What Are The Best Supplements for Menopause?

The shift that occurs during menopause comes with significant hormonal changes. These fluctuations can lead to a wide range of symptoms, from hot flashes to mood changes and beyond. Many people rely on natural support during menopause, including dietary supplements. This article explores 21 common supplements that may be considered for menopause symptom support and the scientific evidence behind their benefits, effectiveness, and safety.

1. Black Cohosh

Black cohosh is an herbal supplement that has been in use for hundreds of years. It’s typically used for hormone-related support in people assigned female at birth, although the mechanisms behind its action are still not fully understood. It does not seem to raise estrogen, progesterone, or testosterone, so the benefits exist outside of direct hormone effects.

Clinical trials that studied black cohosh’s impact on menopause-related symptoms have produced mixed results. A Cochrane review of 16 randomized, controlled trials determined there’s not enough evidence to broadly recommend black cohosh for menopause support. But the analysis did note that more research is justified based on the potential for benefit. Another review of 35 studies showed a clearer benefit when black cohosh was consumed at higher doses (40-120 mg daily).

Herbs can interact with medications and other dietary supplements, so before you try black cohosh, check with your medical provider.

2. Red Clover

Red clover (Trifolium pratense) is an herbal supplement that contains isoflavones that are thought to be beneficial for menopause. Once consumed, some red clover isoflavones are metabolized into genistein and daidzein, the same ones that are found in soy. Isoflavones have been found to help with hot flashes, night sweats, and other hormone-related concerns with menopause and aging, although not all studies produce the same results.

A double-blind, randomized controlled trial of 62 perimenopausal people, between the ages of 40-65, studied red clover extract paired with probiotics versus a placebo for 12 weeks. Participants in the study had been experiencing 5 or more hot flashes per day, on average. The red clover group experienced a significant decrease in daily hot flashes, and the supplement was well-tolerated. Though these initial findings are encouraging, larger studies are needed to confirm the results.

3. Soy Isoflavones

Soy isoflavones have phytoestrogen properties, which can also be found in some grains, seeds, nuts, and fruits. Their benefit lies in that they can support the body in similar ways to estrogen, without actually affecting hormone levels. Some clinical studies show little to no benefits from phytoestrogens, while others demonstrate support for hot flashes and other symptom relief.

Soy isoflavones can also be obtained from consuming dietary soy, and some research concludes that people who are menopausal can benefit from adding more soy foods to their diets. Overall, study designs for isoflavones vary widely, and it’s not possible to draw firm conclusions for any specific benefit. Larger studies need to be done, but overall, there is definite positive potential.

4. St. John's Wort

St. John’s wort is an herbal supplement that has widely been used as a natural mood support. Studies have found that it’s more effective than a placebo for that purpose, although mainly in shorter study periods (12 weeks or less). When it comes to menopause, it has been studied, but the results have not led to definitive conclusions. A randomized controlled trial of 100 people found that St. John’s wort worked better than a placebo to address hot flashes.

Another randomized, placebo-controlled study of 70 postmenopausal people found that St. John’s wort helped address hot flashes and mood during the 8-week study period. Participants received 270–330 mcg three times per day. Still, more research is needed to clearly understand how St. John’s wort affects menopause, and whether the results hold up in larger study groups.

St. John’s wort has the potential to cause many interactions, and some of them can be serious. Don’t start taking St. John’s wort without consulting your physician.

5. Valerian Root

Valerian root (Valeriana officinalis) is an herbal supplement sometimes consumed as a tea, capsule, or tincture. It is often used to support healthy sleep and relaxation because it is thought to impact gamma-aminobutyric acid (GABA) signaling, a neurotransmitter that supports relaxation and has sedative qualities.

Most studies on valerian root in menopause lack consistency in design, dosage, methods, and duration. While individual studies show benefits of valerian root for sleep (530 mg twice daily), hot flashes (225 mg three times daily), and healthy mood (350 mg twice daily), larger trials are needed to understand whether the results can be replicated.

