Menopause Supplements: What Works and What Doesn't, According to Experts

Millions of women seeking relief from menopause symptoms are spending significant amounts on supplements that offer little to no proven benefit, according to consumer analyses and health experts. A review of 26 popular menopause supplements by consumer group Which? found that many products, often costing over £400 annually, were no more effective than a standard multivitamin.

Experts emphasize that not a single product analyzed contained the right combination of nutrients at scientifically proven doses to alleviate symptoms such as hot flashes and mood changes. "Women should be wary of products making broad claims that are not supported by good-quality evidence," stated Joyce Harper, Professor of Reproductive Science at University College London, who led a study analyzing over 200 menopause supplements.

Supplements with Evidence

While many products on the market fall short, experts identify a few nutrients with genuine evidence for supporting women through menopause. Vitamin D is recommended, particularly as estrogen decline during menopause affects calcium absorption and bone health. Many people in the UK are deficient in vitamin D due to limited sun exposure, and experts suggest a daily intake of 1000 international units (25 micrograms) for most individuals, regardless of menopausal status.

Calcium is also crucial for bone health, but Dr. Paula Briggs, a consultant in sexual and reproductive health and Chair of the British Menopause Society, advises against automatically supplementing. Whether additional calcium is needed depends on individual bone density, which may be assessed through a DEXA scan, with a doctor advising on supplementation.

For mood and anxiety-related symptoms, folate and vitamin B12 may help, but only if a deficiency exists. Studies indicate that a lack of these nutrients can impact mood regulation. Research suggests significant portions of vegetarians and vegans are deficient in B12.

Iron deficiency can be a concern for women experiencing heavy bleeding during perimenopause. However, Dr. Briggs stresses that iron supplements should only be taken under medical supervision following a blood test, due to the risks of overdose, including gut issues and, in severe cases, liver damage.

Ingredients Lacking Evidence or Posing Risks

Several popular ingredients in menopause supplements have mixed or insufficient evidence of effectiveness. Black cohosh, an herb widely promoted for hot flashes, has shown mixed results in studies, and some research suggests it could potentially harm liver health, with rare cases of liver damage reported.

Supplements containing red clover and other isoflavones, which have weak estrogen-like effects, are also common. While some trials showed symptom reduction, placebo groups often experienced similar or greater improvements. The British Menopause Society advises women with a history of breast cancer to avoid soy and red clover isoflavones due to their potential estrogenic activity.

Experts also caution against excessive intake of certain vitamins. Too much vitamin B6 can lead to nerve damage, and high levels of vitamin D can cause vomiting and confusion through dangerous calcium build-up. Ashwagandha, found in many products, has also been linked to rare cases of liver injury.

"The fundamental problem is that supplements do not have to undergo the same rigorous testing as medicines," Dr. Briggs noted. "There's no necessity for them to undergo the same kind of testing as drugs would have – clinical trials to show that they're actually any more effective than placebo."

Hormone Replacement Therapy (HRT)

In contrast to supplements, Hormone Replacement Therapy (HRT) has undergone extensive clinical trials demonstrating its effectiveness. HRT, typically a combination of estrogen and progesterone, is proven to alleviate hot flashes and night sweats and can help with vaginal dryness. However, the evidence for HRT's effectiveness in treating other symptoms like brain fog, mood problems, and general aches is less conclusive.

Dr. Briggs emphasizes that HRT is not for every woman experiencing menopause. "It should be there for women who are symptomatic, who aren't at any increased risk by taking it, and who want to take it," she advised.