5 Effective Supplements for Menopausal Symptoms

Each year, roughly 1.3 million women in the United States enter menopause [1]. Hormonal changes around this time can contribute to psychological and vasomotor symptoms (like hot flashes and night sweats) that can affect quality of life. Certain supplements may offer relief by reducing the side effects of these hormone-related changes. But which supplements can really make a difference and which symptoms do they address? And importantly, how do you know which to try?

Here, we discuss the research behind supplements for menopausal symptoms and how to incorporate them into your routine.

Always remember to consult with your doctor before starting any new supplement. 

What is menopause?

Menopause is the absence of a period for at least 12 consecutive months. The start of menopause varies, but the average age of onset is 51 years [1]. Women may enter menopause naturally, or its onset may be accelerated due to cancer treatment, medical conditions, or a hysterectomy. 

Menopause occurs as a result of age-related declines in estrogen due to decreases in the number of ovarian follicles. Changes in hormone levels characterize menopause, notably decreases in estrogen, dehydroepiandrosterone sulfate (DHEAS), and testosterone, and increases in follicular stimulating hormone, luteinizing hormone, and sex hormone binding globulin (SHBG). [1,2]

Why do women experience menopausal symptoms?

Decreases in estrogen contribute to menopausal symptoms. Lower estrogen levels affect the central nervous system, resulting in changes to neurotransmitter activity that can influence body temperature, metabolic rate, and heart rate. [3] Vasomotor menopausal symptoms include hot flashes, night sweats, and sleep disturbances. Mood and memory changes and urogenital issues are also common menopausal symptoms. 

Menopausal symptoms may also be prompted by oxidative stress, which can increase during menopause. Likewise, menopause can exacerbate imbalances between free radicals and antioxidant activity, which may influence menopausal symptoms. 

 

Supplements for menopausal symptoms

Many supplements for menopausal symptoms contain phytoestrogens, plant compounds with similar properties to estrogen. Phytoestrogens can mitigate symptoms associated with menopause, such as hot flashes, night sweats, and sleep disturbances—some of the most common concerns among women experiencing menopause. 

Research suggests supplements like black cohosh, sage, vitamin E, red clover, and vitamin D may reduce menopausal symptoms based on the Menopause Rating Scale (MRS). This five-point rating system evaluates physical, psychological, and genitourinary symptoms of menopause. [4]

InsideTracker offers supplement recommendations that may help manage menopausal symptoms. Depending on certain blood biomarker levels that change with menopause like estradiol, progesterone, cholesterol, and others, as well as factors like BMI and menopausal status, you may see these recommendations. 

Curious to know more? Let’s explore the science behind these supplements.

Black cohosh

Black cohosh (Cimifuga racemosa) is a flowering plant native to North America. How black cohosh benefits menopausal symptoms is unknown, but some research suggests this medicinal plant may help hot flashes and other vasomotor symptoms. [5]

Several small studies support the use of 40 milligrams (mg) of black cohosh to relieve the severity and frequency of hot flashes. [5,6] Notably, one study of 120 women found 40 mg of black cohosh reduced the number of hot flashes by 85% after six months. [6] 

Meta-analyses yield conflicting evidence on the benefits of black cohosh for menopausal symptoms. One meta-analysis of randomized controlled trials among more than 2,000 women observed improvements in overall menopausal symptoms and hot flashes with black cohosh extract. [7] However, another equally large meta-analysis of randomized controlled trials did not find any benefit of black cohosh on hot flashes and night sweat severity and frequency. The average study duration was 22 weeks, and the median black cohosh dosage was 40 milligrams. [8] 

While black cohosh may help with hot flashes and night sweets, it does not relieve anxiety or depressive symptoms associated with menopause. [7,9]

Black cohosh is generally well-tolerated. Potential side effects include nausea, vomiting, headache, and dizziness. [5]

Bottom line on black cohosh for menopausal symptoms: Taking 40 milligrams daily of black cohosh may reduce hot flashes and night sweat frequency and intensity—supplement with black cohosh at any time of the day, with or without food. But if you experience more menopausal symptoms at night, try taking black cohosh after dinner.

Sage extract

Sage (Salvia officinalis) is a medicinal plant native to Mediterranean Europe. Research shows supplementing with sage in doses ranging from 100 to 3400 mg for four weeks can improve MRS scores and may even reduce MRS by 39.2% compared to a placebo. [10-12] Specifically, sage supplements improve hot flashes, night sweats, sleep, joint and muscular discomfort, depressive symptoms, irritability, anxiety, and sexual issues. [11]

Menopause can affect mood, cognition, and memory. Sage acts on neurotransmitters, affecting mood and cognition, and may promote a sense of calmness. [4] Additionally, due to its effect on the nervous system, sage may enhance memory. [13] 

Most research is limited to four months of sage supplementation. Though generally well-tolerated, thujone (a compound in sage and found in high amounts in sage oil) may cause seizures. Therefore, long-term consumption or high doses of sage are not recommended.

Bottom line on sage for menopause: Sage extract can be taken in moderate doses for short intervals (supplement cycling). Taking sage regularly for more than two months is not recommended. Cycle off the daily supplement for at least four weeks before reintroducing. Supplement with 100 mg thujone-free sage extract three times daily, with or without food. Do not take more than the recommended dose. 

