By Rebecca Styles
Research Lead | Hautū Rangahau
Hot flushes and night sweats are the most talked about symptoms of menopause, but symptoms can also include tiredness, trouble sleeping, brain fog and weight gain, among others. So, what works to relieve symptoms?
We talked to a range of experts about hormone replacement therapy (HRT), some specialised supplements, non-hormonal treatment options and wellbeing approaches.
Which of these will work best for you is often a matter of trial and error. Many people try a range of treatments before finding an approach that suits them and this can take a little time.
What is hormone replacement therapy
HRT, also known as menopausal hormone therapy, is used to treat menopause symptoms. It works by replacing the oestrogen and progesterone hormones that your body is producing less of. HRT can come as a tablet, patch, cream or vaginal treatment, and requires a prescription to access in Aotearoa.
Taking HRT can help keep your bones healthy, as reducing hormone levels can accelerate bone loss and increase risks of fractures or osteoporosis. HRT can also help reduce the risk of heart disease for some people.
Who can take HRT?
Most people with menopause symptoms can take HRT, although there are some exceptions. For example, HRT may not be suitable if you have a history of breast, ovarian or womb cancer, or have untreated high blood pressure or liver disease.
The Australasian Menopause Society said HRT is safe for most women to use while in their 50s or in the first 10 years after the onset of menopause. The added risk of blood clots, stroke and breast cancer associated with HRT is very small and similar to the risk associated with other factors, such as being overweight.
Your doctor will be able to recommend a treatment that takes into account any health conditions you have.
Seeing your GP about HRT
If you’re interested in starting HRT, you can visit your doctor or go directly to a menopause clinic. Before the appointment, keep track of your symptoms and any other treatments you’ve already tried.
Dr Prabani Wood, the medical director at The Royal New Zealand College of General Practitioners, advised menopause consultations can be complex, so it’s best to book a longer consultation.
“Menopause includes so many symptoms and impacts periods, mood, weight, sleep, confidence, and relationships that it can take time to discuss and ensure that other conditions are not causing these symptoms. It is important to screen for family history in terms of individualising risk to ensure patients can make an informed decision about whether Menopause Hormone Therapy (MHT) is suitable for them. Then time is needed for discussing possible side effects of medications and ongoing monitoring/screening when on these medications, e.g. mammograms, blood tests, blood pressure checks.
“Often bone health is discussed and a plan made for this with a baseline bone density scan. It is also important to discuss lifestyle advice with regard to supplements, diet and exercise.”
Some GPs have separate menopause clinics that can dedicate more time to complex cases, Dr Wood explained.
“More complex cases may include women with persistent symptoms, premature menopause, endometriosis, women with breast cancer family history. Heavy periods may require more individualised risk management and treatments, and some women may need additional testosterone for libido but that also helps with brain fog and fatigue.”
An initial consultation at a specialist menopause clinic can cost between $125 and $450, and usually lasts between 45 minutes and an hour. Follow ups are cheaper, ranging from $62 to $200.
Supplements for menopause symptoms
There is an abundance of supplements on supermarket and chemist shelves claiming to “support you through menopause” – and a plethora of Insta ‘experts’, some advising us to take creatin, while others swear by magnesium.
So, what supplements do we really need during menopause?
Mikki Williden is a registered nutritionist who works with people to reach their health goals. She suggested that if menopause symptoms are interfering with your daily life, it’s a good idea to get some blood tests done first to check for any nutritional deficiencies before you reach for supplements.
The key nutrients blood tests can detect are vitamin D, iron, zinc, b12 and folate.
Iron levels can be low in perimenopause but tend to rise in post-menopause as periods stop.
Mikki said another important consideration is whether the supplements you’re planning to take are safe, particularly as supplements can interfere with medication.
What the evidence says about supplements
The consensus from the medical specialists we spoke to was there isn’t enough scientific evidence to support claims that supplements can reduce menopause symptoms.
The Australasian Menopause Society said, “no complementary medicine is as effective as oestrogen therapy for menopausal symptoms”.
Health New Zealand said that most of us get all the nutrients we need from our diet. Unless a doctor has suggested a supplement, it can be better to spend your money on food that benefits your health.
Despite this, many supplements claim on their labels to support perimenopause and menopause symptoms.
Supplement ingredients A - Z
We analysed some of the common ingredients in supplements that claim to support perimenopause and menopause symptoms to see whether there was any evidence to support such claims.
Ashwagandha root (withania root)
Ashwagandha root is the main ingredient in BePure Meno Calm. It also features in Good Health Peri-Meno.
A 2021 study in The Journal of Obstetrics and Gynaecology Research based on 91 participants found it may relieve mild to moderate symptoms of menopause.
