Menopause supplements: money down the drain?

By all accounts, they’re doing a brisk trade. Wellington Menopause Clinic co-founder Professor Bev Lawton said she sometimes sees people in her clinic with bags of 10 or 12 supplements.

Unfortunately, there’s no good evidence these high-priced herbals work.

Prof Lawton is blunt. Her view: supplements for menopausal symptoms are money down the drain.

Lax regulation of dietary supplements means manufacturers don’t need approval before putting products on the shelf – and there are plenty of them taking up space. We investigated the ingredients in several popular supplements and the evidence to support product claims.

Ingredients A-Z

Black cohosh

Black cohosh is the main ingredient in Remifemin, which claims to offer “Natural Menopause Support” backed by “60 years of research”. It’s also used in Go Healthy Go Meno-Free.

Although one of the more researched ingredients used in menopausal supplements, there’s insufficient evidence black cohosh helps with symptoms, according to a 2012 review by the Cochrane Collaboration, which conducts systematic reviews on healthcare.

Most of the 16 studies reviewed were of “uncertain quality” and better research was needed before any conclusion could be drawn on whether the herb helps or not, the authors said.

In the Remifemin pack, a flyer is included that states a 2005 study found the supplement performed similarly to a low-dose oestrogen patch in reducing the number of hot flushes. However, it wasn’t a “blind” trial – the women in the study knew they were taking the supplement.

We asked Remifemin for other evidence its product helped with menopause symptoms. It provided a summary of research, which included nine blind trials. Four of these were included in the Cochrane review. Two others have been excluded from systematic reviews because of insufficient data. The remaining studies didn’t focus on menopausal symptoms.

There are risks with taking black cohosh. Prof Lawton said it can affect the liver and cause diarrhoea. Other side effects include cramping and headaches.

Information about the risks are on the supplement packs, but you may have to put your specs on to read it because of the tiny print.

Chaste tree

Chaste tree is used in Harmony Menopause, a “natural formula” to help with “relief from symptoms related to menopause”.

It’s also known as the chasteberry, vitex or monk’s pepper. Whatever the name, there’s no evidence to show it works to relieve menopausal symptoms.

Dong quai

This plant is in Go Healthy’s Go Meno-Free menopause and hot flush support, alongside other ingredients, to “effectively help menopause and hot flush symptoms”.

But there’s no good quality research to show dong quai reduces hot flushes.

While the herb affects oestrogen levels in other animals, it’s not known if the same happens in humans. The US National Institutes of Health advises people with hormone-sensitive conditions – such as breast, uterine and ovarian cancer and even endometriosis or uterine fibroids – to avoid dong quai.

Other possible side effects are sensitivity to the sun and it may also interfere with Warfarin (a medicine that prevents blood clots).

Red clover

Red clover is the main ingredient in Promensil, which claims to relieve hot flushes and night sweats.

Red clover contains isoflavones – a group of phytoestrogens (compounds in plants that mimic oestrogen). The theory is these plants may balance out hormonal fluctuations that cause menopausal symptoms. However, there’s a lack of scientific evidence backing this up.

A 2013 Cochrane Collaboration assessed five studies on Promensil and four studies that looked at red clover generally. It found no evidence Promensil, or other extracts of red clover, helped reduce hot flushes.

Rehmannia glutinosa root (Chinese foxglove)

Rehmannia is the main ingredient in Ethical Nutrients Menopause and Hot Flush Fix. The supplement offers “relief of menopausal symptoms”, but studies on whether Rehmannia works are thin on the ground.

It’s used in traditional Chinese medicine, in combination with other ingredients, and reputed to help with a range of conditions. We couldn’t find any evidence it helps with menopausal symptoms.

Metagenics, which owns the Ethical Nutrients brand, said its Menopause and Hot Flush Fix has been discontinued.

Sage

Sage is one of the main ingredients in Go Healthy Go Meno-Free Menopause.

If you want some sage advice, bypass this herb for treating menopausal symptoms. Australia’s Royal Women’s Hospital said there’s no evidence it works.

