Common menopause symptoms include hot flashes, vaginal dryness, chills, night sweats, weight gain, irregular periods, labile moods, decreased sex drive, poor sleep, bone loss, headaches, anxiety, and depression (2).
Since itâ€™s a completely natural process, treatments focus primarily on symptom management. A variety of pharmaceutical drugs are available, but the risk of side effects leads many women to use alternative therapies either alongside â€” or instead of â€” conventional treatments (1).
Remember to consult your healthcare provider before adding any supplements to your routine.
Here are 10 herbs and supplements commonly used to manage menopause symptoms, plus the evidence behind them and relevant safety information.
1. Black cohosh
Black cohosh (Actaea racemosa) is a flowering plant native to the eastern regions of North America (3).
Long used in Native American herbal medicine to treat a variety of illnesses, itâ€™s currently most often taken to alleviate night sweats and hot flashes associated with menopause.
Two reviews that included data on over 8,000 perimenopausal, menopausal, and postmenopausal women concluded that insufficient evidence exists to determine whether black cohosh is any more effective than a placebo at treating menopause symptoms (4, 5).
Black cohosh isnâ€™t recommended if you have a history of liver disease, and some reports note adverse reactions from contaminated supplements. Thus, itâ€™s best to choose supplements that have been tested for purity by a third party (6).
Adverse effects are relatively rare, but the most reported are mild nausea, upset stomach, and skin rashes (6).
2. Red clover
Red clover (Trifolium pratense) is an herbaceous flowering plant in the legume family (7).
Itâ€™s a rich source of isoflavones. These compounds function similarly to the hormone estrogen and may help alleviate symptoms associated with the decline in estrogen production that occurs with menopause (7).
Red clover is frequently used to treat or prevent various menopause symptoms, including hot flashes, night sweats, and bone loss.
A review of 11 studies in menopausal women found red clover more effective at alleviating hot flashes than a placebo (8).
Nonetheless, this evidence is weak, and more research is needed.
Two small older studies showed that supplemental doses of red clover isoflavones may slow bone loss in menopausal women, compared with a placebo (9, 10).
No serious side effects have been reported, but mild symptoms like headache and nausea are possible. Due to a lack of robust safety data, you shouldnâ€™t take red clover for longer than 1 year (7, 11).
Note that this flowering plant may not be safe for children, pregnant or breastfeeding women, or women who have breast cancer or other hormone-sensitive cancers (7).
3. Dong quai
Dong quai (Angelica sinensis), also known as female ginseng, is an Asian herb thatâ€™s closely related to celery, carrot, and parsley. It grows in the cooler regions of China, Korea, and Japan.
Dong quai is frequently used in traditional Chinese medicine to support womenâ€™s health and treat symptoms associated with premenstrual syndrome (PMS) and menopause (11).
Despite its popularity, thereâ€™s very little human research to support dong quaiâ€™s efficacy for menopause symptoms.
One study in 71 women that compared dong quai and a placebo revealed no significant differences in hot flashes or vaginal dryness (11).
However, two separate studies using dong quai in conjunction with other herbs, including red clover, black cohosh, and chamomile, found that hot flashes and night sweats were significantly reduced (1).
Ultimately, more research is needed.
Dong quai is generally safe for most adults but may increase your skinâ€™s sensitivity to the sun. It may also have a blood-thinning effect, so its use is discouraged among people who take blood thinners (12).
4. Evening primrose oil
The seeds of evening primrose (Oenothera biennis) are used to make evening primrose oil (EPO).
This flowering plant is native to central and eastern North America, and its seed oil is frequently used to treat menopause symptoms like hot flashes and bone loss.
Yet, study results are mixed.
One older study concluded that EPO was no more effective than a placebo at mitigating hot flashes. However, a more recent study noted that EPO was approximately 10% more effective at reducing hot flash severity than a placebo (1, 13).
Another older study compared a calcium supplement and combined EPO, calcium, and omega-3 supplement for stopping bone loss in pre- and post-menopausal women. Both groups retained bone mineral density, but the EPO supplement wasnâ€™t more effective than the calcium (14).
The short-term use of EPO is generally safe for most adults. Reported side effects are mild but may include nausea and stomach pain (15).
EPO may interact negatively with certain HIV drugs. You should talk to your healthcare provider before taking EPO, especially if youâ€™re on any other supplements or medications (15).
Maca (Lepidium meyenii) is a Peruvian vegetable in the Brassica family, alongside broccoli, cabbage, and Brussels sprouts.
It has been used for centuries in traditional folk medicine to treat physical ailments, such as anemia, infertility, hormonal imbalances, and certain menopause symptoms like diminished sex drive, moodiness, and vaginal dryness (16).
Evidence for macaâ€™s efficacy for menopause is very limited. However, a few small studies indicate that itâ€™s significantly more effective than a placebo for boosting sex drive and reducing psychological symptoms like anxiety and depression (16, 17, 18).
No significant adverse effects have been documented, but very little safety data is available. Itâ€™s unknown whether maca interferes with medications, so itâ€™s best to check with your healthcare provider before taking it.
Whatâ€™s more, macaâ€™s recent surge in popularity makes it particularly susceptible to contamination and other quality control issues during production (19).
