20 Supplements and OTC Meds for Menopause - GoodRx (2024)

If you're going through menopause, you’re likely familiar with some of the unpleasant changes and symptoms. Hot flashes, brain fog, low energy, memory difficulties, mood changes — these symptoms can take a big toll on your daily life. And if you’re currently experiencing symptoms but can’t (or don’t want to) use hormone replacement therapy, you may wonder what options you have.

There are hundreds of natural alternatives to menopausal hormone therapy that claim to help with symptoms at all stages of menopause. But the research on many of these supplements is either mixed or lacking. Some can even cause harm in high doses. In fact, when it comes to hot flashes and night sweats, the North American Menopause Society doesn’t recommend any supplements or herbal remedies at all.

But if you’re curious about what’s out there, read on. We’ll walk you through 20 popular menopause supplements so you can make the best decision for you.

1. Plant phytoestrogens (or ‘natural’ estrogens)

What are they? Phytoestrogens are plant compounds that are similar to estrogen. They can be eaten, or taken as a pill or supplement.

Phytoestrogens are found naturally in many foods, including:

• Soy products like edamame, tofu, tempeh, and miso

• Legumes (beans), such as kidney beans, chickpeas, peanuts

• Seeds like sunflower seeds and flaxseed

• Fruits like strawberries, cranberries, and blueberries

• Vegetables, such as zucchini, broccoli, garlic, and carrots

• Black and green teas

Many other supplements also contain phytoestrogens, including:

• Red clover

• Sage

• Licorice

• Ginseng (more on this below)

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The claims: Phytoestrogens seem to have weak estrogen-like effects. In theory, this could lead to benefits similar to those of hormone replacement therapy, like improvements in hot flashes, vagin*l dryness, mood, heart and brain health, muscle mass, and bone density.

The evidence: The scientific evidence is mixed. Phytoestrogens may improve hot flashes, but there isn’t much evidence that they help with other menopause symptoms. And, the benefit hasn’t consistently been seen across studies. In many studies, phytoestrogens didn’t work any better for menopause symptoms than placebo treatment.

Precautions: In general, plant estrogens seem to be safe to use in moderate amounts — especially if consumed in food. A 2009 research review found that phytoestrogen supplements didn’t increase the rates of endometrial cancer, breast cancer, or vagin*l bleeding any more than placebo. In fact, eating phytoestrogen-rich foods might even help to protect your heart, blood vessels, and bones after menopause — and could even lower your risk for some types of breast cancers.

Worth a try? Possibly. If you’re interested in using phytoestrogens, consider starting with food-based options. Note that many soy-based foods are highly processed. It’s best to stick to lesser-processed sources like tofu, tempeh, and edamame, for the greatest health benefits. If you have cancer or another medical condition, talk with your healthcare professional before increasing your phytoestrogen intake. In some cases, it may actually be better to avoid phytoestrogens rather than to increase them.

2. Black cohosh

What is it? Black cohosh is an herb from the buttercup family. It’s been used for hundreds of years to support women’s health. In the past, it was believed to have estrogen-like effects, but that’s no longer supported by research. In fact, it’s not clear exactly how it works in the body.

The claims: Black cohosh is marketed for many menopause symptoms, including hot flashes, night sweats, vagin*l dryness, and mental health.

The evidence: It’s not clear if black cohosh works. Though some people report that black cohosh is helpful for menopause symptoms, in many studies it hasn’t worked any better than a fake (placebo) supplement.

And 2019 literature review found no evidence that black cohosh consistently helped with menopause symptoms. It also wasn’t clear — when it did work — whether black cohosh worked well on its own or only when it was used together with other herbs. And yet, black cohosh is approved in Germany and other parts of Europe specifically for menopause symptoms.

Precautions: Overall, black cohosh has a good safety record. In clinical trials, people have taken black cohosh for up to a year with no problems. But keep in mind: Just like other supplements, black cohosh should only be used with medical guidance. It can cause mild side effects like upset stomach, weight gain, and rash — and in rare cases, it has been linked to serious liver problems. It’s also not clear whether black cohosh interferes with hormone-sensitive cancers (like certain breast cancers).

Worth a try? Possibly, but only under medical supervision.

3. St. John’s wort

What is it? St. John’s wort is a flowering shrub that has been used as medicine for centuries. Though researchers aren’t sure exactly how it works, St. John’s wort contains chemicals that may have antioxidant, anti-inflammatory, and mood-stabilizing effects.

The claims: St. John’s wort is best known as a treatment for depression. It’s also marketed as a mood and immune system booster.

The evidence: There’s evidence that St. John’s wort may be helpful with some types of menopause symptoms — especially mood and sleep. It may also be effective for hot flashes and night sweats. But overall, there’s just not enough evidence to know for certain whether it works.

Precautions: St. John’s wort seems to be safe when used for up to 3 months. But take notice: St. John’s wort can interfere with many other important medications. With this in mind, the International Menopause Society recommends St. John’s wort should only be used with caution, and under appropriate medical guidance.

