Menopause symptoms like hot flashes, night sweats, brain fog, mood changes and sleep problems can be a significant disruption.
Some people are turning to supplements to manage those issues rather than using treatments approved by the Food and Drug Administration, such as hormone therapy. But, experts say, menopause supplements aren't necessarily helpful. And, in some cases, they can be dangerous.
The rising popularity of menopause supplements, experts say, highlights a lack of access to evidence-based options, rampant misinformation about hormone therapy and gaps in our knowledge about menopause — even among specialists.
Current menopause treatments
"The primary treatment — and the first-line treatment — should be hormone (estrogen) therapy, especially for moderate-to-severe menopause symptoms," Dr. Anna Barbieri, assistant clinical professor in the department of obstetrics and gynecology at Mount Sinai School of Medicine, tells TODAY.com
"There is just nothing as effective and nothing that has as wide-ranging effects and benefits as hormone therapy," Barbieri adds.
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Effectively managing hot flashes, most often through hormone therapy, may have long-term health benefits, too, Dr. Lauren Streicher, medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause, tells TODAY.com.
Health
Not only do hot flashes last seven years on average (and often longer for Black women), but we also know that "hot flashes are associated with cardiovascular disease, brain fog during perimenopause, potentially declines in cognitive function down the road and multiple other medical problems," Streicher says.
However, some people should steer clear of hormone therapy due to other health conditions. That includes a current or past hormone receptor-positive cancer (primarily breast and endometrial cancers), as well as a history of stroke, blood clots or cardiovascular disease, Barbieri explains.
If someone can't or prefers not to take hormone therapy, that's where non-hormonal options come in. Those include the off-label use of antidepressant medications and the recently-approved drug fezolinetant.
There are also all kinds of lifestyle and behavior techniques people may use to stay generally healthy, whether or not those techniques directly help with hot flashes, Dr. Monica Christmas, associate professor and director of the Center for Women’s Integrated Health at The University of Chicago Medicine, tells TODAY.com.
That might include avoiding certain triggers (such as alcohol), cognitive behavioral therapy, maintaining good diet and exercise habits and even hypnosis, she says.
What doctors don't want is for you to jump into taking supplements on your own.
"I cannot tell you how many times I have identified supplements people were using that where unnecessary, potentially harmful or interacting with other medications," Barbieri says. "Or people who were using 25 supplements where they could just use hormone therapy."
Should you take menopause supplements?
There are a lot of reasons someone might want to try an over-the-counter supplement to manage menopause symptoms. Of course, there's a wealth of options available on the internet — many with little or no evidence that they actually work, and some with evidence that they can be harmful.
“Most of them just haven’t been studied,” Streicher says. “But some of them we know absolutely are not safe to use.”
In its 2023 position statement on non-hormone therapies, the Menopause Society (formerly known as the North American Menopause Society) did not recommend any dietary supplement to manage menopause symptoms. For the majority of the supplements the group looked at, their conclusions were due to flawed studies, mixed results or an overall lack of evidence.
The experts TODAY.com spoke to generally agree, but take a more nuanced position: There can be a place for supplements in managing menopause symptoms, they say. But their usefulness depends on your symptoms, what other treatments you're comfortable with and the specific supplements you're using.
For Streicher, it makes sense to talk about supplements when patients have only mild symptoms, or if they have more intense symptoms and already take a prescription medication but want to try something on top of that.
A typical example for Barbieri might be a patient with breast cancer and sleep issues who can't take hormone therapy. "If someone does not use medication for sleep, and lifestyle interventions don't work, then we may turn to something like magnesium and l-theanine or inositol," she says, which research shows are safe for patients with a history of breast cancer who cannot take hormone therapy.
Other people "feel that menopause is natural ... and they just want to use certain lifestyle interventions and only feel comfortable with supplements no matter what," Barbieri says. "That's OK, I just need to know that."
More than anything, experts say, the decision whether to take menopause supplements should be based on a knowledgeable provider having a genuine conversation with a patient about what really might work for them and their preferences. (edited)
"As providers, we do need to be able to give good information and understand that (supplements are) going to be a preference of some people," Christmas says. "And if it doesn't work, (we need to be) respectful that maybe shoving hormone therapy down their throat still might not be the answer."
Common ingredients in menopause supplements
There are a ton of supplements on the market, many of which contain proprietary blends of ingredients.
