Menopause marks the end a person’s menstrual cycles. It’s defined as 12 months after a person’s last period. The average age for menopause in the United States is 52.
People undergoing menopause may experience symptoms like hot flashes, night sweats, mood swings, and urogenital atrophy. These symptoms start during perimenopause, the period preceding menopause, and can continue to postmenopause. They can range in severity. Some supplements may be able to help you cope with the uncomfortable symptoms of menopause.
Black cohosh (Cimicifuga racemosa) has been used used to treat hot flashes and mood swings. Researchers say it may be the most promising alternative to hormone replacement therapies (HRT) for this purpose. It helps reduce the symptoms of menopause because it contains phytoestrogens (the plant chemical with similar effects to estrogen).
Many menopause symptoms are a result of a drop in estrogen levels during menopause, so supplementing it with phytoestrogen can help alleviate these symptoms. Numerous studies have found that using a black cohosh extract called Remifemin is a safe way to treat menopause symptoms, with lower doses showing greater efficacy than larger ones.
People in clinical trials took black cohosh for as long as 12 months with no serious side effects, but more human research is necessary to confirm its efficacy and safety.
Before you start using black cohosh or other phytoestrogens, check with your doctor to make sure it’s safe for you to use, especially if you’re:
- Experiencing hormone-sensitive conditions such as endometriosis, polycystic ovarian syndrome (PCOS), and breast cancer
- Taking statins (to help reduce cholesterol), as animal research has shown potential interactions with phytoestrogen
Menopausal women take calcium supplements (carbonate and citrate) to help prevent bone loss (osteoporosis), but how well it reduces their fracture rates is still unclear. Most research on calcium supplements also includes vitamin D, making it difficult to determine calcium’s effects on bone loss alone.
People can lose up to 20% of their bone density during the five to seven years following menopause.
Research evaluating the use of vitamin D and calcium to prevent fractures in postmenopausal women has repeatedly found no evidence of benefit from supplementation with vitamin D3 and calcium.
It’s important to note that taking calcium can interfere with your absorption of medications such as:
- Antibiotics, including fluoroquinolone, tetracycline, gentamicin
- Blood pressure medications
- Beta blockers
- Bisphosphonates (osteoporosis medication)
Calcium supplementation is not advised for people with kidney or cardiovascular problems, since it has been linked to an increased risk of kidney stones and heart disease.
Maca may be used to help with hot flashes and sleep issues. One small study found those who received Maca had reduced symptoms of depression and the medication helped lower their blood pressure.
Maca hasn’t been rigorously researched for use in treating menopause, and its safety has not been confirmed. More research is required before conclusions can be made.
Evening Primrose Oil
Evening primrose oil (EPO) is made from a yellow flowering plant native to North and South America. It can potentially help with hot flashes, but research is mixed on whether it really works. One 2013 study on 56 menopausal women 45–59 years of age found those who took 500 mg daily of EPO for six weeks had less frequent, less severe, and shorter hot flashes.
EPO can interfere with how your body metabolizes medications and other supplements including:
- Blood thinners like Fragmin (dalteparin), Coumadin (warfarin), heparin, Lovenox (enoxaparin), and Plavix (clopidogrel)
- Antipsychotic drugs like Compazine (prochlorperazine), Mellaril (thioridazine), Permatil (fluphenazine), Stelazine (trifluoperazine), and Thorazine (chlorpromazine)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, Advil (ibuprofen), Aleve (naproxen), and Voltaren (diclofenac)
Despite its widespread popularity in helping with calcium absorption and building bones, there is not enough evidence to support vitamin D (400 international units [IU]) supplementation during menopause for reducing hot flashes or preventing bone fractures.
It can potentially be used, however, to help improve symptoms of low moods and depression during menopause and increase calcium levels.
Be Careful of Vitamin D Toxicity
Vitamin D toxicity can occur at doses beyond the typical prescription amount, primarily at levels above 10,000 IU per day. Older adults aged 50 to 70 should aim for at least 600 IU and no more than 4,000 IU of vitamin D per day. Most people will not need more than 2,000 IU of vitamin D a day.