Shatavari

Shatavari is found in Go Healthy and Nutra Life Meno-Life Hot Flush Relief supplements.

Shatavari is used in traditional Indian medicine (also known as Ayurvedic) to treat menopause symptoms.

A 2018 study by the Queensland University of Technology found a blend of three herbs, which included shatavari, helped reduce menopausal symptoms. However, the study was paid for by a supplement company that bases its formulations on Ayurvedic medicine.

We couldn’t find any other evidence it works or is safe.

Soy

Soy is used in Nutra-Life Meno-Life Hot Flush Relief. Like red clover, soy is an isoflavone.

Attention focused on soy when a study on Japanese women found hot flushes reduced when they ate more soy. However, a subsequent study didn’t support these findings. It found no relationship between soy consumption and a reduction in hot flushes or night sweats.

A Cochrane Collaboration review in 2013 found no conclusive evidence that soy consumption would effectively reduce hot flushes.

Wild yam

Also known as Chinese Yam, we found it in Harmony Menopause to reduce night sweats.

Wild yam contains the chemical diosgenin, used in supplements for its oestrogen properties. However, the US National Institutes of Health said there’s no good evidence it works.

Withania root (Ashwagandha)

Withania root is included in Go Healthy’s Go Meno-Free supplement. The company claims the herb “helps to increase the body’s resistance to stress, and to generally enhance physical and mental functioning”.

The jury’s still out on whether it helps reduce stress. The US National Institutes of Health states the herb is “possibly effective” for improving symptoms.

Withania can potentially interfere with diabetes, blood pressure, immunosuppressants, sedatives and thyroid medications.

Zizyphus

Zizyphus is one of the main ingredients in Go Healthy Go Meno-Free. It’s also in Nutra Life Meno-Life Hot Flush Relief.

There’s no good quality evidence Zizyphus itself can treat menopause symptoms. That said, the studies focused on various mixes of Chinese herbal medicines, which included Zizyphus and Rehmannia. Typically, Chinese medicine is a blend of herbs, rather than a single plant.

What can help

If supplements don’t offer a solution, what can help with menopause symptoms?

Watch what you eat

Putting on weight during menopause may make the symptoms worse. Try to avoid spicy food and alcohol.

Keep active

Exercise can reduce the risk of osteoporosis and help your mental well-being. Try aerobic exercise, yoga, and strength training. But exercise won’t help with hot flushes.

Accessorise

Wearing layers, carrying a fan and drinking iced water can help manage your body temperature.

What about HRT?

Also known as menopausal hormone therapy, hormone replacement therapy (HRT) is available in tablets, patches, creams or vaginal treatments. They contain oestrogen, or are combined with progestogen, to replace the oestrogen your ovaries stop producing during and after menopause.

HRT came in for bad press in the early 2000s after studies linked it to an increased risk of strokes, blood clots, heart disease and breast cancer. Latest research shows no increased risk for heart disease (for women under 60) and a small increased risk for stroke, blood clots and breast cancer.

The Australasian Menopause Society states that for the majority of women who use HRT for menopause symptoms, the benefits are considered to outweigh the risks. However, HRT is generally not recommended if you have a history of breast cancer or stroke.

If you’re considering HRT, your first port of call is your GP. They’ll work through your risk factors and treatment options. The Australasian Menopause Society also lists doctors in main centres that are registered with it.

Talk therapy

Sarah Connor started Menopause over Martinis – a potluck dinner with a group of women – to discuss “the change of life” (alcohol optional).

Connor has hosted three dinners in Wellington so far and said the main benefit for women is “realising that they’re not the only one” going through menopause.

Anyone can host a dinner. She’s heard of women in Auckland, Wellington, New Plymouth and Dunedin arranging events, as well as in Australia and the UK.

Connor said the gatherings can help reduce feelings of isolation some women feel.

Women also chat about the changes they’re going through. “Learning that menopause is a normal stage of life and there are ways to get through it” is a big help, she said.

The Australasian Menopause Society also notes cognitive behavioural therapy (a talking therapy) may help to reduce stress levels.