However, ashwagandha root has some safety concerns. In February 2024, the Therapeutic Goods Administration in Australia issued a safety advisory stating the plant could cause gastrointestinal symptoms. In rare cases, it has also been linked with liver injuries.
Good Health told us its products are “developed through a robust formulation process that considers the available scientific literature, traditional herbal use, safety parameters and appropriate therapeutic dosing.”
Black cohosh
Black cohosh is the active ingredient in Remifemin, which claims to “support[s] a normal balanced temperature in women through the years of hormonal change”. It’s also an ingredient in Swisse Menopause Balance, BePure Meno Calm, Good Health Peri-Meno and Lifestream Meno Soothe.
The Australasian Menopause Society (AMS) notes there are various types of black cohosh, and say that some extracts, such as isopropanolic, may be beneficial.
A 2020 review of recent research into the isopropanolic form of black cohosh noted that it may improve menopausal symptoms, including hot flushes. The studies included in the review were conducted over a short time period and on small numbers of people.
However, the AMS also noted there are some safety concerns. If you do decide to use it, it says to do so with caution.
Calcium and vitamin D
Calcium is included in Swisse Ultiboost Menopause Balance and Harmoney Menopause, and there are standalone calcium supplements you can buy. Adults need at least 500mg of calcium a day.
The Australasian Menopause Society doesn’t recommend calcium supplements. It noted that while studies showed a marginal reduction in fracture risk for people taking calcium supplements, the evidence was “weak and inconsistent”.
Osteoporosis New Zealand stated research shows it’s safer and more effective to get your calcium from food sources, rather than supplements. It also said Vitamin D is vital to help your body absorb calcium. You get vitamin D from the sun and from some food, like fatty fish and egg yolks.
A 2023 study into the role of vitamin D and menopausal women’s health said vitamin D supplements are safe, inexpensive and play a role in the overall health of menopausal women, although more studies were needed to determine the right doses and whether there are any risks.
Chaste tree
Chaste tree – also known as chasteberry, monk’s pepper or vitex – is an ingredient in Lifestream Meno Soothe, Harmony Menopause and Clinicians Menopause Balance.
There’s no strong evidence to show chaste tree is effective in reducing menopausal symptoms, and it has potential side effects including nausea and stomach pain. It’s not recommended for women with hormone-sensitive conditions like breast, ovarian or uterine cancers.
Chinese foxglove (rehmannia glutinosa root)
Rehmannia glutinosa is the main ingredient in Harmony Menopause. The product’s website said the plant is traditionally used in Chinese medicine to relieve hot flushes and night sweats, but we couldn’t find any studies on its use or effectiveness.
Chinese yam (wild yam)
Wild yam is also found in Harmony Menopause. There is a lack of research on whether Chinese yam works, with a 2001 study on its cream form by the US National Institutes of Health noting it had little effect on menopausal symptoms.
Creatine
Creatine (a compound of three amino acids) is currently being touted in social media feeds as the must-have supplement for menopause, although it wasn’t an ingredient in the supplements we looked at.
Mikki said creatine is a worthwhile supplement for women with menopausal symptoms: “There are hundreds of clinical trials supporting the use of creatine monohydrate for supporting recovery, bone density, brain health, mood and sleep”.
She recommends it for women who can tolerate it, although potential side effects include nausea, muscle cramps, and diarrhoea.
A 2025 study published in Journal of the International Society of Sports Nutrition said evidence suggests creatine can help with muscle strength, exercise performance, body composition, cognitive function and mood. However, benefits may differ depending on hormonal life stage, and the study called for more nuanced research of creatine’s impact for perimenopause, as well as pregnancy.
Dong quai
The University of Rochester Medical Center said claims that dong quai supports menopausal symptoms have not been proven through research.
Potential risks associated with the plant include extreme sun sensitivity and an upset stomach. It may also slow blood clotting, meaning people taking blood thinners should steer clear.
Fenugreek seed
Fenugreek contains phytoestrogen compounds with a similar structure to human oestrogen.
A 2006 study, by the Cochrane Library, compared two groups of postmenopausal women: one group taking oestrogen and progesterone, the other fenugreek seed. The study found women who took fenugreek experienced a reduction in hot flushes, but HRT had a greater effect.
Sage
Garden sage is an ingredient in Swisse Ultiboost Menopause Balance, red sage in Good Health Peri Meno, and sage leaf in Be Pure Menocalm.
The US National Center for Complementary and Integrative Health notes that ‘sage’ refers to many plants derived from the genus Salvia. There have been a few small studies to see whether sage is effective in reducing hot flushes and improving memory. While it may be useful for hot flushes, there’s no definitive answer as to whether it helps with memory.