Vitamin D is a hormone precursor, meaning it works more like a hormone than a vitamin. There are many drugs that interfere with vitamin D absorption and metabolism, such as thiazide diuretics (water pills), which are prescribed for blood pressure, fluid retention, diabetes, and kidney stones.
Red clover can help reduce hot flashes, and research supports its use. However, further trials are needed to confirm its efficacy and safety.
Red clover is another phytoestrogen, so the same precautions apply. Talk to your doctor about red clover if you have hormone-related conditions like PCOS.
Red clover has many interactions and should only be taken under the supervision and guidance of a health professional.
Valerian root and rhizomes (Valeriana officinalis) are taken to help with hot flashes and sleep during menopause. One 2013 clinical trial of 68 menopausal women with hot flashes found those who were prescribed 255 mg Valerian capsules three times a day for eight weeks experienced significantly fewer hot flashes.
Long-term safety data aren’t available. There is not enough evidence from clinical studies to support using valerian for insomnia.
Valerian can interact with other medications or supplements including:
- Sedatives like benzodiazepines or barbiturates
- Dietary supplements including St. John’s wort, kava, and melatonin
Phytoestrogens like isoflavones, which are particularly abundant in soy, can help with hot flashes and protect against bone loss. Soybeans contain the highest level of isoflavones.
Isoflavones have been found to help reduce vasomotor symptoms like hot flashes or night sweats and prevent bone loss, although researchers say it’s still not clear yet whether they are effective.
A supplement with at least 54 milligrams of genistein (a soy isoflavone) per day is suggested for hot flashes. Anecdotal evidence suggests other menopausal symptoms like irritability and depression may be lessened with isoflavones.
Due to their impact on your hormones, isoflavones from soy can interact with how your body processes certain medications, including:
- Monoamine oxidase inhibitors (MAOIs): A type of antidepressant that interacts adversely with fermented soy products
- Antibiotics: May reduce the effectiveness of soy products by negatively impacting the natural gut flora needed to effectively process isoflavones
- Estrogens: Including Premarin, estradiol, and other HRT for menopause; should not be taken with isoflavones because the isoflavones may reduce the effect of estrogen
- Nolvadex (tamoxifen): A drug used in the treatment of a type of cancer; should not be taken with isoflavones
- Coumadin (warfarin): A drug whose effectiveness may be reduced by soy products
People with certain medical conditions such as kidney stones, hypothyroidism, diabetes, or hypoglycemia shouldn’t take soy supplements.
Dehydroepiandrosterone (DHEA) is a naturally occurring male steroid sex hormone responsible for making testosterone and estradiol (a form of estrogen). Women have less DHEA than men, and their levels drop later in life, which can impact menopausal transition as well as sexual, mental, and physical health.
A study found a 50% or greater reduction in depression among people who took DHEA. The researchers concluded that DHEA can be effective for treating midlife-onset major and minor depression.
The FDA classifies DHEA as a dietary supplement, meaning manufacturers of DHEA have no obligation to prove their products are either safe or effective.
Red ginseng, or Korean red ginseng (Panax ginseng), may help reduce hot flashes during menopause. A small clinical trial of 72 postmenopausal women found ginseng was effective for relieving menopause symptoms. The researchers also found ginseng has protective cardiovascular effects. However, more evidence is needed to support these claims.
Contraindications for ginseng include:
- Blood thinners
- Antiplatelet medications
- Herbal products that thin blood or lower blood sugar
- Drugs that work on the immune system
- Excess caffeine
You should always consult with a healthcare provider before beginning a new herbal supplement, but women with conditions affected by estrogen, such as uterine fibroids, breast cancer, uterine or ovarian cancer, or endometriosis, should be particularly proactive about seeking advice.
Wild yam (Dioscorea villosa) is said to act in a similar way to estrogen and may therefore help with menopause symptoms. The National Institutes of Health stated there is insufficient evidence wild yam can aid in the treatment of symptoms like low libido or vaginal dryness.
Wild yam may interfere with hormone levels and hormone-based treatments or hormone-related health conditions. It’s also not known whether it’s safe for pregnant and nursing persons or whether or not wild yam interacts with other drugs and supplements.