Worth a try? Possibly. But due to the risk of side effects and drug interactions, it’s safest under medical supervision.

4. Probiotics (Lactobacillus and Bifidobacteria species)

What is it? Probiotics are the “good” bacteria found in fermented foods and some yogurts.

The claims: People take probiotics to help with hot flashes, night sweats, bone density, heart health, vagin*l tissue thinning, and blood sugar regulation.

The evidence: Although there’s still not a lot of research on probiotics and menopause, the evidence that does exist is promising — especially when it comes to lactic acid-producing bacteria (like Lactobacillus).

Precautions: Probiotics seem to be safe to use for most healthy people. But you should avoid probiotics if you have severe immunosuppression — when your immune system’s function is reduced. Otherwise, expect temporary digestive symptoms as your body adjusts to the probiotics.

Worth a try? Possibly. Though research is limited, probiotics could be worth a try. And they provide other health benefits, too.

5. Apigenin

What is it? Apigenin is a plant compound called a flavonoid. It’s found in chamomile, parsley, basil, and other foods. It’s one of the active compounds in chasteberry, a plant that’s used to treat premenstrual syndrome (PMS) and painful menstruation.

The claims: Apigenin is believed to improve sleep, dry mouth, hot flashes, blood sugar problems, libido, breast tenderness, and anxiety.

The evidence: Apigenin is hard to isolate and study as a stand-alone supplement. In studies on chamomile extracts and chasteberry in human menopause, the evidence is weak. Apigenin doesn’t appear to help hot flashes. One small randomized controlled trial showed that chamomile extract wasn’t better than the placebo to improve insomnia.

Precautions: Apigenin seems to be safe when consumed in foods. It’s unlikely, but in theory it could cause sedation at very high doses.

Worth a try? Probably not. It’s unlikely to harm you, but also unlikely to help.

6. Wild yam (natural ‘progesterone’ cream)

What is it? Wild yam is a root used in traditional Chinese medicine. It comes in both creams and supplements.

The claims: Wild yam is reported to treat symptoms of many health conditions, including menopause. This may be because diosgenin — a naturally occuring compound in wild yam — is said to increase hormone levels in the body, including progesterone.

The evidence: Diosgenin can be turned into hormones in a laboratory, but it doesn’t do this in our bodies. This means that wild yam cream or supplements won’t change your progesterone, estrogen, or other hormone levels.

There’s not much evidence that it helps with menopause symptoms either, including hot flashes and night sweats. Only a small amount of research studies have been done on wild yam, with mixed results.

Precautions: The U.S. National Institute for Health classifies wild yam as “possibly safe” when applied to the skin. In animals and at high doses, it’s been linked to liver and kidney problems. So check with your healthcare professional before using wild yam, especially if you have another medical condition.

Worth a try? Probably not.

7. Omega-3 fatty acids

What is it? Omega-3 fatty acids are the “healthy fats” found in fatty fish, algae, flaxseed, chia seeds, and other foods.

The claims: Omega-3s improve mood, fatigue, bone density, and hot flashes.

The evidence: When it comes to menopause symptoms, the evidence is mixed. There’s some evidence that omega-3 supplements may help with night sweats during menopause, but they don’t seem to work as well for hot flashes, or for improved sleep. It’s also not clear whether omega-3s help with bone density.

Precautions: None.

Worth a try? Yes, and not just for the potential menopause benefits. Omega-3 fatty acids (especially two of the main types, DHA and EPA) are widely known to have many health benefits. Make sure you’re getting a high enough dose though — at least 2 g (2,000 mg) of combined EPA and DHA.

8. Calcium

What is it? Calcium is a mineral that your body needs for many different processes. It’s found naturally in many foods — from dairy products to almonds, broccoli, and canned sardines. Not only that, many packaged foods are fortified with calcium, too.

The claims: Calcium improves bone health, reducing the risk of osteoporosis and fractures. In theory, this offsets the risk of decreased bone density after menopause.

The evidence: The theory isn’t backed by much evidence. For most healthy adults, a specific calcium supplement isn’t necessary, as long as you’re meeting your daily calcium requirements from food — about 1,200 mg per day for women older than 50 years.

Precautions: Taking too much calcium can lead to kidney stones, heart disease, constipation, and even death.

Worth a try? Probably not, unless you already have osteoporosis and a low calcium intake. Otherwise, it’s best to get your calcium in whole food form. If you do take a supplement, make sure you take one that also contains vitamin D, since your body needs vitamin D to absorb calcium.

9. Vitamin D

What is it? Vitamin D is both a hormone and a fat-soluble vitamin. Your body can make it from sunlight, or you can get it in your diet from fatty fish. Your body needs vitamin D to maintain healthy bones and muscles. You also need vitamin D to better absorb calcium from your diet.

