Setting the Record Straight on Menopause Supplements
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This article was written by Jen Connolly, Nutrition Coach & Student Nutritionist, and Maeve Hanan, Disordered Eating Specialist Dietitian and founder of Dietetically Speaking.
Given the substantial impact of the menopause, women can often be vulnerable to marketing claims promoting ‘miracle’ supplements and treatments. In this article, we will explore the myths surrounding menopause supplements and provide clear, evidence-based advice on managing symptoms sensibly.
What is Menopause?
Menopause is the phase in a woman’s life that signals the end of her reproductive years, typically occurring between the ages of 45 and 55 (but it can happen earlier). It’s characterised by a decline in ovarian function and oestrogen levels, with the official onset of Menopause marked by the absence of periods for 12 consecutive months.
While menopause is a natural part of ageing, it can also result from certain medical or surgical interventions.
The transition to menopause, known as perimenopause, can be gradual and it can last several years, often impacting physical, emotional, and mental well-being, with wide ranging symptoms. In fact, 80-90% of women will experience some menopausal symptoms, with 25% of women describing symptoms as severe and debilitating (1).
The wide ranging symptoms include;
- Changes in the menstrual cycle
- Vasomotor symptoms such as night sweats and hot flushes
- Issues with memory and concentration
- Mood changes
- Sleep issues and fatigue
- Joint pain
- Vaginal dryness and urinary symptoms
- Headaches and migraines
- Palpitations
- Dry or itchy skin
- Thinning hair or hair loss
- Anxiety
The Truth About Supplements in Menopause
The menopause supplement industry is booming, valued at $16.93 billion in 2023 and continuing to grow (2).
A quick search on Google will reveal a multitude of supplements targeted at treating menopause symptoms with claims such as ‘balances hormones naturally’ and ‘the best treatment for meno’.
There are countless supplements claiming to ‘balance hormones naturally’ or cure menopausal symptoms. However, it’s important to recognise that no supplement can stop or reverse menopause. Hormone Replacement Therapy (HRT) remains the gold standard and first line treatment for managing symptoms, though prescribable, non-hormonal treatments are available for those who cannot or choose not to take HRT (3).
Let’s take a look at some of the ingredients in the most marketed supplements and at what the evidence really says.
Black Cohosh
Traditionally used in Native American medicine, it is often marketed as a natural alternative to HRT for managing hot flushes. However, the evidence on its effectiveness is inconsistent.
A review of 16 randomised controlled trials, involving around 2,000 participants, found no significant benefit in reducing hot flushes compared to HRT (4).
Some smaller studies have shown limited benefits, but these tend to be small and short-term, making it hard to draw firm conclusions .
There is little evidence supporting Black Cohosh for improving sleep, anxiety, or depression in menopausal women. Additionally, its side effects, such as digestive issues and skin rashes, are not fully understood. It is not recommended for those with liver conditions or individuals taking medications that affect liver health.
Red Clover
Often marketed for hot flushes and bone health, it has weak supporting evidence. Studies are often small, methodologically flawed, or limited to animal models.
There are also different varieties of red clover, which adds further inconsistency to its reported benefits. While some trials suggest a mild reduction in hot flushes, the evidence remains inconclusive, and potential interactions with medications should be considered before use (5,6,7). For example, this supplement is not recommended for women with oestrogen-receptor-positive breast cancer.
Soy Isoflavone
A type of phytoestrogen (mostly found in soybeans) that have shown some evidence of reducing hot flushes, albeit mildly. A systematic review in 2019, for example, found that soy isoflavones may alleviate menopause symptoms (and provide support for osteoporosis prevention) (8).
However, soy is not a cure-all, and women with oestrogen-sensitive conditions should be cautious about its use. More research is needed to understand its full impact on menopausal symptoms.
Magnesium
This is an important mineral, involved in many chemical processes in your body and there is evidence to show it may support heart health, blood sugar, bone health etc. However, it is most often used in menopause specifically, to aid sleep and this is where the evidence is more inconsistent. Some (observational) studies show an association between magnesium and sleep health, while randomised controlled trials show inconsistent results (9).
Lion’s Mane & Ashwagandha
These are often marketed for cognitive and mood benefits during menopause, but there is little high-quality evidence supporting their use.In fact, most studies showing benefits are limited or animal based (10,11).
