# Menopause supplements that actually work: what the evidence says about nine popular picks

The supplement aisle promises cooler nights and calmer days. The trials tell a quieter story. Here’s what each popular menopause supplement has actually shown, what it can do to your liver or your medicines, and how to spot a product that was properly tested.

Source: https://nourishandstrong.com/menopause-supplements
Published: 2026-11-07
Updated: 2026-11-07
By: the Nourish & Strong team
General information, not medical advice.

**The short answer:** most menopause supplements work no better than a placebo for hot flashes. The Menopause Society’s 2023 review did not recommend any supplement or herbal remedy for them, and Cochrane reviews found no clear benefit from black cohosh, soy or red clover. Calcium and vitamin D matter for your bones, and creatine may help muscle when you also lift weights.

For treatments that do ease hot flashes, see [how to stop hot flashes](https://nourishandstrong.com/how-to-stop-hot-flashes).

## Do menopause supplements work?

For hot flashes and night sweats, most don’t beat a dummy pill in well-run trials. In 2023, The Menopause Society reviewed the research on non-hormone treatments and listed supplements and herbal remedies under "not recommended." It also said hormone therapy remains the most effective treatment for hot flashes.

Why do so many people feel a supplement helped? The placebo effect is strong. A 2014 trial in the journal Menopause shows it well. Women took omega-3 capsules or a placebo for 12 weeks. Hot flashes fell by about 2.5 a day with omega-3 and by 2.7 a day with the placebo. The capsules made no difference.

## What supplements help with menopause symptoms?

No supplement has strong evidence for hot flashes, but a few have a real job elsewhere, mainly calcium and vitamin D for bones and creatine for muscle. The ratings in the last column are our summary of the sources listed.

| Supplement | What the research found | Main safety note | Evidence |
| --- | --- | --- | --- |
| Black cohosh | Cochrane, 2012: 16 trials, 2,027 women, no difference from placebo in hot flash frequency. A 2023 review cited by NCCIH found possible benefit. | Rare but serious liver damage reported | Weak and mixed |
| Soy isoflavones | Cochrane, 2013: 43 trials, no conclusive evidence for hot flashes. NCCIH says any effect may be small. | Bloating, constipation, nausea | Weak |
| Red clover | Cochrane pooled 5 trials of one red clover extract: no significant difference from placebo. NCCIH calls results inconsistent. | Appears well tolerated in studies up to 2 years | Weak |
| Evening primrose oil | NCCIH: not enough evidence for any health condition, menopause symptoms included | Stomach upset, nausea, diarrhea | None |
| Magnesium | 2015 trial, 289 women with a history of breast cancer: magnesium oxide did no better than placebo for hot flashes | More diarrhea than placebo | Tested, no benefit for hot flashes |
| Omega-3 (fish oil) | 2014 trial, 355 women: no improvement in hot flashes, sleep or mood after 12 weeks | See our fish oil guide | Tested, no benefit |
| Calcium and vitamin D | Not a hot flash treatment. Their job is bones, and the fracture evidence is mixed. | Small rise in kidney stones (USPSTF) | Mixed, for bones only |
| Ashwagandha | NCCIH: some preparations may help sleep and stress, but there isn’t enough evidence for menopause | Rare liver injury; several drug interactions | Weak for menopause |
| Creatine | 2026 review of 7 trials, 608 women after menopause: small gains in lean mass and leg strength, mostly when paired with strength training. Bone density didn’t change. | Side effects mild and similar to placebo | Moderate, for muscle with training |

We’ve covered [magnesium glycinate for sleep](https://nourishandstrong.com/magnesium-glycinate) and [whether fish oil is worth taking](https://nourishandstrong.com/is-fish-oil-worth-taking) in their own guides.

## Is black cohosh bad for your liver?

It may be, in rare cases. NCCIH says cases of liver damage, some very serious, have been reported in people taking products labeled as black cohosh. The NIH Office of Dietary Supplements counts at least 83 such cases worldwide. Nobody has proven black cohosh caused them. Some products have been found to contain the wrong herb or unlisted mixtures, which may explain some cases.

Since 2007, Australia has required black cohosh labels to warn that it may harm the liver. The U.S. Pharmacopeia (USP) advises people with liver disorders to avoid it. USP adds that anyone who develops abdominal pain, dark urine or yellowing skin or eyes while taking it should stop and contact their doctor.

Most black cohosh studies lasted 6 months or less, so long-term safety is unknown. NCCIH also says it’s uncertain whether black cohosh is safe for people who have had breast or uterine cancer.

## Are menopause supplements safe?

Not automatically, because supplements are not checked for safety or effectiveness before they’re sold. The FDA does not approve dietary supplements before they reach shelves, and in most cases the company doesn’t have to show the FDA its safety evidence first.

The NHS adds that the quality and purity of these products can’t always be guaranteed, and that "natural" doesn’t mean safe.

