Supplements for Menopause: Do They Work?

The FDA might investigate a company only after problems are reported. False advertising claims by supplement makers can be investigated by the Federal Trade Commission.

Supplement makers work around the rules with vague claims, Streicher says. And, she adds, they often back their claims with studies that don’t last long enough to prove that any apparent benefit is more than a temporary placebo effect.

The placebo effect is “real but it’s not sustained,” she says.

Talking to your doctor about supplements

Whenever you take a supplement or other over-the-counter remedy, it’s important to let your doctor know, says Dr. Monica Christmas, an associate professor of obstetrics and gynecology at the University of Chicago.

One reason is that even if a supplement is safe for most people, it might harm you if you take certain medications or have a health condition, she says. In some cases, such as when a supplement might harm your liver, the doctor might urge you to get regular blood testing, she adds.

Herbal supplements are increasingly linked to liver damage, according to the American Pharmacists Association. The most common offenders are bodybuilding supplements, but ingredients such as turmeric, ashwagandha and green tea extracts that are sometimes found in menopause supplements have also been linked to liver damage.

What’s more, dozens of such cases have been reported after women took products labeled as black cohosh, an especially popular hot flash remedy. But at least some of those have been linked to mislabeled or contaminated products, not the herb itself, according to LiverTox, a National Institutes of Health website.

When there aren’t obvious safety concerns, Christmas says, she doesn’t try to talk patients out of using unproven products they believe are helpful.

“Minds are very powerful,” she says. “So if somebody comes in and they believe in what they’re taking, it doesn’t really matter what I say.”

But Christmas also makes sure patients know she has evidence-based options to offer if a supplement stops working for hot flashes or other symptoms.

That happens a lot, she says. “People will say, ‘Oh, I thought it was working the first couple of weeks I took it, but I’m not really noticing any difference anymore, and I’m waking up drenched every night.”

Other options for hot flashes and night sweats include hormone therapy, but also non-hormonal medications, weight loss and cognitive behavioral therapy, according to the Menopause Society.

A healthy diet, good sleep and exercise also go a long way for overall wellness in the menopausal years, Christmas says.

Choosing supplements

It’s possible that some supplements for hot flashes offer some relief to women with mild symptoms that might be hard to detect in studies, says Dr. JoAnn Pinkerton, a professor of obstetrics and gynecology at the University of Virginia. She notes that even when women have moderate to severe symptoms, about half report improvement when they take a placebo in a rigorous hormone therapy trial.

If you want to try a supplement, she urges, be aware that many of the “marked-up” products sold on slick websites are available in more affordable versions.

Christmas urges women to look for products verified to follow good manufacturing practices by a third party.

Beyond hot flashes, supplements do sometimes have an appropriate role, doctors say. For example, Streicher says she regularly recommends vitamin D for women with low levels. And, she says, taking an occasional melatonin supplement to fall asleep when you travel isn’t a problem.

“The problem is sustained use, or high dosages, or both,” she says — especially when it comes to supplements that may offer no benefit, carry unknown risks and drain your wallet.

Chasteberry

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Popular menopause supplement ingredients

What’s in your menopause supplement? Here are a few popular ingredients often touted for hot flash relief — and some of the reasons they aren’t recommended by the Menopause Society, which represents health care professionals specializing in menopause treatment:

• Soy products. While soy can have estrogen-like effects on the body, especially in people able to metabolize it in a certain way, limited studies of soy foods and supplements for hot flash relief have produced mixed results. Results are mixed even when women take supplements containing equol, a substance that some people produce in their gut when they consume soy. Equol is often touted as more beneficial than soy itself.
• Black cohosh. Multiple studies have produced “insufficient evidence” that this widely used herb works better than a placebo for hot flashes and night sweats, the society says. Reports of mislabeling and liver damage have raised safety concerns.
• Wild yam. Often sold as creams, these products sometimes illegally contain hormones such as estrogen and progesterone, making them unapproved, possibly unsafe hormone drugs, the society says.
• Dong quai. This root doesn’t seem to work. It may also make you more sensitive to the sun and act as a blood thinner, which could increase bleeding risks, especially in people taking blood-thinning drugs such as warfarin (Coumadin).
• Chasteberry. Extracts from this Mediterranean tree or shrub might have estrogen-like effects. But they have been tested in various doses and formulations without showing clear effectiveness.
• Maca. Supplements containing this South American root vegetable haven’t undergone rigorous enough study to know if they work. Maca contains weak phytoestrogens (plant estrogens) and has been promoted as a remedy for low sex drive as well as hot flashes.
• Vitamin E. Studies suggesting this vitamin might work better than placebos for hot flashes have been too small to be convincing, the society says.
• Marijuana. More than a quarter of women have used marijuana to treat menopause symptoms, including hot flashes, insomnia and mood problems, according to the society. But there’s no good evidence it helps. Smoking marijuana can cause lung damage and other health problems. Edible forms have been linked to overdoses and fall injuries.