Menopause supplements: Effectiveness, side effects, and safety

Some people may wish to take supplements, such as black cohosh and vitamins, to relieve menopausal symptoms. However, there is little evidence that these supplements have a significant effect on symptoms of menopause.
Share on Pinterest
This article discusses common supplements that people may use to manage menopause symptoms. It also discusses the effectiveness and any potential side effects of these supplements.
Sex and gender exist on spectrums. For the purposes of this article, we use “male” and “female” to refer to a person’s sex assigned at birth. Learn more.
Learn more
What are perimenopause and menopause? 
Menopause is the clinical term for when a person’s estrogen levels drop and they stop menstruating. The age of menopause varies from 40–58 years of age, although females in the United States usually go through menopause around age 52.
Menopause
age 52
However, menopause does not happen all at once. On average, it takes people about 4 years to transition into menopause. Perimenopause describes this transitional period. During this time, a person’s periods may change in:
regularity
duration
heaviness
A person is going through menopause when they do not menstruate for 12 months.
Menopausal symptoms can develop during perimenopause and may include:
hot flashes
hot flashes
difficulty sleeping
difficulty sleeping
mood changes
mood changes
vaginal dryness
vaginal dryness
loss of bone density
increase in cholesterol levels
increase in cholesterol levels
Learn more about the symptoms of menopause.
Learn more about the symptoms of menopause.
According to a 2005 review of studies, roughly two-thirds of women have menopausal symptoms during perimenopause. Up to 90% of women seek advice from a healthcare professional about managing menopause symptoms. Menopause symptoms can vary widely from person to person and may last for several years.
two-thirds of women
Up to 90%
several years
It is important to remember that menopause supplements are not regulated by the Food and Drug Administration (FDA). Products may have proprietary blends, which means that the company does not list the amounts of the ingredients on the product packaging. Additionally, products may contain active or inactive ingredients that are not listed.
People should discuss taking supplements with a healthcare professional or a pharmacist. Some supplements may cause side effects and interact with prescription or nonprescription medications.
Menopause supplements 
The National Center for Complementary and Integrative Health (NCCIH) states that there is no clear evidence that dietary supplements can relieve menopause symptoms. Additionally, the NCCIH notes that there is little research on the long-term safety of dietary supplements.
National Center for Complementary and Integrative Health (NCCIH)
Learn more about natural remedies for menopause.
Learn more about natural remedies for menopause.
The following are some menopause supplements a person may use, alongside their effectiveness and any potential side effects.
Black cohosh 
Black cohosh is one of the more common herbal menopausal supplements.
Black cohosh
more common
Native Americans have used this plant to treat conditions such as fever, cough, and irregular menstruation. European settlers also used black cohosh to support female reproductive health.
fever
cough
irregular menstruation
More recently, people may use black cohosh to treat menopausal symptoms such as:
hot flashes
night sweats
vaginal dryness
irritability
Originally, scientists thought that black cohosh worked like estrogen. More recent studies suggest that this herb works by mimicking the neurotransmitters:
scientists thought
studies
neurotransmitters
dopamine
serotonin
serotonin
norepinephrine
However, there is no evidence to suggest that black cohosh has an effect on hormone levels in the body, including estradiol.
no evidence
Older studies suggested that black cohosh may be effective for the relief of menopausal symptoms, either alone or in combination with other herbs. However, more recent research suggests that black cohosh has no significant effect on menopause symptoms. The authors note that more high-quality research needs to be conducted on this subject.
either alone
in combination
more recent research
Learn more about black cohosh and menopause.
Learn more about black cohosh and menopause.
The National Institutes of Health (NIH) state that black cohosh does not appear to interact with any medications. However, people should always ask a healthcare professional before taking any supplements to make sure it is safe to use with other medications.
National Institutes of Health (NIH)
However, the Memorial Sloan Kettering Cancer Center warns that black cohosh may interact with the following medications:
Memorial Sloan Kettering Cancer Center
Tamoxifen: Black cohosh may interfere with the way tamoxifen works.
Chemotherapy drugs: Black cohosh may increase the toxicity of the chemotherapy drugs doxorubicin and docetaxel.
Cytochrome P450 3A4: This enzyme plays an important part in metabolizing medicines. Black cohosh may interact with drugs that this enzyme metabolizes.
