Supplements and herbal products: what the evidence M-1 holds says

Evidence on black cohosh for hot flashes is mixed. A 2012 Cochrane review of 16 trials (2,027 women) found no clear benefit over placebo, while a 2023 meta-analysis of 22 trials (2,310 women), including black cohosh combined with other ingredients, found a small improvement in hot flashes and overall menopause symptoms, but not in anxiety or low mood. Studies used different extracts and doses, so a result from one product may not apply to another, and the Menopause Society does not recommend herbal remedies as an established treatment for hot flashes.

Early, limited, mixed, or indirect research. Some people may find this useful, but we can't be confident about the average effect.

Evidence on soy isoflavones is mixed. A 2025 meta-analysis of 12 studies found a small improvement in overall menopause symptoms but no significant effect on hot flashes, sweating, or other vasomotor symptoms, and the Menopause Society does not recommend soy foods, soy extracts, or the soy metabolite equol for hot flashes. A 2019 meta-analysis of small trials found that equol supplements lowered hot-flash scores in women who don't naturally produce equol, but that is too limited to predict who will benefit or to recommend a product.

Early, limited, mixed, or indirect research. Some people may find this useful, but we can't be confident about the average effect.

Biotin is essential when a true deficiency is present, but taking biotin has not been shown to improve hair growth for people who aren't deficient.

Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.

Some high-dose biotin supplements, common in "hair, skin and nails" products, can interfere with certain laboratory tests — including some troponin tests used to detect a heart attack. Not every test is affected. The FDA advises telling your clinician and the lab if you take biotin.

There is reasonably consistent research, but important limitations or unanswered questions remain.

If testing finds an iron or vitamin D deficiency, treating it is generally supported in people with hair loss. Evidence that these supplements help without a confirmed deficiency is inconsistent — and too much vitamin A or selenium can itself contribute to hair loss.

Early, limited, mixed, or indirect research. Some people may find this useful, but we can't be confident about the average effect.

Reviews of pattern hair-loss treatment describe the evidence for supplements as variable, and no supplement has established evidence for treating female pattern hair loss. When looking at a product's study, it helps to check who was studied, what it was compared against, how long it ran, who funded it, and whether the tested product matches what's sold.

Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.

Specific standardized red clover isoflavone extracts may modestly reduce hot flashes: a 2021 meta-analysis of 8 trials found about 1.7 fewer hot flashes a day than placebo on average, with results varying widely between studies and clearer effects at higher isoflavone doses over 12 weeks. Products differ in the amount and type of isoflavones they contain, so a result from one extract may not apply to another, and the Menopause Society does not recommend herbal remedies for hot flashes.

Early, limited, mixed, or indirect research. Some people may find this useful, but we can't be confident about the average effect.

Evening primrose oil hasn't been shown to reliably reduce hot flashes. A 2025 meta-analysis of 6 small trials (450 women) found no significant change in how many hot flashes women had or how intense they were, though episodes were shorter, and one 2021 trial found fewer night sweats but no change in hot flashes. The quality of this evidence was rated moderate to low.

Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.

Vitamin E hasn't been shown to reliably reduce hot flashes: in a 2022 meta-analysis, vitamin E alone made no significant difference to how often hot flashes happened compared with placebo, and a 2022 systematic review concluded that more good-quality data are needed. A small benefit was seen only when vitamin E was combined with omega-3, in two studies.

Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.

Omega-3 (fish oil) supplements didn't reduce hot flashes in a large randomized trial: among 355 peri- and postmenopausal women, 12 weeks of omega-3 made no difference to how often hot flashes happened or how bothersome they were — or to sleep or mood — compared with placebo. A 2022 meta-analysis also found no significant effect of omega-3 alone on hot flashes.

There is reasonably consistent research, but important limitations or unanswered questions remain.

Magnesium oxide didn't reduce hot flashes in a placebo-controlled trial of 289 postmenopausal women with a history of breast cancer, and diarrhea was more common with magnesium. That trial doesn't address sleep (see "Magnesium for sleep") or muscle cramps, which M-1 hasn't yet reviewed.

Early, limited, mixed, or indirect research. Some people may find this useful, but we can't be confident about the average effect.

Melatonin hasn't been shown to help menopause-related sleep problems specifically. A 2026 meta-analysis of trials in menopausal women found the evidence on sleep, menopause symptoms, and mood inconclusive, and a 2024 review of nutritional approaches to menopause-related sleep problems found mostly small, varied studies that mainly reported improvements in how people felt they slept.

Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.

Herbal sleep aids such as valerian have little good-quality evidence. Valerian is the most studied, but trial results have been inconsistent — possibly because extracts vary in quality — though reviews describe it as generally well tolerated. These studies weren't specific to menopause.

Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.

Ashwagandha has limited menopause-specific evidence: a 2025 placebo-controlled trial in postmenopausal women reported that ashwagandha and shatavari extracts reduced menopause symptom scores, but it is a single trial of particular extracts. NIH reports rare cases of liver injury linked to ashwagandha supplements, notes it may interact with diabetes, blood pressure, thyroid, sedative, and immune-suppressing medicines, and says its safety beyond about three months isn't known.

Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.

St John's wort has evidence for mild to moderate depression in general adult studies — a 2016 systematic review found it worked better than placebo and about as well as antidepressants, though the evidence was mixed and rare harms weren't well studied — but those studies weren't about menopause. It can weaken the effect of many medicines, including hormonal contraceptives, warfarin, and some antidepressants, heart, and cancer drugs.

Early, limited, mixed, or indirect research. Some people may find this useful, but we can't be confident about the average effect.

Purified pollen extracts, sold under several brand names, haven't been shown to beat placebo for hot flashes: a 2024 meta-analysis found large improvements in uncontrolled studies, but when only controlled studies were pooled the improvements were no longer significant, suggesting the earlier results may reflect a placebo effect. No significant side effects were reported.

Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.

Maca, ginseng, and dong quai are different plants with limited evidence for menopause symptoms. Reviews of small trials found some favorable results for maca and Korean red ginseng, but too few rigorous studies — and, for ginseng, a high risk of bias — to draw firm conclusions. In a placebo-controlled trial of 71 women, dong quai didn't reduce menopause symptoms, and NIH notes it may interact with the blood thinner warfarin.

Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.

A large placebo-controlled trial found that flaxseed lignans (410 mg a day) didn't reduce hot flashes, though a 2016 review of smaller studies suggested some benefit. A few small studies suggest common sage might reduce how often hot flashes happen; sage is likely safe in food amounts and larger amounts have been used for up to 8 weeks in studies, but it contains thujone, which can be toxic in large amounts.

Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.

Whether vitamin D and calcium supplements help prevent fractures depends on who takes them. The US Preventive Services Task Force recommends against daily low-dose supplements (400 IU or less of vitamin D and 1,000 mg or less of calcium) to prevent fractures in postmenopausal women living in the community, and found too little evidence to judge higher doses. That advice doesn't apply to women with osteoporosis, a previous fracture, a high risk of falls, or vitamin D deficiency.

There is reasonably consistent research, but important limitations or unanswered questions remain.

Evidence on curcumin (from turmeric) for menopause symptoms is limited and mixed: a 2025 meta-analysis of 14 trials in postmenopausal women reported a small improvement in hot flashes, while another 2025 review found conflicting results for hot flashes and no effect on physical, psychological, or sexual symptoms. Products vary in purity and dose, and NIH reports liver damage in some people taking highly absorbable curcumin formulations.

Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.

Collagen and probiotic supplements have limited menopause-specific evidence. One six-month trial in menopausal women found collagen peptides, especially combined with calcium and vitamin D, improved skin hydration and elasticity — a single trial of one product. Research on probiotics in menopause is still emerging and focuses mainly on gut and vaginal bacteria and disease risk rather than symptom relief.

Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.

Over-the-counter CBD products aren't FDA-approved — the only approved CBD medicine treats certain seizure disorders — and FDA warns that CBD can cause liver injury, interact with other medicines, and cause drowsiness, and that many products haven't contained the amount of CBD they claimed. In 2026, the EU's food-safety authority said important safety questions about CBD, including effects on the liver and hormonal systems, remain unresolved.

There is reasonably consistent research, but important limitations or unanswered questions remain.

L-theanine, an amino acid found in tea, may modestly improve how well people feel they sleep: a 2025 meta-analysis of 18 randomized trials (about 900 people) found small improvements in self-reported time to fall asleep, daytime functioning, and overall sleep quality. Many of those trials tested L-theanine mixed with other ingredients, and the right dose and length of use aren't known. A 2026 trial in 128 peri- and postmenopausal women with poor sleep found a combination product containing L-theanine, GABA, magnesium, and other ingredients improved sleep scores over 3 weeks compared with placebo — but it can't show which ingredient helped, and most of its authors work for the company that makes the product.

Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.

Magnesium for sleep has limited evidence. In a 2025 placebo-controlled trial of 155 adults aged 18 to 65 with poor sleep (mostly women, not specifically in menopause), 250 mg of magnesium taken as magnesium bisglycinate each evening for 4 weeks improved insomnia scores slightly more than placebo — a small effect — with no difference in other sleep, tiredness, or mood measures; people who got less magnesium from food seemed to benefit more. A 2021 review of three small trials in older adults found people fell asleep about 17 minutes sooner with magnesium, but rated the evidence low to very low quality.

Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.

Algae-derived calcium hasn't been shown to protect bones better than other forms of calcium. The studies behind marketing claims for one brand were observational or open-label, with no placebo group: women's bone scans were compared with the bone loss researchers expected, and one study was partly funded by a company in which its lead author held shares. The products tested also contained vitamin D, vitamin K2, and other minerals — one version included strontium, which makes bone density scans read higher than the bone's calcium alone would — so the results can't show that the algae source itself made a difference.

Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.