6. Melatonin

Melatonin is a hormone naturally made in the body, but it can be taken as a supplement, too. Your body uses melatonin as part of the circadian rhythm, to know when it’s time to sleep. Menopause is associated with sleep challenges, including issues falling or staying asleep. Night sweats can also be disruptive for high-quality rest. Studies on melatonin have produced mixed results. It may help people fall asleep faster, but more research is needed.

Overall, cognitive behavioral therapy is considered to be the most effective way to address ongoing sleep challenges, but in people with menopause-related sleep symptoms, melatonin can be considered a good choice. Melatonin can interact with medications, so check with your doctor before you start taking it.

7. Calcium

Calcium is a mineral that is needed for skeletal health all throughout life, and it doesn’t lose its importance during menopause. If anything, it becomes more crucial as the way that bones remodel changes during the aging process. Calcium is also important for healthy sleep. Sleep challenges can be typical during hormone changes and throughout menopause. Low calcium has been linked to disrupted REM sleep, and while it’s not clear how specifically, supporting adequate calcium intake is important for many reasons.

It’s possible to get plenty of calcium from your diet. Dairy foods contain it, but even if you’re dairy-free because of lactose intolerance or follow a plant-based diet, you can still get calcium from collard greens, kale, sesame seeds, broccoli, and mustard. It’s also added to fortified orange juice, usually with vitamin D. If you don’t get enough calcium from food sources, dietary supplements can help support your optimal intake. The RDA for people who experience menopause is 1,000 mg per day through age 50, and 1,200 mg per day for 51 and older. Stick to the recommended dietary allowance unless your doctor says otherwise. Too much calcium can be problematic for kidney health and gastrointestinal comfort.

8. Vitamin D

Vitamin D is a fat-soluble nutrient that, together with calcium and vitamin K, is essential for healthy bones and tissues. For postmenopausal people, vitamin D is also beneficial for muscular and pelvic health, including bladder control. Vitamin D supports overall urinary tract health, vaginal pH balance, and libido. Vitamin D supports immune system balance, which becomes an increasingly important part of a healthy aging process.

The Endocrine Society recommends that all adults consume between 37.5-50 mcg daily (1,500-2,000 IU).

Before you start taking vitamin D, check with your doctor. Since it’s fat-soluble, it can accumulate in the body. Too much is harmful. A medical provider can run a blood test to check your levels and make a dosage recommendation based on your specific need.

9. Omega-3 Fatty Acids

Omega-3 fats are essential for humans, necessary for healthy tissue responses, immune cell function, neurological health, and more. Whether a person is in menopause or not, omega-3s are vital for wellness. You can get them from dietary sources like salmon and mackerel. Fish oil supplements also provide these healthy fats.

When it comes to direct menopause support:

• Fish oil may be able to decrease the frequency of hot flashes. A study of 120 adults born female (between ages 40-55) who experienced hot flashes were randomly assigned to receive fish oil or placebo for 8 weeks. The fish oil group experienced a significant decrease in hot flashes while the placebo group did not. The intensity of hot flashes did not change between the groups. Larger clinical trials are needed to confirm these results. A more recent meta-analysis found that fish oil may help with night sweats, but did not seem to reduce hot flashes.

• It’s unclear whether fish oil can impact mood or cognitive symptoms in menopause, and other studies that looked at hot flashes noted that the results are inconsistent.

Still, even without a certain impact for menopause, omega-3s are essential fats that are needed for all humans.

10. Sea Buckthorn

Sea buckthorn (hippophae rhamnoides), also known as seaberry, is an herbal supplement that is rich in bioactive compounds, including vitamins, carotenoids, polyphenols, phytosterols, and fatty acids. It has not been broadly studied, but the evidence that exists is supportive for general wellness purposes.

For menopause specifically, there are only two studies. A double-blind, placebo-controlled trial of 116 postmenopausal adults studied the effects of oral sea buckthorn on menopause-related symptoms of vaginal dryness and discomfort. The participants took 3 grams daily of sea buckthorn or placebo for 3 months. Those who took sea buckthorn experienced better vaginal comfort and epithelial integrity compared to the placebo. Since conventional hormone replacement approaches are not a good match for everyone, researchers concluded that sea buckthorn offers a potential alternative for those who struggle with vaginal symptoms of menopause.