Simvastatin: Black cohosh may increase the side effects a person experiences with simvastatin.
It is important to note that, as the FDA does not regulate black cohosh, it is difficult to know which ingredients a manufacturer uses for their product. Some products may have adulterants, which means manufacturers may substitute black cohosh for similar synthetic ingredients.
may have
The NIH states that, worldwide, there have been at least 83 cases of liver damage linked with black cohosh use. The organization says this may be partly due to adulterants and impurities. However, there has been no independent analysis of the link between black cohosh and liver damage.
83 cases
Additionally, the amount of black cohosh may vary from supplement to supplement. This variance makes it more difficult to determine whether a person will experience side effects as a result of a higher dose.
may vary
Side effects from taking black cohosh may include:
uterine bleeding
breast pain
breast pain
musculoskeletal pain and discomfort
People who take larger doses may experience gastrointestinal effects such as bloating and cramping.
bloating
Less common side effects include:
dizziness
dizziness
nausea
nausea
vomiting
vomiting
Calcium and vitamin D
Every person has levels of calcium in their body. Adult females have around 1,200 grams (g) of calcium in their bodies, and this level remains consistent until estrogen levels drop during menopause.
1,200 grams (g)
Learn more about calcium.
Learn more about calcium.
Vitamin D also plays a role in bone health. During menopause, a person’s bone density may decline, leading to osteoporosis. Not having enough calcium and vitamin D is a risk factor for this condition.
may decline
osteoporosis
Learn more about vitamin D.
Learn more about vitamin D.
The Women’s Health Initiative Trial investigated the effects of calcium and vitamin D supplements on menopausal symptoms. The participants took 1000 mg of calcium and 400 international units (IU) of vitamin D during the course of the study, and the researchers followed up with the participants after an average of 5.7 years.
Women’s Health Initiative Trial
The researchers found that there was no difference in symptoms between the group that took supplements and the group that did not. Sleep disturbances, energy levels, and emotional well-being were similar between the two groups, leading the researchers to conclude that calcium and vitamin D supplements are unlikely to have an effect on symptoms of menopause.
Females should aim to ingest 1,000 mg of calcium per day if they are 50 years of age or under, and 1,200 mg if they are over 50. The tolerable upper limit of calcium is 2,500 mg for those 50 or under, and 2,000 mg for those over 50.
1,000 mg of calcium per day
Females 70 years or under should have 600 IU of vitamin D, with those over 70 needing 800 IU.
Not having enough calcium and vitamin D, or having too much, may cause side effects.
Side effects of having too little calcium include:
include
pins and needles feeling in the fingertips, toes, and lips
pins and needles
muscle pains and cramps in the legs, feet, and stomach
facial muscle twitches
mood changes, such as depression, irritability, and anxiety
anxiety
fatigue
fatigue
rough and dry skin
coarse hair and hair breakage
easily broken fingernails
Side effects of having too much calcium, or hypercalcemia, include:
hypercalcemia
include
vomiting
drowsiness
dehydration
muscle spasms
bone and joint pain
irregular heartbeat
irregular heartbeat
high blood pressure
high blood pressure
Not having enough vitamin D can lead to bone conditions in adults and children. Children who do not have enough vitamin D may develop rickets, and adults may develop osteomalacia. These conditions can cause bone pain and lead to soft and weak bones.
can lead
rickets
osteomalacia
Taking too many vitamin D supplements can lead to hypercalcemia.
Red clover 
Red clover is a legume that contains isoflavones. Isoflavones are compounds that are similar to the hormone estrogen.
contains
Red clover was traditionally used as a treatment for conditions such as:
asthma
asthma
whooping cough
whooping cough
cancer
In recent times, people have used this supplement for:
menopause symptoms
osteoporosis
high cholesterol
However, the NCCIH states that all studies investigating the effects of red clover on menopausal symptoms and bone density in menopausal females have had inconsistent results. There is not enough evidence to suggest red clover can effectively relieve symptoms of menopause.
NCCIH
The Memorial Sloan Kettering Cancer Center states that red clover can interact with the following medications:
Memorial Sloan Kettering Cancer Center
Anticoagulants: Red clover may increase the effects of these medications. However, more clinical research is needed.