Sage Leaf Extract
Sage is part of the mint family and there are over 900 varieties. There has only been very limited, with often cited studies including less than 100 women (12,13).
Caution should be taken if taking sage supplements, due to the number of varieties. Some varieties are not safe to take over prolonged periods (e.g. those containing thujone). Other varieties can potentially interfere with diabetes medication.
Soya Bean Extract
Promoted for its phytoestrogen content, but similar to soy isoflavones, it may provide only mild relief for certain symptoms.
Vitamin D
Vitamin D is the only supplement that is recommended for all women (and everyone else!), during the Autumn and Winter months.
Vitamin D plays an important role in keeping bones, teeth and muscles healthy. The body creates vitamin from direct sunlight on our skin and we can also get it in our diet (sources include oily fish, egg yolk and fortified foods e.g. cereals). However, during Autumn and Winter the amount of vitamin D our body creates from sunlight is greatly reduced, hence why a 10 microgram vitamin D supplement is recommended for most people in the UK and Ireland during this time (14).
Sensible, Evidence-Based Advice for Peri/Menopause
Instead of turning to unproven supplements, there are several evidence-based lifestyle changes and interventions that can help manage menopausal symptoms and support longer term health. Post menopause, bone health and heart health become particularly important.
Enjoyable Movement:
Regularly taking part in a weight-bearing type of movement that you enjoy, where your feet and legs support your weight (e.g. walking, running, yoga, dancing, tennis, strength training) supports bone health, muscle strength, flexibility and balance. Cardio exercise that gets the heart pumping is also good for the heart and overall health (e.g. brisk walking, running, dancing, cycling, swimming).
If you’re looking for ideas, the NHS has some good exercises that are free and easy to do at home.
Gentle Nutrition:
There are a number of things you can add into your diet to support health at this lifestage, such as:
- Incorporating lots of colour in your diet i.e. a variety of fruit and vegetables
- Including dairy every day e.g. milk, cheese, yoghurt
- Eating plenty of wholegrains
- Consuming oily fish once or twice a week e.g. sardines, mackerel, salmon, trout and herring.
- Taking a vitamin D supplement during autumn and winter to support bone health in particular, some people benefit from taking this year-round depending on their sun exposure during spring and summer.
In some cases, additional supplements can be beneficial depending on your diet and health conditions.
For example, depending on dietary intake calcium supplements can support bone health, while omega-3 supplements can be useful for heart health, particularly for those not consuming oily fish regularly.
It can also help to experiment with reducing caffeine and alcohol; as for some women these can make hot flushes and night sweats worse.
Prioritise Mental Health:
The British Menopause Society recommends Cognitive behavioural therapy (CBT) (a type of talk therapy) that can help with stress, anxiety and depression. It has also been found effective for managing menopause symptoms such as hot flushes, night sweats and even sleep (15). Mindful practices such as meditation, yoga, or gentle stretching may also help with combating stress, which can exacerbate symptoms. There are many other kinds of therapy available which can be helpful depending on each person’s situation and mental health priorities.
Optimise Sleep:
Some changes can have a positive impact on sleep and therefore a knock-on benefit on overall symptoms.
For example:
- No screens before bedtime
- Keeping the bedroom dark and cool
- Relaxation and breathing exercises
- Avoiding caffeine after 2pm
- Getting to bed earlier
Prioritise Your Relationship With Food:
Menopause can often be a challenging time for protecting your relationship with food. This stems from a variety of changes that take place during this phase of life such as hormonal changes, changes in body composition and emotional eating.
These can potentially lead to poor body image and disordered eating behaviours. You can read more about How Menopause Can Impact Your Relationship with Food in our previous article.
Consult Healthcare Professionals:
While it can be tempting to buy into the latest trends (or advice on Facebook groups!), individualised advice from healthcare professionals, such as GPs, registered dietitians, or menopause specialists, should always be the first line of action.
Hormonal and non-hormonal treatments can be tailored to meet each woman’s specific needs, ensuring the best possible care.
Consulting a healthcare professional can also help avoid unnecessary and costly supplements that may interfere with medications or cause adverse effects.
