Menopause

Self-care for menopause can be approached in a number of ways—but it can be hard to know just where to start. To make it easier, our doctors recommend trying these simple steps first:

Control symptoms with isoflavones
Supplements containing at least 80 to 100 mg a day of isoflavones from soy or red clover may help control symptoms

Cool down with black cohosh
Take 20 mg of a concentrated herbal extract twice a day for relief from hot flashes

Eat soy and flaxseed
Make foods high in phytoestrogens, such as flaxseed, tofu, soy milk, tempeh, and roasted soy nuts, a regular part of your diet

Find relief with exercise
Even light aerobic activities can help reduce menopausal symptoms

Quit smoking
Smokers are more likely to experience hot flashes and other menopausal symptoms

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full menopause article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

Product checklist for menopause

Rating	Nutritional Supplements	Herbs
	Soy	Black cohosh
	Progesterone	Red clover Sage and alfalfa (in combination)
	DHEA Flavonoids (hesperidin) Vitamin C Vitamin E	Alfalfa Asian ginseng Blue vervain (Verbena hastata) Burdock Dong quai Licorice Motherwort Sage St. John’s wort Wild yam
See also: Homeopathic Remedies for Menopause
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Dietary changes that may be helpful

Soybeans contain compounds called phytoestrogens that are related in structure to estrogen, though some reports show soy’s estrogenic activity to be quite weak.¹ Soy is known to affect the menstrual cycle in premenopausal women.² Societies with high consumption of soy products have a low incidence of hot flashes during menopause.³

In one double-blind trial, supplementation with 60 grams of soy protein caused a 33% decrease in the number of hot flashes after four weeks and a 45% reduction after 12 weeks.⁴ However, in further analysis of the data in this trial, researchers credit constituents in soybeans other than phytoestrogens for the therapeutic effect.⁵ In one controlled clinical trial, high intake of phytoestrogens from soy and flaxseed reduced both hot flashes and vaginal dryness; however, much (though not all) of the benefit was also seen in the control group.⁶ In another double-blind study, 100 mg per day of isoflavones extracted from soy was effective in relieving hot flashes.⁷

As a result of these studies, doctors often recommend that women experiencing menopausal symptoms eat tofu, soy milk, tempeh, roasted soy nuts, and other soy-based sources of phytoestrogens. Soy sauce contains very little phytoestrogen content, and many processed foods made from soybean concentrates have insignificant levels of phytoestrogens. Supplements containing isoflavones extracted from soy are commercially available, and flaxseed (as opposed to flaxseed oil) is also a good source of phytoestrogens.

Vitamins that may be helpful

Many years ago, researchers studied the effects of vitamin E supplementation in reducing symptoms of menopause. Most,¹³ ¹⁴ ¹⁵ ¹⁶ ¹⁷ but not all,¹⁸ studies found vitamin E to be helpful. Many doctors suggest that women going through menopause take 800 IU per day of vitamin E for a trial period of at least three months to see if symptoms are reduced. If helpful, this amount may be continued. Using lower amounts for less time has led to statistically significant changes, but only marginal clinical improvement.¹⁹

In 1964, a preliminary trial reported that 1,200 mg each of vitamin C and the flavonoid hesperidin taken over the course of the day helped relieve hot flashes.²⁰ Although placebo effects are strong in women with hot flashes, other treatments used in that trial failed to act as effectively as the flavonoid/vitamin C combination. Since then, researchers have not explored the effects of flavonoids or vitamin C in women with menopausal symptoms.

The mineral boron is known to affect estrogen metabolism. In one double-blind trial using 2.5 mg of boron per day for two months, hot flashes and night sweats worsened in 21 of 43 women, but the same symptoms improved in ten others.²¹ Women who are experiencing hot flashes or night sweats that have been diagnosed as menopausal symptoms and who are also supplementing boron (sometimes found in significant amounts in osteoporosis formulas and multivitamin-mineral supplements) should consider discontinuing use of boron-containing supplements to see if the severity of their symptoms is reduced.

