Menopause is a natural phase in a woman’s life when menstruation stops, typically occurring in their late 40s or early 50s. It is characterized by hormonal changes that lead to various symptoms such as hot flashes, mood swings, and weight gain. Prescription hormone therapy is considered the standard of care and offers a low risk option for managing menopausal symptoms in patients within 10 years of menopause or younger than 60 years and that do not have contraindications such as a history of breast cancer, coronary disease, blood clots, or active liver disease (UpToDate – Menopause). Herbal supplements, although not a first line option, offer a natural approach to managing menopause symptoms, and may provide relief. We will discuss some safe herbal supplements below.
Key Herbal Supplements for Menopause
Black Cohosh For Menopause
Black cohosh is a popular herbal supplement known for its potential to alleviate menopausal symptoms and is rated as possibly effective by Natural Medicine’s Comprehensive Database. Several studies have suggested that it can reduce menopausal symptoms and hot flashes frequency when compared to placebo and potentially has similar effectiveness to some hormonal therapy options. On the contrary, a large meta analysis that included many black cohosh studies suggested that it is not that helpful for menopausal symptoms (Franco et al 2016).
As stated above, prescription hormonal therapy is the preferred option for managing menopausal symptoms; however, for those seeking non-hormonal options, black cohosh is reasonable to try. Black cohosh is generally well tolerated, but some potential side effects include gastrointestinal discomfort, headaches, and breast tenderness. There have been rare cases of liver damage, but it is unclear if these were actually due to black cohosh.
Per Natural Medicine’s Comprehensive Database, the black cohosh supplement with the best evidence for menopause is Remifemin by Nature’s way, which is NSF certified and is reasonably priced at $22.13 for a 60-day supply.
SUMMARY
Black cohosh is a popular herbal supplement for menopause symptoms with conflicting evidence to support its use. We recommend NSF certified products such as Remifemin for those looking to try this supplement.
Sage For Menopause
Sage is an herb known for its culinary uses as well as its potential benefits in managing menopause symptoms. It has been traditionally used to reduce excessive sweating and hot flashes. Sage extracts or sage tea can be consumed to help alleviate these symptoms. However, sage extracts that contain a significant amount of thujones should be used with caution if you have a history of seizures.
A sage extract called Menosan by A.vogel was shown to reduce menopausal symptoms (Wilfried et al. 2021). It is not sold directly in the United States, but it is available on the manufacturer’s website as well as this website for £11.99 for a 50ml bottle and £20.99 for a 100ml bottle. The directions state to take 15 – 20 drops, which is about 1 ml, three times a day, so a 100ml bottle should last about 30 days. Menosan DOES contain thujones and should not be taken by people with a history of seizures (direct communication from A.vogel, reproducible upon request).
A.vogel also offers a sage product in a pill form called Menoforce, which is taken as one tablet once a day and sells for £15.99 for 30 tablets. Menoforce does NOT contain measurable amounts of thujones and is recommended over Menosan for patients with a history of seizures (direction communication from A.vogel, reproducible upon request).
We want to make it clear that Menosan and Menoforce are not USP or NSF certified, but may be reasonable options because they have been clinically studied.
SUMMARY
Sage extract can be used for menopause, and a thujone-free product called Menoforce by A.vogel has been studied and shown to alleviate some menopausal symptoms. Menosan does contain thujones and should be avoided in people with a history of siezures.
Soy Isoflavones for Menopause
Soy protein and soy isoflavones are possibly effective for menopausal symptoms with some studies showing reductions in hot flashes. Other studies have not replicated these findings (Natural medicines comprehensive database). The meta analysis of studies mentioned above in the black cohosh section also looked at soy for menopause and concluded that it can be helpful for hot flashes (Franco et al 2016).
Soy Menopause supplement by NatureMade is USP certified, but seems to be out of stock at online retailers at the time of this writing.
St. John’s Wort For Menopause
St. John’s Wort is a popular herbal supplement known for its potential benefits in managing mild to moderate depression as well symptoms of menopause. A meta-analysis of small clinical trial showed that taking up to 900mg per day of St. John’s wort for up to 16 weeks, alone or in combination with other herbs, reduced the frequency and severity of hot flashes when compared with placebo (Natural Medicine’s Comprehensive Database and Liu et al. 2014). It is very important to note that St. John’s wort has some serious drug interactions with prescriptions drugs. It can increase the risk of serotonin syndrome when taken together with SSRIs such as Paxil and Prozac. It can also severely reduce the effectiveness of some prescription medications such as the prescription blood thinners Eliquis and warfarin.
Unfortunately, we were unable to identify any standalone St. John’s wort products that are available on the market and that are USP or NSF certified, therefore, we cannot make a specific product recommendation.
SUMMARY
St. John’s Wort is a popular herbal supplement used for managing mild to moderate depression and menopausal symptoms, but it has serious drug interactions with prescription medications, including SSRIs and blood thinners, and no specific certified products could be identified for recommendation.
Combination Herbal Supplement Products For Menopause
Taking products containing a combination of more than one herbal supplement that has been shown to reduce menopausal symptoms is reasonable.
A specific combination product containing black cohosh plus St. John’s wort that has been studied in menopausal patients is Remifemin plus St. John’s wort and is available from foreign websites, but is a bit costly.