Chasteberry may influence hormone levels. It’s thought to work by increasing your progesterone levels or altering your prolactin levels. Prolactin is associated with ovulation and menstrual cycle changes.
Chasteberry isn’t associated with serious side effects, but you need to follow the same precautions as those for using phytoestrogens.
Chasteberry also works on your dopamine system and can interfere with Parkinson’s medications such as selegiline, amantadine, and levodopa.
Flax seeds are another phytoestrogen supplement that may help treat hot flashes and improve moods and sexual health during menopause. One study found flax seeds may reduce the number of hot flashes and improve mood and quality of life in postmenopausal women who are not receiving estrogen therapy.
Medications that may interact with flax seeds include:
- Blood thinners
- Medications that alter blood flow (aspirin) or pressure
- Blood sugar medications, including insulin and metformin (glucophage)
- Medications or supplements that work like estrogen
- Constipation aids
Lignans are precursors to phytoestrogen and are mainly found in seeds like flax seeds. It’s important to note there are more bioactive lignans in ground flax seeds than whole flax seeds. Also, flax seed oil does not contain the lignans unless they have been added.
St. John’s Wort
St. John’s wort (Hypericum perforatum) is best known as a natural supplement for treating symptoms of depression and is said to be an effective treatment for hot flashes as well. A study of 100 women (average age of 50) in Shiraz, Iran, who were treated for eight weeks found St. John’s wort to be effective for treating hot flashes in perimenopausal or postmenopausal women.
The popular herbal supplementation has been used for centuries. It also has a long list of potential contraindications including any herbal supplements that work on increasing serotonin levels (5-hydroxytryptophan or 5-HTP, L-tryptophan, or SAMe).
Other drug interactions include:
- Oral contraceptives
- Blood thinners such as warfarin
- Sedatives and medications used to treat anxiety
- Drugs used to treat cancer, heart conditions, and HIV/AIDS
- Over-the-counter medications for sleep, coughs, and colds
Dong quai (Angelica sinensis), also known as dang gui and female ginseng, has been found to affect estrogen levels in animals. However, studies haven’t looked into whether the same is true in humans.
The National Institutes of Health states there is insufficient scientific evidence to support using dong quai for menopause symptoms but taking dong quai with other herbal supplements may be effective.
Do not take dong quai with:
- Blood thinners
- Plavix (clopidogrel)
- Voltaren or Cataflam (diclofenac)
- Advil or Motrin (ibuprofen)
- Aleve (naproxen)
- Fragmin (dalteparin)
- Lovenox (enoxaparin)
- Eliquis (apixaban)
- Xarelto (rivaroxaban)
While a 2019 study that tested the herb on human and mouse breast-cancer cells suggested dong quai doesn’t stimulate breast cancer growth, researchers still urge caution for people with estrogen-receptor-positive breast cancer who want to use dong quai.
Frequently Asked Questions
What supplements can help with irritability during menopause?
When you have irritability during menopause, you may find relief from supplements such as black cohosh and flax seeds. These herbal remedies work on your hormones to help reduce mood swings.
What herbs are good for menopause?
Many types of herbs are used to manage menopausal symptoms, including black cohosh, red clover, soy, ginseng, wild yam, flax seeds, and St. John’s wort. Some of these herbs have more scientific support for their efficacy and safety than others.
Where can I buy black cohosh?
You can buy black cohosh from natural and health food stores, supplement stores, drug stores, online through retailers like Amazon, or directly from suppliers. Do some research on their quality measures and control standards before buying supplements.
Menopausal symptoms like hot flashes, sleep disturbance, and irritability may be alleviated with natural remedies such as black cohosh and soy products. It’s important to note that research is still needed to support the use of many of these supplements. Before starting any new natural treatment, check with your doctor to make sure it’s safe for you to use it.
A Word From Verywell
Natural doesn’t always mean safe, and safe doesn’t always mean safe for everyone. Dietary supplements are unregulated and can contain unlisted ingredients that may interact with medications or pose risks if you have other medical conditions or are readying for surgery. So while these supplements offer an alternative to hormone replacement therapy, they are still not risk-free. You want to put some thought into where you source your supplements, and you want to discuss your plans with your doctor.