Interactions are the other risk:

- **St. John’s wort** can speed the breakdown of many medicines, including some antidepressants, birth control pills and heart medicines, according to the NIH.
- **Ashwagandha** may interact with medicines for diabetes, blood pressure, thyroid and seizures, plus sedatives and immunosuppressants, says NCCIH. It isn’t recommended for people with thyroid or autoimmune disorders, or before surgery.
- **Soy foods high in tyramine**, such as tofu and soy sauce, have caused dangerously high blood pressure in people taking MAOI antidepressants.
- **Calcium** can interfere with thyroid medicine and some antibiotics. Our guide to [calcium supplements](https://nourishandstrong.com/calcium-supplements) covers the timing.

The NIH notes that some supplements raise bleeding risk or change your response to anesthesia, so tell your surgical team.

## Do menopause supplements contain estrogen?

No, they don’t contain human estrogen, but some contain plant compounds that can act like a weak form of it. The NHS says red clover contains plant hormones that can act in a similar way to estrogen. Soy isoflavones belong to the same family, called phytoestrogens. The Cochrane review found no sign that these products stimulated the lining of the womb or the vagina in studies lasting up to two years.

Black cohosh is less clear. The NIH says its active ingredients are unknown, and studies disagree on whether it affects estrogen levels at all. Separately, the NHS doesn’t recommend "bioidentical" hormone products, because they aren’t regulated.

## Is creatine good for menopause?

For muscle and strength, it may help a little when combined with strength training. A 2026 review in the Journal of the International Society of Sports Nutrition pooled 7 trials of women after menopause. Creatine added about 0.37 kg of lean mass and 7.5 kg to leg-press strength. Trials using lower doses without strength training showed no measurable effect, and bone density didn’t change. It didn’t measure hot flashes. Our guide to [creatine for women](https://nourishandstrong.com/creatine-for-women) goes deeper, and [how to keep muscle as you age](https://nourishandstrong.com/how-to-keep-muscle-as-you-age) covers the training that makes it count.

## Is ashwagandha good for menopause?

There isn’t enough evidence to say so. NCCIH lists menopause among the conditions where research hasn’t shown whether it helps. It may be safe for up to 3 months, but rare cases of liver injury have been reported.

## Should I take supplements during menopause?

Supplements make the most sense when they fill a gap your food can’t, which for menopause usually means calcium or vitamin D for your bones. The NIH says women lose about 1% of their bone density a year on average after menopause, and it recommends 1,200 mg of calcium a day for women aged 51 to 70.

More isn’t better, though. The U.S. Preventive Services Task Force found that low-dose calcium and vitamin D pills don’t prevent fractures in women after menopause who don’t have osteoporosis. The NHS advice is to eat plenty of calcium-rich food and take a calcium supplement if your doctor prescribes it.

Start with [what to eat during menopause](https://nourishandstrong.com/what-to-eat-during-menopause) and [how to get vitamin D](https://nourishandstrong.com/how-to-get-vitamin-d). If you’re weighing a calcium pill, read [which calcium supplement is best](https://nourishandstrong.com/calcium-supplements) first.

## Which menopause supplements are best?

The best choice is a product you have a clear reason to take that has passed independent quality testing. Here’s how to choose:

- **Look for an independent seal.** The NIH names three groups that test supplements: U.S. Pharmacopeia, NSF International and ConsumerLab.com. A seal means the product was properly made, contains what the label says and doesn’t contain harmful levels of contaminants. It doesn’t mean the product is safe or that it works.
- **Read the Supplement Facts panel.** The FDA requires the amount of each ingredient to be listed, except for ingredients inside a "proprietary blend." A single-ingredient product tells you exactly what you’re getting.
- **Check the herb’s name.** Black cohosh and blue cohosh are different plants. NCCIH says blue cohosh may cause high blood pressure, high blood sugar and chest pain.
- **Report a bad reaction** to your doctor or the FDA at 800-FDA-1088.

## What should you do next?

Today, write down the name and amount of every supplement you take. Ask your doctor or pharmacist to check the list against your medicines. If hot flashes are wearing you down, ask about treatments with real evidence. The NHS offers CBT, and The Menopause Society says hormone therapy should be considered for women within 10 years of their final period.

Food does more for your bones and muscles than most pills. If you’d like it planned for you, the [Menopause Meal Plan](https://nourishandstrong.com/menopause-meal-plan) gives you four weeks of high-protein meals with grocery lists.

## Quick questions

### Do menopause supplements work?

Most don’t work better than a placebo for hot flashes. The Menopause Society’s 2023 review did not recommend supplements or herbal remedies for hot flashes, and Cochrane reviews found no clear benefit from black cohosh or phytoestrogens such as soy and red clover. Calcium and vitamin D support bone health, which is a different job.