Humulus lupulus (hops) strobile
The properties of hops have been investigated for their impact on sleep.
A 2014 assessment by the European Medicines Agency found no evidence that hops alone are effective for helping with insomnia or as a mild sedative. The same study noted three small controlled clinical trials had tested hops’ effectiveness for menopausal symptoms; the studies didn’t provide enough evidence that hop extracts act as a plant-based oestrogen.
Magnesium
Many people swear by magnesium for sleep or anxiety. Dr Louise Newson is a UK-based GP and menopause specialist, who’s prominent on Instagram. She notes that while more evidence is needed, if you have a deficiency, magnesium supplements may help with sleep or feelings of anxiety.
The Australasian Menopause Society said there’s no evidence magnesium helps with hot flushes or night sweats.
For some people, magnesium can cause diarrhoea.
Red clover
Red clover contains isoflavones; plant compounds that mimic oestrogen and may balance out hormonal fluctuations that cause menopausal symptoms. It’s the main ingredient in Promensil, which claims to relieve hot flushes and night sweats.
A 2013 Cochrane Collaboration assessed five studies on Promensil and four studies that looked at red clover generally but found no conclusive evidence that the plant reduced the severity or frequency of hot flushes or night sweats.
Schisandra
We found schisandra in Lifestream’s Meno Soothe, and the company’s website claimed the ingredient “supports a calm mind, the liver’s natural detoxification processes, and healthy hormone metabolism.”
We asked Lifestream for more information about schisandra because we couldn’t find any, but we didn’t hear back before publication.
Soy
Soy products contain compounds that mimic oestrogen.
The Australasian Menopause Society said studies into whether plants that mimic oestrogen are effective vary. While some studies show soy may help in early menopause, others show it had no benefit when compared to a placebo.
Why are natural health products so popular?
We asked consumers who take natural health products such as vitamins, what they take and why they take them.
Lifestyle changes: diet and exercise
Mikki works with clients whose menopausal symptoms are interfering with their day-to-day life. One of the first questions she asks is what they eat.
For Mikki, a good diet includes good sources of protein (at least 30g in a meal), vegetables and fruit.
“We have normalised eating small amount of protein, women especially under eat it,” she said.
Quality protein sources include animal protein and a range of vegetarian sources, such as legumes, soy, nuts, seeds, eggs and whole grains. A 120g piece of cooked chicken contains about 35–40g of protein.
The Australasian Menopause Society also recommended three main meals and two protein snacks per day, plus smaller portions.
Stress management, down time and exercise are also important during menopause. Exercising regularly can help decrease the severity of symptoms, benefits mental health and can reduce the risk of chronic disease as we age.
The Australasian Menopause Society recommended people aim for 2.5 hours of moderate to vigorous exercise a week, such as brisk walking, jogging, cycling or swimming. If people are aiming to lose weight and reduce cancer risk, it recommended they do 5 hours of moderate intensity activity each week.
Flexibility training like stretching, yoga or Pilates, and some strength training to build muscle twice a week is also beneficial.
Have a chat with your doctor before jumping on the treadmill about the right level of activity you.
Menopause and mental health
The Australasian Menopause Society explains that people going through menopause are at a higher risk of mood changes, depression and anxiety.
Karen Nimmo is a clinical psychologist and gave us some pointers for navigating the transition.
“It can be unnerving – almost frightening – to feel so off your game and/or unlike yourself. Invest time in educating yourself on the psychology of menopause. See a professional, take a course or jump online and do some research. There’s a deluge of info about the physical symptoms but not enough (to my mind) on how to cope with the mental and emotional changes. Because menopause often coincides with empty nesting, it’s a life transition phase for women, and couples – that means it may be a good time to assess where you’re at, reframe your life and relationship and set some new goals for the future.”
Physical symptoms can overlap with changes to mental health, Nimmo said, and when the everyday stresses of family life and careers are added, it can be hard to determine what the cause of any issues is.
“It can be hard to pinpoint when things changed, when you started to feel more moody or more anxious. You just know that a year or so ago, you felt better than this! It’s helpful to see a health professional to gauge where you’re at hormonally – there can be significant relief (for everyone) in knowing that menopause is the driver of this change and getting HRT assistance if you need it. It can be life changing.”
If you’re perimenopausal and have children undergoing their own hormonal fluctuations at the same time, it’s important for everyone in the household to understand that hormones can make people behave differently. Nimmo suggests cutting other family members some slack, but also said hormones aren’t a reason to be mean and nasty.
“If your moods lead you into that territory, then an apology is the right thing to do.”
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