Additionally, supplements are not regulated by the FDA in the same way that pharmaceutical drugs are. It's up to the supplement manufacturer and distributors to ensure the safety and correct labeling of their products, the FDA explains.
That's why, if you're going to use any supplements, the experts recommend looking for a label that indicates it has been third-party verified, which means you can be more confident that it actually contains the ingredients that it advertises. Specifically, Barbieri suggests looking for USP or GMP supplement certifications on a product.
And keep the placebo effect in mind, Christmas says. When you take something new, you might feel better initially. "But the placebo effect can't be sustained," Streicher says.
Here are a few common ingredients you may see in menopause supplements:
Vitamins and minerals
If someone is deficient in vitamins and minerals during menopause, supplements may be a good idea, experts say.
For instance, low levels of vitamin D are correlated with poor bone health and depression, Barbieri explains. "Because these are factors that are important for all of my menopausal patients, I will actually check vitamin D and will replace that — no question," she says.
The same goes for vitamin B12 and ferritin (a form of iron) which women may not get enough of via food, particularly those following plant-based or vegetarian diets. "These are essential nutrients that are going to result in improved health and sense of well-being if someone is deficient in them," Barbieri says.
If you think you could benefit from a supplement to treat a deficiency, talk to your doctor about testing first.
Isoflavones, phytoestrogens and "plant-based hormones"
Phytoestrogens are plant compounds that mimic estrogen when broken down in the body. Isoflavones are a type of phytoestrogen that comes from soybean products.
This is a major category of menopause supplements, but they are not safe for people avoiding hormone therapy due to their health histories, the experts say.
“If you have a history of an estrogen-derived cancer, like a breast cancer, you shouldn’t be taking (phytoestrogen supplements) either,” Christmas says. “Those are nuances that maybe people don’t think about when they see a supplement in the health food store or local pharmacy,” she adds.
For those interested in phytoestrogen supplements who have a low-risk health history, Streicher recommends looking into S-equol. "It's the only one that really has science (behind it)," she says, "because it's the active metabolite of soy, which is what's been shown to actually potentially help with hot flashes."
Just keep in mind that people’s experiences with these kinds of supplements vary widely, Streicher says, because people metabolize them differently.
While phytoestrogen supplements are not recommended for people avoiding hormone therapy, those patients generally are OK to eat phytoestrogens occurring naturally in food, such as soy, Barbieri explains.
What about general "plant-based hormone" products? Creams are often marketed with such language, Barbieri says, adding that they may contain a version of progesterone made in a lab using a compound in yams, she says. That language is aimed at people who want to feel natural by using that, but “plants do not have human hormones,” she stresses.
Black cohosh
"Black cohosh is commonly reported to help with hot flashes and night sweats, although it hasn't been proven to do that," Christmas says, "and it actually can increase liver enzymes."
If you have an underlying liver condition, you should steer clear of black cohosh she says. Or, if you decide to take it, "you should be monitored frequently with serology to make sure your liver function isn't worsening," Christmas adds.
St. Johns wort
Often advertised to help with hot flashes and depression, St. Johns wort can also interact with many other medications that can have an impact on someone’s health, Christmas says.
Combinations of herbs
Some products contain a huge blend of many types of botanical ingredients and may or may not actually list the ingredients, Streicher says. For instance, you don't know what you're getting with products labeled simply "Chinese herbs," she says.
Before you try menopause supplements...
It's tempting to just buy the bottle, but the experts discouraged trying a new supplement without talking to your doctor.
First, set up a doctor's appointment just to talk about menopause. Resist the urge to simply tack a conversation about menopause onto the end of another appointment, Christmas says.
Making an appointment specifically for menopause symptoms "automatically sets a different tone," she explains, and "it's probably going to get you a little bit more time in front of that health care professional." Ideally, this should be an in-depth and individualized discussion to go through your specific symptoms, what you've already tried and your treatment preferences.
Unfortunately, many doctors — even OB-GYN specialists — don't receive much (if any) training in menopause, Streicher says.
So, if your doctor isn't well-versed in menopause treatments, find a specialist. All the experts recommend starting by using this tool from the Menopause Society to find a menopause expert near you.
If you're in a major city, you'll likely be able to find someone pretty easily, Streicher says. But if not, telehealth consultation services like Midi and Gennev may be your best option. (Streicher provides educational work for Midi.)
This story first appeared on TODAY.com. More from Today:
