The emails arrive in my in-box every week – women wanting to know if I promote supplements for menopause – [no I don’t, because I’m not a Naturopath] – or asking why they are still getting hot flushes, anxiety and insomnia, even though they are taking a variety of menopause supplements.
This was me as well. But spending hundreds of dollars on supplements that were marketed to me in menopause, did not solve any of my symptoms into the long term, nor did they help my weight, sleep, blood pressure, gut health or joint pain.
Exploring Supplement’s efficacy
At the time, I didn’t understand (nor was I being told by health practitioners), the science behind their efficacy. I had no idea how they worked, what plants they were sourced from (and in many cases, not even plants, but synthetic materials), and how many of them differ in their effect depending if women are in peri-menopause or post-menopause, and if women are on HRT.
If you explore over-the-counter menopause supplements, many of these contain B-vitamins and folate as well as phyto-estrogen compounds. Supplements for menopause symptoms are well marketed and judging by economic reports by Forbes (2022), the menopause supplement industry is predicted to grow to $22.7 billion by 2028 as women seek out alternative treatments (Clayton, Forbes Magazine, 2022), then the menopause supplement industry is not going away!
Understanding the role of supplements in menopause symptoms is an important consideration for Practitioners, especially as these days, supplements are heavily marketed to midlife women.
But it’s not just menopause supplements is it?
Numerous women take supplements promoted in the fitness and sports industries too, and I don’t think that consideration is being given to how these may interact with menopause supplements or HRT.
It’s an issue I discuss with Practitioners who undertake my 12 week Practitioner training on lifestyle science for menopause.
As I scrambled to understand why I was feeling hot and bothered, overweight, anxious, exhausted and depressed and I was already on menopause HRT, my pantry also resembled a health-supplement shop or pharmacy.
There were so many different bottles of menopause supplements and yet, none really made any difference or they might only help one symptom and not another symptom.
I now understand why.
Menopause supplements do not target the different stages of menopause, nor are many supplements evidenced against women’s health and ageing studies and the lifestyles of women, including how much exercise they do, as well as the type of exercise undertaken.
Depending on the stage of menopause women are in, their current lifestyle, which includes nutrition, their stress levels, exercise volume and intensity and any underlying medical conditions, and/or are on other medications, and the gut and liver health of the individual, then all of these factors affect whether menopause supplements may work or not.
This is an important point.
One of the first studies to explore whether botanical and dietary supplements work for women in menopause was undertaken by Associate Professor Stacie Geller and Laurie Sturdee, from the University of Illinois and reported in the Journal of Women’s Health in 2005. [Botanical and Dietary Supplements for Menopausal Symptoms: What Works, What Doesn’t]
I would like to thank these researchers. Because their studies helped to point me in the direction of changing my nutrition in peri-menopause to include powerful plant-based nutrients, instead of taking too many artificial supplements (and yes, all supplements in a bottle or packet are ‘man-made’).
Their studies also helped me to understand that many supplements marketed to women contain powerful herbs such as Black Cohosh, Red Clover, St John’s Wort and/or other herbs that either have anti-inflammatory effects, which improves blood vessel elasticity or anti-anxiety effects that help to slow down parasympathetic nervous system activity.
The image below of all the supplements, was taken as I passed through the Boots Pharmacy at Heathrow Airport. When I asked the young shop assistant what the difference was between them all, she had no idea.
Hence, my recommendation to all of my clients, is to explain that the ingredients matter and that women are best to see a Naturopath or Alternative Medical Therapist, to discuss supplements and any side-effects or interactions with their current medications, including their HRT if they are on it.
Understanding Black Cohosh
Black Cohosh is an herb which has anti-inflammatory effects.
The roots/rhizomes of black cohosh have been used traditionally by Native Americans for a variety of complaints, and Black Cohosh has also been used as a treatment of menopausal disorders in Germany for over 50 years.
So, does it work?
Well, I will let you decide based on if your clients are taking it. In the study by Geller and Sturdie, it was evidenced to help reduce hot flushes and for some women, anxiety – not other symptoms. As the study states,
“The evidence to date suggests that black cohosh is safe and effective for reducing menopausal symptoms, primarily hot flashes and possibly mood disorders.”
Multiple clinical investigations have also suggested that black cohosh extracts are effective in reducing the frequency and intensity of hot flashes among perimenopausal and postmenopausal women, whereas other randomized controlled trials have reported no vasomotor symptom (hot flush) benefits at all. [Geller, Shuman et al, 2009].