Conclusion
The appeal of supplements during menopause is understandable, but these should be approached with a critical eye. Many marketed solutions are not backed by robust evidence, and some may even pose risks. Beyond the vitamin D supplement we are all recommended to take in the Northern Hemisphere during autumn and winter it’s best to focus on lifestyle changes, consult with healthcare professionals, and rely on evidence-based treatments like HRT for the best symptom management during this life stage.
If you are looking for support with navigating menopausal changes and symptoms, or your relationship with food, you can find out about our support services here or book a free 15-minute discovery call with one of our Dietitians.
References
- Hamoda, H. (2021). What is menopause? British Menopause Society. Available from: https://thebms.org.uk/wp-content/uploads/2023/08/17-BMS-TfC-What-is-the-menopause-AUGUST2023-A.pdf
- Grand View Research. (2021). Menopause Market Size, Share & Trends Analysis Report By Treatment (Hormonal, Non-hormonal), By Distribution Channel (Hospital Pharmacies, Retail Pharmacies, Online), By Region, And Segment Forecasts, 2021 – 2028. Grand View Research. Available from: https://www.grandviewresearch.com/industry-analysis/menopause-market
- National Institute for Health and Care Excellence (NICE). (2023). Menopause: Diagnosis and Management. NICE. Available from: https://www.nice.org.uk/guidance/conditions-and-diseases/gynaecological-conditions/menopause
- Mishra, G. D., Kuh, D., & Cooper, R. (2019). A life course approach to reproductive health: Theory and methods. Maturitas, 124, 31-37. https://doi.org/10.1016/j.maturitas.2019.03.013
- Ghazanfarpour M, et. al. Effects of red clover on hot flash and circulating hormone concentrations in menopausal women: a systematic review and meta-analysis. Avicenna J Phytomed. 2015 Nov-Dec;5(6):498-511. PMID: 26693407; PMCID: PMC4678495.
- Kim, M. R. et. al. (2020). Combination of red clover and hops extract improved menopause symptoms in an ovariectomized rat model. Evidence-Based Complementary and Alternative Medicine, Article ID 7941391. https://doi.org/10.1155/2020/7941391
- Gościniak A, et. al. Multidirectional Effects of Red Clover (Trifolium pratense L.) in Support of Menopause Therapy. Molecules. 2023; 28(13):5178. https://doi.org/10.3390/molecules28135178
- Chen L-R, Ko N-Y, Chen K-H. Isoflavone Supplements for Menopausal Women: A Systematic Review. Nutrients. 2019; 11(11):2649. https://doi.org/10.3390/nu11112649
- Arab, A., Rafie, N., Amani, R. et al. The Role of Magnesium in Sleep Health: a Systematic Review of Available Literature. Biol Trace Elem Res 201, 121–128 (2023). https://doi.org/10.1007/s12011-022-03162-1
- Spelman, K. (2017). Neurological Activity of Lion’s Mane (Hericium erinaceus). Journal Compilation ©2017, AARM. https://doi.org/10.14200/jrm.2017.6.0108
- Gopal, S., et. al. (2021). Effect of an ashwagandha (Withania Somnifera) root extract on climacteric symptoms in women during perimenopause: A randomised, double-blind, placebo-controlled study. Journal of Obstetrics and Gynaecology, 42(5), 665-671. https://doi.org/10.1111/jog.15030
- Bommer, S., Klein, P. & Suter, A. First time proof of sage’s tolerability and efficacy in menopausal women with hot flushes. Adv Therapy 28, 490–500 (2011). https://doi.org/10.1007/s12325-011-0027-z
- De Leo V, Lanzetta D, Cazzavacca R, Morgante G. Trattamento dei disturbi neurovegetativi della donna in menopausa con un preparato fitoterapico [Treatment of neurovegetative menopausal symptoms with a phytotherapeutic agent]. Minerva Ginecol. 1998 May;50(5):207-11. Italian. PMID: 9677811.
- NHS. (2023). Vitamin D. National Health Service. Available from: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/
- British Menopause Society. (2022). Cognitive Behavioural Therapy (CBT). Available from: https://thebms.org.uk/wp-content/uploads/2022/12/01-BMS-TfC-CBT-NOV2022-A.pdf