Vitamin E

Vitamin E is a fat-soluble vitamin that functions as an antioxidant. Vitamin E curbs free radicals and reduces inflammation. As an antioxidant, vitamin E may improve biomarkers of oxidative stress, which may worsen during menopause. [3] Moreover, vitamin E may improve menopausal symptoms like insomnia and hot flashes.

Changes in hormones contribute to sleep disturbances—the prevalence of insomnia increases significantly with menopause. [14] As chronic insomnia is associated with other health conditions affecting longevity, interventions that ameliorate sleep disturbances are essential to improving healthspan. One study observed improvements in sleep quality and a reduction in sleep medication with taking 400 IU of vitamin E daily. [14]  

Supplementing with 400 international units (IU) of vitamin E for at least four weeks may reduce the severity and frequency of hot flashes in postmenopausal women. [3,15] However, vitamin E does not appear to alleviate other menopausal symptoms like anxiety. [3]

Vitamin E is not recommended if you take anticoagulant or antiplatelet medications, as doses found in supplements may contribute to bleeding.

The bottom line on vitamin E for menopausal symptoms: Supplementing with 400 IU vitamin E may mitigate menopausal symptoms of insomnia and hot flashes. As vitamin E is a fat-soluble vitamin, consume your supplement with a fat source (like nuts, yogurt, or avocado) to optimize absorption.

 

Red clover

Red clover is a potent source of isoflavones, a type of phytoestrogen that exerts estrogen-like effects and may relieve menopausal symptoms.

Red clover supplements may reduce the occurrence of hot flashes in peri- and postmenopausal women. [16] Dosages of 40 to 80 mg of red clover appear most effective at lowering the number of hot flashes, with more significant reductions observed at higher doses among women who experience more hot flashes. [17] Notably, one randomized controlled trial observed a 73.5% decrease in hot flash frequency and a 72.2% decrease in night sweats after 12 weeks of supplementing with 40 mg of red clover twice daily. [18] 

One meta-analysis found red clover reduced hot flashes when taken for three to four months. However, habitually supplementing with red clover for longer durations (12 months) did not benefit hot flashes. [19]

Bottom line on red clover for menopausal symptoms: Supplementing 40 to 80 mg daily of red clover may alleviate vasomotor menopausal symptoms, namely hot flashes and night sweats.

Vitamin D

Estrogen plays a role in bone metabolism. During menopause, the decline in estrogen creates an environment that promotes bone loss over bone building. This shift increases the risk of osteoporosis and fractures. [1] But vitamin D supplementation can help support bone health and maintain calcium balance.

Vitamin D, or the “sunshine vitamin,” is associated with many health outcomes. Among postmenopausal women, supplementing with vitamin D can increase bone mineral density and may reduce the risk of fractures and frailty. Moreover, low vitamin D status is associated with other age-related conditions, including metabolic syndrome and sarcopenia. [20] 

A blood test can reveal vitamin D status to determine whether a supplement may be beneficial. Vitamin D levels decrease with age as the body’s ability to produce vitamin D from sunlight declines. Suboptimal vitamin D levels are common in the general population, particularly among older adults. Supplementing is often the most effective way to restore and maintain vitamin D levels.

Key takeaways

• Menopause is the absence of a period for 12 consecutive months, accompanied by hormonal changes that cause vasomotor and psychological symptoms that can affect quality of life. 
• Supplements like black cohosh, sage, red clover, and vitamin E may alleviate the severity and frequency of hot flashes and night sweats, two of the most commonly reported menopausal symptoms. Taking vitamin D may help combat bone mineral density loss.
• Despite minimal evidence of these supplements benefiting anxiety and depressive symptoms, reduced frequency and severity of hot flashes and night sweats can positively influence mood and allow greater participation in activities of daily living.
• Always consult your physician before starting a new supplement.
  

Research supports the use of supplements for reducing menopausal symptoms, but the best way to tell whether supplementation is right for you is by getting your blood tested.

InsideTracker’s personalized recommendations for women experiencing menopause include individually tailored guidance for menopausal symptom reduction and strategies to optimize important biomarkers that shift during this period, including estradiol and progesterone, cholesterol, and more.

References

1. https://www.ncbi.nlm.nih.gov/books/NBK507826/
2. https://pubmed.ncbi.nlm.nih.gov/12017547
3. https://pubmed.ncbi.nlm.nih.gov/31987231/
4. https://pubmed.ncbi.nlm.nih.gov/21630133/
5. https://pubmed.ncbi.nlm.nih.gov/25276716/
6. https://pubmed.ncbi.nlm.nih.gov/17565936/
7. https://pubmed.ncbi.nlm.nih.gov/37192826/
8. https://pubmed.ncbi.nlm.nih.gov/22972105/
9. https://pubmed.ncbi.nlm.nih.gov/19745648/
10. https://pubmed.ncbi.nlm.nih.gov/33615001/
11. https://pubmed.ncbi.nlm.nih.gov/32318472/
12. https://pubmed.ncbi.nlm.nih.gov/31435607/
13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5783135/
14. https://pubmed.ncbi.nlm.nih.gov/36904186/
15. https://pubmed.ncbi.nlm.nih.gov/17664882
16. https://pubmed.ncbi.nlm.nih.gov/33920485/
17. https://pubmed.ncbi.nlm.nih.gov/26471215/
18. https://pubmed.ncbi.nlm.nih.gov/21870906/
19. https://pubmed.ncbi.nlm.nih.gov/25074017/
20. https://pubmed.ncbi.nlm.nih.gov/32551035/