Aging in women is characterized by a progressive decline in blood DHEA (dehydroepiandrosterone) and DHEA-sulfate (DHEAS) levels. These levels can be restored with DHEA supplementation. This process also improves the response of some brain chemicals, called endorphins, to certain drugs.²² These endorphins are involved in sensations of pleasure and pain; improving their response may explain why DHEA has an effect on mood symptoms associated with menopause. In one double-blind trial, however, menopausal women who took 50 mg of DHEA per day for three months had no improvement in symptoms compared with women taking placebo.²³ Further study is needed to validate a role for DHEA in the management of menopausal symptoms.

Natural progesterone supplementation has been anecdotally linked to reduction in symptoms of menopause.²⁴ ²⁵ ²⁶ In one trial, natural progesterone was found to have no independent effect on symptoms, and synthetic progestins were found to increase breast tenderness.²⁷ However, a double-blind trial found that topical administration of natural progesterone cream led to a reduction in hot flashes in 83% of women, compared with improvement in only 19% of those given placebo.²⁸ Preliminary research has found that oral, micronized progesterone therapy is associated with improved quality of life among postmenopausal women. However, oral micronized progesterone is available only by prescription in the United States.²⁹ Hot flashes, anxiety, depression, sleep problems, and sexual functioning were among the symptoms improved in a majority of women surveyed. Synthetic progestins, also available only by prescription, have reduced symptoms of menopause.³⁰ ³¹ ³²

Progesterone is a hormone and, as such, concerns about its inappropriate use (i.e., as an over-the-counter supplement) have been raised. The amount of progesterone in commercially available creams varies widely, and the progesterone content is not listed on the label because the creams are legally regulated as cosmetics, not dietary supplements. Therefore, a physician should be consulted before using these hormone-containing creams as supplements. Although few side effects have been associated with topical progesterone creams, skin reactions may occur in some users. Effects of natural progesterone on breast cancer risk remain unclear; research has suggested both increased and reduced risk.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Double-blind trials support the usefulness of black cohosh for women with hot flashes associated with menopause.³³ A review of eight trials concluded black cohosh to be both safe and effective.³⁴ Many doctors recommend 20 mg of a highly concentrated extract taken twice per day; 2–4 ml of tincture three times per day may also be used.

A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.³⁵ These herbs include licorice, alfalfa, and red clover. In a double-blind trial, a formula containing tinctures of licorice, burdock, dong quai, wild yam, and motherwort (30 drops three times daily) was found to reduce symptoms of menopause.³⁶ No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times daily in capsules) had no effect on menopausal symptoms or hormone levels.³⁷ A double-blind trial using a standardized extract of subterranean clover (Trifolium subterraneum), a relative of red clover, containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flashes, though it did improve function of the arteries.³⁸ An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind study.³⁹ In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks.⁴⁰

Sage may reduce excessive perspiration due to menopausal hot flashes during the day or at night.⁴¹ It is believed this is because sage directly decreases production of sweat. In a preliminary study, supplementation with a product containing extracts of the leaves of sage and alfalfa resulted in complete elimination of hot flushes and night sweats in 20 of 30 women, with varying degrees of improvement in the other ten cases.⁴²

Blue vervain (Verbene hastata). is a traditional herb for menopause; however, there is no research to validate this use. Tincture has been recommended at an amount of 5–10 ml three times per day.

Preliminary evidence suggests that supplementation with St. John’s wort extract (300 mg three times daily for 12 weeks) may improve psychological symptoms, including sexual well-being, in menopausal women.⁴³

A double-blind trial found that Asian ginseng (200 mg per day of standardized extract) helped alleviate psychological symptoms of menopause, such as depression and anxiety, but did not decrease physical symptoms, such as hot flashes or sexual dysfunction, in postmenopausal women who had not been treated with hormones.⁴⁴

Warning: Kava should only be taken with medical supervision. Kava is not for sale in certain parts of the world.

In a double-blind trial, a standardized kava extract was found to be effective at reducing anxiety and other symptoms associated with menopause.⁴⁵ The study used 100 mg of kava extract standardized to contain 70% kava-lactones, three times per day. Most commercially available kava extracts contain up to 35% kava-lactones. In another study, administration of kava enhanced the anti-anxiety effect of hormone replacement therapy in postmenopausal women.⁴⁶

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

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Menopause

is not a disease...

About menopause

What are the symptoms of menopause?

Medical options for menopause

Dietary changes that may be helpful

Lifestyle changes that may be helpful

Vitamins that may be helpful

Herbs that may be helpful

Holistic approaches that may be helpful