Another product by Nutrilite called Menopause Ease contains black cohosh, soy protein, and soy isoflavones and is NSF certified. It also contains acerola cherry concentrate, which is safe.
SUMMARY
There are two reliable herbal combination products available called Remifemin plus St. John’s Wort and Menopause Ease.
Red Clover For Menopause
Red clover is another herbal remedy that has been studied for managing menopausal symptoms. It contains compounds that mimic estrogen in the body, helping to balance hormonal fluctuations. The evidence for red clover for menopausal symptoms is mixed and possibly biased so we cannot make a recommendation in support of this herbal supplement.
Dong Quai For Menopause
Dong quai is a traditional chinese herb that been studied for managing menopausal symptoms. It is believed to help regulate hormone levels and reduce hot flashes. Like red clover, the evidence for dong quai is mixed so we cannot make a recommendation in support of this herbal supplement.
Evening Primrose Oil For Menopause
Evening primrose oil is an herbal supplement that contains gamma-linolenic acid (GLA), an omega-6 fatty acid. It has been studied to reduce menopause symptoms such as hot flashes and mood swings. Like red clover and dong quai, the evidence for evening primrose oil is mixed so we cannot make a recommendation in support of this herbal supplement.
Chasteberry For Menopause
Chasteberry, also known as vitex agnus-castus, is a herbal supplement that has been used for centuries to address hormonal imbalances. It has been studied to reduce menopause symptoms such as hot flashes and mood swings. Like red clover, dong quai, and evening primrose oil, the evidence for chasteberry is mixed so we cannot make a recommendation in support of this herbal supplement.
Lifestyle Changes to Complement Herbal Supplements For Menopausal Symptoms
Balanced Diet and Hydration
Maintaining a balanced diet during menopause is crucial for overall well-being. Focus on consuming a variety of fruits, vegetables, whole grains, and lean proteins. Certain foods rich in phytoestrogens, such as soy products, flaxseeds, and lentils, may provide additional support in managing menopause symptoms. Additionally, staying hydrated by drinking an adequate amount of water is essential for maintaining optimal health and minimizing symptoms.
Regular Exercise and Stress Management
Engaging in regular physical activity has multiple benefits during menopause. Exercise helps improve mood, promote weight management, and enhance overall cardiovascular health. Aim for a combination of aerobic exercises, strength training, and flexibility exercises. Furthermore, stress management techniques such as mindfulness meditation, deep breathing exercises, and yoga can help reduce stress levels and enhance well-being.
Quality Sleep and Relaxation
Quality sleep is essential for managing menopause symptoms. Establish a consistent sleep routine by going to bed and waking up at the same time each day. Create a calm and comfortable sleep environment, free from distractions. Practice relaxation techniques such as progressive muscle relaxation or aromatherapy to promote better sleep. Avoid caffeine and electronic devices close to bedtime to improve sleep quality.
Conclusion
Your doctor should be consulted if you are experiencing significant menopausal symptoms because prescription hormonal therapy is effective and low risk. Herbal supplements are a potential alternative to prescription hormonal therapy. Black cohosh, sage, and St. John’s wort have the most evidence for reducing menopausal symptoms, but the overall evidence base is weak. We recommend only taking products that are USP or NSF certified if possible. The sage products mentioned above are not NSF certified, but have been clinically studied and did not show any safety issues. Combination herbal supplements are available and also are reasonable to try. Remember to consult with a healthcare professional before starting any new herbal supplements, especially St. John’s wort.
REFERENCES
Natural Medicine’s comprehensive database. Black Cohosh professional monograph. Accessed 6/15/2023.
UpToDate. Menopause hormone therapy: Benefits and risk. Accessed 6/15/2023.
Wilfried D, Nina CDG, Silvia B. Effectiveness of Menosan® Salvia officinalis in the treatment of a wide spectrum of menopausal complaints. A double-blind, randomized, placebo-controlled, clinical trial. Heliyon. 2021 Feb 10;7(2):e05910. doi: 10.1016/j.heliyon.2021.e05910. PMID: 33615001; PMCID: PMC7881233.
Liu YR, Jiang YL, Huang RQ, Yang JY, Xiao BK, Dong JX. Hypericum perforatum L. preparations for menopause: a meta-analysis of efficacy and safety. Climacteric. 2014 Aug;17(4):325-35. doi: 10.3109/13697137.2013.861814. Epub 2013 Dec 27. PMID: 24188229.
Franco OH, Chowdhury R, Troup J, Voortman T, Kunutsor S, Kavousi M, Oliver-Williams C, Muka T. Use of Plant-Based Therapies and Menopausal Symptoms: A Systematic Review and Meta-analysis. JAMA. 2016 Jun 21;315(23):2554-63. doi: 10.1001/jama.2016.8012. PMID: 27327802.
Disclaimer: The information provided in this blog post is for educational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. As a clinical pharmacist, I strive to provide accurate and up-to-date information, but the field of herbal supplements is constantly evolving. Individual responses to herbal supplements may vary, and it is important to consult with a qualified healthcare professional before starting any new herbal supplement regimen. Additionally, it is crucial to carefully read and follow the instructions, warnings, and precautions provided by the manufacturers of herbal supplements. The author and the website disclaim any liability for any adverse effects or consequences resulting from the use or misuse of the information contained in this blog post.