A 2023 review of 22 studies of products containing black cohosh extracts, alone or in combination with other herbs, found that they were potentially beneficial for overall menopause symptoms. As the report mentioned, data on specific symptoms showed improvements in hot flashes but not anxiety or depressive symptoms.
So, it’s your client’s decision, in conjunction with their Naturopath. Supplements containing Black Cohosh may or may not, have an effect on your client’s sleep, sore joints, weight, depression, itchy skin or any other symptom that they may have been experiencing.
Understanding Red Clover and St John’s Wort
If your clients are taking supplements, then please encourage them to look at the ingredients list … because they might also contain phytoestrogen extracts, including soy compounds (phyto-oestrogens), St John’s Wort and/ or Red Clover.
The botanicals St John’s Wort and Red Clover (Trifolium pratense L.) are popular among women seeking alternative therapies for the management of menopausal symptoms, especially vasomotor symptoms (hot flushes).
However, researchers suggest that these supplements may be better viewed as having an effect on cardiovascular outcomes, not vasomotor symptoms.
‘Phytoestrogen extracts, including soy foods and red clover appear to have at best only minimal effect on menopausal symptoms but have positive health effects on plasma lipid concentrations and may reduce heart disease.’ [Geller et al., 2009].
For your clients going into post-menopause, this may be a good thing.
Heart disease is the number 1 health concern for women globally who are moving into post-menopause.
St John’s Wort is another herbal product that is marketed heavily to women during their menopause transition. Women think that this is designed to help with hot flush management, but according to numerous studies, there is inconsistent evidence to support the efficacy and safety for hot flushes, but the news is better for help with depression.
St John’s Wort has been shown to improve mild to moderate depression in the general population and appears to show efficacy for mood disorders related to the menopausal transition.
What I don’t think that many women understand is that they must all be careful about over-the-counter supplements. It’s the same for sports supplements too.
There are numerous studies to show that there may be questions about the efficacy of sports supplements as well, and many women also don’t consider the interaction of sport and fitness supplements with hormone replacement therapy or menopause-related supplements.
Women taking menopause supplements who are on any medications whatsoever, must report this to their Doctors. And lots don’t.
I know this, because a report from Alisa Johnson and colleagues in America, following a large literature review of alternative therapies in menopause, concluded that,
“the majority of women using Complementary Alternative Medicine (CAM) do not discuss it with their health care providers …(and) women often report feeling confused about their options and rely on the internet as their primary source of information.” (Johnson et al, 2019, p. 1).
What does work?
There is interesting research in the 2019 review by Johnson et al, that the following practices and strategies show promise to help with hot flush management. These include:
- mind-body practices such as yoga and mindfulness training,
- stress management techniques,
- hypnosis,
- cognitive behavioral therapy,
- acupuncture
- homeopathy, including essential oils
- phytoestrogens (e.g. soy derivatives)
- reflexology
- Vitamin E
- Evening Primrose Oil
Can I also say that the MyMT™ Hot Flush strategies work as well. The foundation for hot flush management is always sleep and liver health, so this is what my own programmes focus on. I talk about these lifestyle strategies in the Health Professional Certification too.
Hot flush management is just one component of a variety of symptoms in menopause. I found myself that some strategies worked for some symptoms, there were other symptoms that remained.
I wonder if this is a similar experience for your clients as well?
References:
Johnson, A., Roberts, L., Elkins, G. (2019). Complementary and Alternative Medicine for Menopause. Journal of Evidence-Based Integrative Medicine, Volume 24: 1-14
Geller, S. Lee P. Shulman, M. et al (2009). Safety and Efficacy of Black Cohosh and Red Clover for the Management of Vasomotor Symptoms: A Randomized Controlled Trial. Menopause,16(6): 1156–1166.
Geller, S. & Studee, L. (2005). Botanical and Dietary Supplements for Menopausal Symptoms: What Works, What Doesn’t. J. Womens Health, 14(7): 634–649.
Hardcastle, K. (2022). Menopause Supplement Industry To Grow To $22.7 Billion By 2028 As Women Seek Out Alternative Treatments. Forbes
Hemminger A, Wills BK. Vitamin B6 Toxicity. [Updated 2023 Feb 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554500/
National Institute of Health (NIH) Black Cohosh
Palmery, M., Saraceno, A., Vaiarelli, A., & Carlomagno, G. (2013). Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci, Vol. 17 – N. 13. Pages: 1804-1813
