptoms to a doctor.
2. Name the ingredient and the dose. Compare the amount on the label with the amount used in studies. Blends with no individual amounts cannot be compared.
3. Check for interactions. Blood thinners, liver conditions and hormone-sensitive cancers change what is safe.
4. Look for the wrong-herb problem. NCCIH notes that some black cohosh products contained other herbs. Prefer products from companies that name their manufacturer and publish full labels.
5. Set a time limit. The safety data NCCIH cites cover weeks to months, not years. Decide in advance how long you will try it, and stop if you notice liver symptoms or other problems.

FAQ

What supplement is best for menopause hot flashes?

No supplement has clearly been shown to help, according to NCCIH. Black cohosh and soy isoflavones have the most research, and results are inconsistent. Hormone therapy is described by NCCIH as the most effective treatment for hot flashes, which is a conversation for your doctor.

Is black cohosh safe?

NCCIH says it has been used safely in studies lasting up to a year and is generally well tolerated, but rare cases of liver damage have been reported, and it is uncertain whether black cohosh was the cause. People with liver disorders should ask a provider before taking it.

Do soy isoflavones really help menopause symptoms?

They may reduce the frequency and severity of hot flashes, but the effect may be small and the research has not been consistent, per NCCIH.

Are natural menopause remedies safer than medication?

Not automatically. NCCIH lists liver risks for black cohosh, DHEA and kava, bleeding risk for high-dose vitamin E, and interactions with warfarin for dong quai. Natural does not mean risk-free.

The bottom line

For menopause symptoms, supplements have small, inconsistent evidence and real safety issues for some women. The best-supported medical option for hot flashes is hormone therapy, with its own risks, and other prescribed medicines exist. If you want to try a supplement anyway, choose a full-label product, pick one ingredient at a time, check your medicines and health history, and use the refund window if it does nothing. This article is general information, not medical advice. Talk to a doctor or pharmacist about your own symptoms.