The other study looked at the effects of sea buckthorn as an ingredient in a gel to support vaginal itching, dryness, or burning symptoms during menopause. It also included other ingredients like aloe vera, hyaluronic acid, and glycogen. The 12-week study included 60 postmenopausal people, randomized to either the gel or placebo. Those who used the gel experienced better vaginal comfort, pH balance, and improved vaginal dryness and sexual function.

Sea buckthorn is a promising supplement or ingredient for menopausal wellness, but more research is needed before it becomes a forefront consideration.

11. Ginseng

Ginseng is a medicinal plant and adaptogen that is commonly used in Traditional Chinese Medicine (TCM). It is frequently used for mood, cognition, and immune system support, although the evidence for these is mixed. When it comes to menopause, a systematic review of placebo-controlled studies found that ginseng was able to help with hot flashes and overall perception of quality of life during menopausal changes. It did not, however, impact sexual function, hormones, or vaginal health. Larger studies are needed to better understand its effects.

12. Maca Root

Maca root (Lepidium meyenii) is an herb that belongs to the cruciferous vegetable family. It has been used to support sexual wellness, and it appears to have benefits for menopause, too. In a study of 14 postmenopausal people, 3.5 g daily of maca helped to support a healthy mood and outlook, Maca had no impact on hormone levels. Other research has found that maca root was effective for reducing hot flashes and night sweats (known as vasomotor symptoms).

A systematic review of studies that looked at maca’s effect on menopause noted that it supported healthier mood and sexual function outcomes when compared to placebo. Study doses ranged from 2-3.5 g daily. Maca was also supportive of hot flash relief, although some of the trials in the review lacked consistent enough design to clearly identify maca’s impact. However, the overall effect demonstrated that maca outperformed a placebo condition for menopause comfort in the trials included.

Maca isn’t naturally found in foods, but it can be taken as a powdered supplement. It also comes in capsule form.

13. Multivitamins

Multivitamins can support overall nutrient intake, which may be beneficial in many stages of life. While there isn’t clinical trial data that clearly studies the effects of multivitamins on menopause-related symptoms specifically, researchers have looked at the importance of supporting adequate nutritional intake for vitamins during the menopause transition. The impact of vitamins C, D, E, and the B-complex family are wide-ranging. They support healthy hormone, neurological, heart, gastrointestinal, and immune system wellness. They’re also needed for general healthy aging support and cognition.

Instead of supplementing with individual vitamins and minerals, many people opt to take a multivitamin. While additional nutrients might be needed, a multivitamin provides a baseline supplement for adequate intake, although nothing replaces the necessity of a well-balanced diet.

14. Ashwagandha

Ashwagandha is an adaptogen herb that is used for healthy stress responses and sexual wellness. It has been studied for its impact on perimenopause and menopause symptoms. An 8-week randomized, double-blind, placebo-controlled clinical trial of 100 people with perimenopausal symptoms found that ashwagandha root (300 mg taken twice daily) significantly reduced urinary and vaginal symptoms. It also improved quality of life measurements, including mood. Ashwagandha supports healthy stress responses and mood by helping to provide balance to the HPA axis, which influences cortisol, DHEA, and melatonin concentrations.

15. Rhodiola

Rhodiola (Rhodiola rosea) is an herbal adaptogen that has stress-balancing properties. It can also support healthy energy, especially when fatigue is affected by stress-driven processes. Menopause frequently includes symptoms like tiredness, low mood (or changing moods), and a foggy brain. Rhodiola has been shown to support mood, memory, and cognitive wellness. It has also been found to enhance heart, brain, and cellular health.