If you plan on using it, make sure you only purchase it from reputable brands that utilize third-party testing for purity and potency.
Soybeans boast a rich supply of isoflavones, which are structurally similar to the hormone estrogen and may exert weak estrogenic effects in your body (20).
Many common menopause symptoms are related to a decline in estrogen production. Hence, soy is thought to help alleviate symptoms due to its estrogen-like properties.
Yet, the available evidence is mixed.
Population studies associate high soy intake with a reduced incidence of hot flashes, but very few large-scale clinical trials show any significant benefit (21).
A recent review of 95 studies in menopausal women found that supplementing with soy isoflavones may favorably affect bone health, as well as the frequency and duration of hot flashes. However, no specific results can be guaranteed (22).
Soy foods are very safe and generally beneficial, provided you donâ€™t have a soy allergy.
Minimally processed soy foods like soybeans, tofu, and tempeh have the best nutrient profile and highest isoflavone content (21).
Yet, the safety of supplementing long term with high doses of soy isoflavones is less certain. Common side effects may include stomach pain and diarrhea. Consult your healthcare provider before adding soy isoflavone supplements to your routine (23).
7. Flax seeds
Flax seeds (Linum usitatissimum), also known as linseed, are a naturally rich source of lignans.
These plant compounds have chemical structures and functions similar to those of the hormone estrogen. Flax is sometimes used to alleviate menopause symptoms like hot flashes and bone loss due to its supposed estrogen-like activity (24).
A review of 11 studies determined that flax seeds reduced the frequency and duration of hot flashes, but no more so than in the control groups (25).
In a small, 3-month study in 140 menopausal women, those who took flax seeds self-reported significant improvements in various menopause symptoms and overall quality of life (26).
Although the current data is promising, more evidence is needed.
Still, flax seeds are nutrient-dense and considered very safe. Theyâ€™re a great way to boost your intake of fiber and healthy fats regardless of their effect on menopause symptoms.
Ginseng is one of the most popular herbal medicines worldwide.
Used for centuries in traditional Chinese medicine, itâ€™s said to boost immune function, heart health, and energy levels (27).
Several types exist, but Korean red ginseng is most frequently studied in relation to menopause.
A 2016 review of 10 studies suggested that Korean red ginseng may bolster sex drive and improve mood and general sense of well-being in menopausal women (28).
However, the evidence is weak, and more research is needed.
Short-term use of Korean red ginseng appears safe for most adults.
Yet, skin rash, diarrhea, dizziness, difficulty sleeping, and headache are among the most common side effects. It may also impair blood sugar control, so it may be inappropriate if you have diabetes (27, 29).
Ginseng may interact negatively with certain blood pressure, cholesterol, and blood-thinning medications. Consult your healthcare provider before trying ginseng, especially if youâ€™re taking any such drugs (29).
Valerian (Valeriana officinalis) is a flowering plant whose roots are used in a variety of herbal medicine practices to induce relaxation and a sense of calmness (30).
Sometimes called â€œnatureâ€™s Valium,â€ valerian is used to treat menopause symptoms like insomnia and hot flashes. Strong evidence for its efficacy is lacking, but preliminary data is promising.
A small study in 68 menopausal women determined that valerian supplements were significantly more effective at reducing subjective hot flash severity than a placebo. Another small study in 60 menopausal women found similar results (31, 32).
In yet another study in 100 menopausal women, a combination of valerian and lemon balm was significantly more effective at improving sleep quality than a placebo (33).
Valerian has a decent safety record but is associated with mild side effects, such as digestive upset, headaches, drowsiness, and dizziness (30).
Taking valerian is not recommended if youâ€™re on any medications for sleep, pain, or anxiety, as it may have a compounding effect. It may also negatively interact with supplements like kava, melatonin, and St. Johnâ€™s wort (30).
Chasteberry (Vitex agnus-castus) is a medicinal herb native to Asia and the Mediterranean. It has long been utilized for infertility, menstrual disorders, and symptoms of PMS and menopause (34).
Like many other herbs, research findings on its ability to alleviate menopause symptoms are mixed.
A study in 92 women comparing a placebo and a combination of chasteberry and St. Johnâ€™s wort found no differences in any menopause symptoms (35).
However, a more recent study in 52 women taking chasteberry showed significant reductions in anxiety and hot flashes â€” but no meaningful changes in depression or sexual dysfunction (26).
Chasteberry is generally considered safe, but mild side effects like nausea, itchy skin, headache, and digestive distress are possible. You shouldnâ€™t try it if you take antipsychotic medications or drugs for Parkinsonâ€™s disease (34).
The bottom line
For many women, menopause causes uncomfortable physical and psychological symptoms, such as hot flashes, difficulty sleeping, anxiety, and depression.
Pharmaceuticals are considered the most effective treatment, but many women prefer natural alternatives.
Herbs and foods like maca, soybeans, valerian root, black cohosh, flax seeds, and red clover are among the most popular menopause supplements, but most lack strong evidence to support their use.
Much like pharmaceuticals, herbal supplements may come with side effects and interact negatively with certain medications. You should always consult your healthcare provider before adding supplements to your routine.
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