### Is black cohosh safe?

Black cohosh is generally well tolerated in studies lasting up to a year, but rare cases of liver damage, some serious, have been reported. NCCIH says it’s uncertain whether black cohosh caused them. The U.S. Pharmacopeia advises people with liver disorders to avoid it. Ask your doctor before trying it, especially if you take medicines.

### Is black cohosh safe to take long term?

No one knows yet. The NIH Office of Dietary Supplements says most studies of black cohosh lasted 6 months or less, so no published studies have assessed its long-term safety. NCCIH says it has been used safely in studies lasting up to a year. If you develop dark urine, belly pain or yellow skin, call your doctor.

### Is black cohosh safe for breast cancer survivors?

It’s uncertain. NCCIH says it isn’t known whether black cohosh is safe for women who have had hormone-sensitive conditions such as breast or uterine cancer, and it’s also uncertain whether it reduces hot flashes caused by breast cancer treatment. Talk with your oncology team before taking it or any other herbal product.

### Does black cohosh increase estrogen?

The evidence is unclear. The NIH Office of Dietary Supplements says black cohosh’s active ingredients and how it works are unknown, and studies disagree on whether it raises estrogen levels. Some researchers think it may act on the brain instead. Red clover and soy are different: they contain plant compounds that can act like weak estrogen.

### What vitamins help with menopause?

Calcium and vitamin D are the two with a clear job during menopause, because both support bone health as estrogen falls. The NIH recommends 1,200 mg of calcium a day for women aged 51 to 70 and 600 IU of vitamin D up to age 70. Neither one is a treatment for hot flashes. Food can cover much of it.

This article is general information, not medical advice. Supplements can interact with medicines and affect conditions such as liver disease. If you take any medicine, are being treated for cancer, have liver, kidney or thyroid problems, or are planning surgery, ask your doctor or pharmacist before starting a supplement.

## Sources

- [The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause, 2023](https://doi.org/10.1097/gme.0000000000002200)
- [Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev, 2012](https://doi.org/10.1002/14651858.CD007244.pub2)
- [Lethaby A et al. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Syst Rev, 2013](https://doi.org/10.1002/14651858.CD001395.pub4)
- [National Center for Complementary and Integrative Health. Black Cohosh](https://www.nccih.nih.gov/health/black-cohosh)
- [National Center for Complementary and Integrative Health. Soy](https://www.nccih.nih.gov/health/soy)
- [National Center for Complementary and Integrative Health. Red Clover](https://www.nccih.nih.gov/health/red-clover)
- [National Center for Complementary and Integrative Health. Evening Primrose Oil](https://www.nccih.nih.gov/health/evening-primrose-oil)
- [National Center for Complementary and Integrative Health. Ashwagandha](https://www.nccih.nih.gov/health/ashwagandha)
- [NIH Office of Dietary Supplements. Black Cohosh: Fact Sheet for Health Professionals (archived copy, December 2025)](https://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/)
- [NIH Office of Dietary Supplements. Dietary Supplements: What You Need to Know (archived copy, January 2026)](https://ods.od.nih.gov/factsheets/WYNTK-Consumer/)
- [NIH Office of Dietary Supplements. Calcium: Fact Sheet for Health Professionals (archived copy, January 2026)](https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/)
- [NIH Office of Dietary Supplements. Vitamin D: Fact Sheet for Consumers (archived copy, January 2026)](https://ods.od.nih.gov/factsheets/VitaminD-Consumer/)
- [Cohen LS et al. Efficacy of omega-3 for vasomotor symptoms treatment: a randomized controlled trial. Menopause, 2014](https://doi.org/10.1097/gme.0b013e31829e40b8)
- [Park H et al. North Central Cancer Treatment Group N10C2 (Alliance): a double-blind placebo-controlled study of magnesium supplements to reduce menopausal hot flashes. Menopause, 2015](https://doi.org/10.1097/gme.0000000000000374)
- [Naddafha S et al. Creatine monohydrate for lean mass, strength, and bone density in postmenopausal women: a systematic review and meta-analysis. J Int Soc Sports Nutr, 2026](https://doi.org/10.1080/15502783.2026.2668435)
- [U.S. Preventive Services Task Force. Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults, 2018](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/vitamin-d-calcium-or-combined-supplementation-for-the-primary-prevention-of-fractures-in-adults-preventive-medication)
- [U.S. Food and Drug Administration. Questions and Answers on Dietary Supplements](https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements)
- [NHS. Menopause: Treatment](https://www.nhs.uk/conditions/menopause/treatment/)
- [NHS. Herbal remedies and complementary medicines for menopause symptoms](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/alternatives-to-hormone-replacement-therapy-hrt/herbal-remedies-and-complementary-medicines-for-menopause-symptoms/)
- [NHS. Osteoporosis: Prevention](https://www.nhs.uk/conditions/osteoporosis/prevention/)