Supplements

Menopause supplements

Hormone therapy remains the most effective treatment for hot flashes and night sweats. Trials of supplements are mixed, and none is described as matching that result.

By Ines Kovac. Published 21 October 2026. 7 minute read.

Summarize with:

A white bowl of dried yellow flowers in front, with a wooden spoon across the rim, on a round wooden board. A second white bowl of darker dried herbs is behind it, and a folded white cloth lies to the right.

The Menopause Society's 2023 nonhormone statement is where that conclusion on hormone therapy comes from. Supplements and herbal remedies are in the group it does not recommend. The evidence grades for that group are Level I to Level II.

Why menopause supplements are hard to judge

NICE NG23 warns that for complementary therapies, the safety, quality and purity of constituents in unregulated preparations may be unknown.

The NHS page on herbal remedies for menopause symptoms says products you can buy in a shop are not tested or regulated in the same way as hormone replacement therapy, so safety and effectiveness are unknown. Ask a GP or a pharmacist.

If you do start a treatment for menopause symptoms, NICE says to review it at 3 months for how well it works and how well you tolerate it, then once a year unless an earlier check is needed.

Hot flashes and night sweats

People look for the best supplement for hot flashes and night sweats. None of these guidelines names one. NCCIH's overview says phytoestrogens, herbs and other dietary supplements have not been clearly shown to relieve menopause symptoms.

NICE asks clinicians to explain a separate point. There is some evidence that isoflavones or black cohosh may relieve vasomotor symptoms. Multiple preparations are available, their safety is uncertain, and interactions with medicines have been reported.

NICE also says to offer HRT to people with vasomotor symptoms associated with menopause. Hormone replacement therapy for menopause explains the prescription and the forms it comes in. Other hormone guides are linked from the HRT topic. The hot flash relief finder lists menopause-specific CBT and prescribed medicines that are not hormones. The hot flashes topic links the other flush guides.

Black cohosh for menopause

Black cohosh is one of the herbs sold for menopause. The Cochrane review concluded there is currently insufficient evidence to support it for menopausal symptoms.

On daily counts, the pooled result found no significant difference between black cohosh and placebo. The mean difference was 0.07 hot flushes per day. The confidence interval ran from minus 0.43 to 0.56. That figure comes from 393 women in three trials.

The safety evidence in that review was inconclusive, because the studies reported it poorly. Isolated hepatitis cases appear in the literature, without enough evidence that black cohosh caused them. NCCIH reports rare cases of serious liver damage in people taking products labelled as black cohosh. Whether the herb caused that damage is uncertain. The 2023 statement cites this review and notes possible harm to the liver.

Soy, red clover and isoflavones

Soy foods and soy extracts that contain isoflavones are Level II in that same statement.

NCCIH's soy page says soy isoflavone supplements or soy protein may reduce how often hot flashes come and how severe they feel. The effect may be small, and study results have not been completely consistent.

Red clover is a different plant in the same shop aisle. NCCIH says research has not shown conclusive benefits of red clover for any health condition. The hot flash studies are inconsistent.

The NHS treatment page groups red clover with black cohosh. Both are sometimes sold for menopause, and there is very little evidence on how well they work or how safe they are.

The NICE counselling above covers soy and black cohosh alike. It does not add a separate instruction for someone who has had breast cancer and is considering a phytoestrogen. A specialist can weigh that history against a named product.

Magnesium for menopause

A placebo-controlled trial of magnesium oxide does not support it for hot flashes. The participants were postmenopausal breast cancer survivors, so the result belongs to that group. The paper says the reduction with magnesium was similar to placebo. Diarrhoea was more common with magnesium.

Sleep is a separate question from flushes. NCCIH says there is very little research on magnesium for insomnia, and not enough rigorous evidence to judge whether it works. Night waking, HRT and CBT-I are set out in insomnia in menopause.

The 2023 statement does not give magnesium a grade for vasomotor symptoms. Personal accounts of magnesium for night sweats disagree with each other. Those posts are personal reports, not a trial of one form of the mineral.

Vitamin D, calcium and other pills

Vitamin D is doing a different job from a flush remedy. The NHS says adults should consider a daily supplement containing 10 micrograms (400 IU) of vitamin D during autumn and winter.

The 2023 statement does not grade vitamin D for hot flashes. The calcium and vitamin D checker shows where that 10 micrograms fits with a daily calcium target after menopause. Diet and menopause covers meals, including calcium from food, and it belongs to the weight and diet topic.

Evening primrose oil is another pill aimed at this life stage. NCCIH says it is still unclear whether the oil helps menopause symptoms. It is one of the herbal products in that group.

Herbal remedies and St John's wort

Herbal remedies for menopause include St John's wort, which some people take for flushes. NHS guidance on sequential combined HRT warns that St John's wort may affect HRT and make it less effective.

For people with a history of breast cancer, or at high risk of it, NICE notes some evidence that St John's wort may help vasomotor symptoms. The same recommendation warns that the right dose is uncertain, potency varies between products, and serious interactions are possible with other medicines, including tamoxifen, anticoagulants and anticonvulsants.

Bring every herbal product to the GP or pharmacist. A printed symptom checklist gives that visit a record of what is bothering you. If hormones are the next conversation, how to start HRT sets out what to ask. Low mood that arrives with the flushes is the subject of HRT, anxiety and low mood.

My take

I would start by talking about HRT, then use the options the relief finder lists. Any supplement goes on the list for that GP visit, and the three-month review above is when you and the GP see whether it helped.

After breast cancer, I would ask a specialist before taking a phytoestrogen and mention the St John's wort interactions above.

If bones are the worry, the calcium checker and the diet guide come first. Keep the autumn and winter vitamin D dose for that question, separate from flushes. The purity warning NICE gives at the start applies to all of them.