Rhodiola’s benefits come from six types of bioactive compounds, including flavonoids, triterpenes, and phenolic acids. These support healthy immune, NFκB, and nitric oxide synthase responses. Rhodiola is broadly applicable outside of menopause, but offers some promising support for people experiencing mood, energy, or stress-related symptoms.

Other Supplements

There are many supplements that are touted as beneficial for relief from menopause symptoms, but the evidence for them may be low quality. Some may have mostly been studied in animals, while others may have human trials that are small, poorly designed, or have not been repeated in subsequent studies. Some menopause supplements that could be included in this category include:

• Ginkgo biloba: There’s very little high-quality evidence that ginkgo helps with menopause. One study found that it may enhance sexual desire in postmenopausal women. A systematic review of a variety of supplements used for cognitive health in menopause suggested that ginkgo could be helpful, but noted that the studies had serious design flaws that made the evidence highly unreliable.

• Coenzyme Q10: This antioxidant-like molecule supports many aspects of health, including heart, metabolism, and cellular energy. It supports the mitochondria (cellular energy factories) as they help generate ATP, the main energy source for the body. Supplements can increase coenzyme Q10 blood levels, but researchers aren’t fully clear on whether that means the body can use it. There’s not a clear use for its role in menopause, although a medical provider may recommend it for other reasons. Ask a doctor before starting it, since it can interact with some medications, including blood thinners.

• Vitamin E: A fat-soluble nutrient, vitamin E acts like an antioxidant in the body. It works closely with vitamin C and supports healthy oxidative responses. While some research has found that vitamin E may have some impact on hot flashes and vaginal changes in menopause, it’s not more effective than other methods, and more high-quality studies are needed to confirm the possible benefits. Most people can get enough vitamin E from food sources like nuts, seeds, avocado, and other healthy oils.

• Dong quai: Dong quai (Angelica sinensis L.) is a TCM herb that is sometimes called “female ginseng.” It is often used in TCM alone or together with other herbs as a tincture to support hormone-related symptoms in people assigned female at birth. However, most evidence comes from animals, and the small human trials that exist are inconclusive. A review of botanical supplements for menopause concluded that there was no evidence for dong quai to be used for this purpose.

• Evening primrose oil: Evening primrose oil, sometimes called EPO, is rich in omega-6 essential fatty acids. Studies testing its impacts on menopausal symptoms are mixed, with some showing a decrease in hot flash severity. Overall, evidence does not support EPO as a primary supplement for hot flash support.

• Probiotics: The beneficial bacteria that exist in the gut microbiome have a host of positive effects, but research on how probiotic supplements specifically affect menopause is limited. Probiotics support gastrointestinal, vaginal, skeletal, dental, metabolic, and heart health. Studies in menopausal people taking probiotics have some mixed results or effects that are not totally clear for menopause-related benefits because probiotics are combined with other nutrients or menopausal symptoms were secondary considerations. Still, overall the evidence is generally promising although people with compromised immune systems should always use caution.

Supplements to Be Cautious With or Avoid

Not all supplements are backed by evidence. While many supplements may be generally safe, some have the potential to interact with medications, health conditions, and even other supplements. There is no one-size-fits-all list of supplements to avoid, but it’s important to speak with your healthcare provider so that you know which ones aren’t optimal for you.

Lifestyle Considerations for Menopause Symptom Management

Menopause impacts everyone differently. While hot flashes, brain fog, mood changes, and tiredness are common, lifestyle changes can have a big impact on quality of life and overall well-being. This can help to address or minimize discomfort associated with hormone changes.

Your medical provider can discuss specific lifestyle changes that might work best for you, but a generally healthy lifestyle is the place to begin:

• A healthy, nutritionally-balanced food plan (like the Mediterranean diet)
• Good hydration
• Quality sleep
• Regular physical activity, including strength training
• Avoidance of tobacco
• Limited alcohol use

The Bottom Line

Supplements alone are not a quick fix for menopause-related symptoms, but when used in addition to a healthy lifestyle, some may be able to provide support. Only your healthcare provider can determine which supplements are safe for you, so be sure to check with them about menopause-related symptoms and possible solutions.