Cytochrome P450 enzymes: Red clover can inhibit some of these enzymes and may interact with medications that the enzymes metabolize.
Methotrexate: Red clover may increase the toxicity of methotrexate, leading to severe vomiting and stomach pain.
Soy 
Soy supplements commonly come in the form of soy protein, isoflavones, or a combination. People may use soy supplements to treat menopausal symptoms, high blood pressure, and high cholesterol, and to improve bone health and memory.
to treat
Learn more about soy.
Learn more about soy.
A 2015 review of studies found that soy isoflavones can reduce the severity of hot flashes. However, the authors note that it took an average of 13.4 weeks for people to notice the effect of the soy isoflavones in comparison with 3.09 weeks when using estrogen hormone replacement therapy (HRT).
2015 review of studies
hormone replacement therapy (HRT)
The NCCIH states that soy isoflavone mixtures may have a beneficial effect on bone health during menopause. However, the evidence is inconsistent.
NCCIH
People who are allergic to soy should not use soy supplements or ingest food or beverages that contain soy.
The NCCIH states that short-term use of soy protein and isoflavone supplements is safe. However, there has not been enough research into long-term use to verify its safety.
NCCIH
The organization also warns that soy may alter the way the thyroid functions in people who have an iodine deficiency. Additionally, as soy contains compounds that are similar to estrogen, people who are pregnant or breastfeeding should contact a doctor before ingesting soy.
iodine deficiency
The most common side effect of ingesting soy is digestive upset. People may experience symptoms such as constipation and diarrhea.
constipation
diarrhea
Ginseng 
Ginseng is another herbal supplement that people may use to relieve menopausal symptoms.
Learn more about ginseng.
Learn more about ginseng.
A 2016 systematic review notes that many studies investigating the effectiveness of ginseng on symptoms of menopause are at a high risk of bias.
2016 systematic review
The authors note that ginseng may have a positive effect on:
sexual function
arousal
total hot flash scores recorded by the participants
However, there is no evidence that this supplement affects:
hot flash frequency
a person’s hormones
the thickness of the endometrium
Short-term oral use of ginseng for up to 6 months is usually safe for most people. However, experts may not recommend the use of ginseng in:
up to 6 months
infants
children
those who are pregnant or breastfeeding
People should contact a healthcare professional if they wish to take ginseng and are currently using medications such as calcium channel blockers, statins, or antidepressants. Ginseng may interact with these medications.
calcium channel blockers
statins
antidepressants
Some side effects of ginseng include:
breast pain
changes in menstruation
increase in heart rate
high or low blood pressure
low blood pressure
headache
headache
loss of appetite
loss of appetite
St. John’s wort 
St. John’s wort is a traditional European herbal remedy for various conditions, including depression and menopause symptoms.
herbal remedy
Learn more about St. John’s wort.
Learn more about St. John’s wort.
Older research found that St. John’s wort supplements had an effect on hot flashes. This study split 100 women into two groups, with one group taking the supplement and the other using a placebo. While there was no significant difference in the hot flashes the participants reported after 4 weeks, the researchers noted that women who took the supplement reported fewer hot flashes after 8 weeks.
Older research
However, the NCCIH states that there have not been enough studies to know whether St. John’s wort is an effective treatment for menopausal symptoms.
NCCIH
St. John’s wort can interact with various medications, causing them to be less effective. An incomplete list of medications that this supplement can interact with includes:
various medications
antidepressants
antidepressants
birth control pills
birth control pills
cyclosporine, a medication that stops the body from rejecting donor organs
cyclosporine
heart medications such as digoxin and ivabradine
HIV drugs such as indinavir and nevirapine
HIV drugs
cancer medications such as irinotecan and imatinib
warfarin
statins such as simvastatin
statins
This supplement can cause the following side effects:
sensitivity to sunlight
insomnia
insomnia
anxiety
fatigue
fatigue
headache
dizziness
dry mouth
dry mouth
Summary
Menopause is a natural stage in life, but it can cause symptoms that negatively affect a person’s quality of life. Some people may wish to use natural supplements. However, there is little evidence that these supplements are effective, and many studies deliver inconsistent results.
People should contact a healthcare professional for advice before taking any dietary supplements. Some supplements can interact with prescription and nonprescription medications and may cause additional side effects.