The claims: Vitamin D works with calcium to help reduce the risk of osteoporosis and fractures. But it’s also reported to help with fatigue, hot flashes, immunity, inflammation, mood changes, and even cancer prevention.

The evidence: Many people, including perimenopausal women, don’t get enough vitamin D. So getting enough vitamin D during the menopausal transition is important to reduce the risk of hip fracture. Research suggests it also helps optimize blood sugar and cholesterol levels. Getting enough vitamin D is the goal — more is not better.

Precautions: Taking too much vitamin D is not safe. It can cause vomiting, abdominal pain, weakness, confusion, kidney stones, and dangerously high levels of calcium in your blood.

Worth a try? Yes, if you have (or you’re at risk for) low vitamin D levels. You can get your vitamin D level tested before you decide. Try testing your levels of 25-hydroxy vitamin D (the most accurate test) yearly to make sure you’re in the target range.

10. Melatonin

What is it? Melatonin is a hormone made by the human body that controls your circadian rhythms. It can also be made in a lab and taken as a supplement.

The claims: It helps you fall asleep.

The evidence: There’s not a lot of research yet on menopause and melatonin. And there’s no clear answer on how well melatonin works for sleep. Some studies suggest that melatonin can help you fall asleep faster, while other studies have found no improvement for adults with chronic insomnia. At this point, neither the American Academy of Sleep Medicine nor the American College of Physicians recommend melatonin due to the lack of consistent research.

Precautions: Over-the-counter (OTC) melatonin supplements aren’t regulated, and there have been reports of supplements containing doses many times higher than what the label says. Too much melatonin can cause daytime sleepiness, irritability, and dizziness. Some research even suggests a higher fracture risk for adults who take melatonin regularly. It’s not recommended for use longer than 3 months, due to lack of long-term safety data.

Worth a try? Probably not. If you need help falling or staying asleep, cognitive behavioral therapy for insomnia is a more effective choice.

If you want to try it, it’s important to know that taking too much can decrease your body’s natural production of melatonin. Try a low dose — ranging from 0.5 mg to 2 mg nightly — for a week if you want to see if it works for you.

11. L-theanine

What is it? L-theanine is an amino acid found in green tea.

The claims: It improves memory, focus, mood, and sleep quality.

The evidence: L-theanine seems to improve sleep by making you feel more relaxed (rather than making you drowsy) — though it hasn’t been studied specifically for this purpose in menopause. Evidence has also shown that L-theanine can improve cognitive performance and symptoms of stress, which could potentially be helpful during menopause.

Precautions: None.

Worth a try? If you tend to feel anxious and think this might be contributing to some of your symptoms, it probably doesn’t hurt to try.

12. DHEA

What is it? DHEA is a hormone your body produces naturally. It can also be made in a lab. Your body uses DHEA to make testosterone and estrogen.

The claims: DHEA is said to increase “natural” estrogen and testosterone in the body. It’s also reported to reduce abdominal fat, improve mood, libido, blood sugar regulation, and bone density, and increase muscle mass and libido.

The evidence: DHEA might work because it’s converted to estrogen in the body. It may improve the function of the immune system, musculoskeletal system, and endocrine system in older adults.

Precautions: DHEA is a hormone. And almost every other developed country — except the U.S. — regulates its use as a controlled anabolic steroid. It can cause acne, weight gain, abnormal hair growth, and cholesterol problems.

Worth a try? No. Unlike prescription hormones, DHEA supplements aren’t regulated. That means you don’t know what dose you’re taking when you take a DHEA supplement. If you’re interested in hormonal therapy, it’s safer to speak with your primary care provider about the many menopausal hormonal treatments available on prescription.

13. Dong quai

What is it? Dong quai is a traditional Chinese medicine used for reproductive health concerns.

The claims: Dong quai has traditionally been used in Chinese medicine for menstrual cramps and menopause symptoms. It’s often used together with other herbs. It may contain compounds that help to open blood vessels, reduce pain, and relax the uterus.

The evidence: There’s no good evidence that dong quai can reduce hot flashes or other menopause symptoms. In one small clinical trial, an herbal supplement containing dong quai and several other herbs was helpful with menopause symptoms. But it wasn’t clear whether this effect was because of dong quai, or other herbs (like chasteberry). In another small clinical trial, dong quai didn’t work any better for menopause symptoms than a fake treatment (placebo).

Precautions: Dong quai should be used with caution: It can interact with medications, increase your sun sensitivity, and change your blood’s natural ability to make clots. In particular, it can interact with blood thinners like warfarin (Coumadin). It can also cause side effects like diarrhea and fever. Lastly, dong quai should also be used with caution if you have a hormone-sensitive cancer.

Worth a try? Probably not — at least not on its own, or without a healthcare professional’s guidance.

14. Evening primrose oil

What is it? Evening primrose oil (EPO) is made from the seeds of the evening primrose plant.

The claims: EPO has been used historically as a remedy for a variety of health problems. It contains essential fatty acids, which have many functions in the body. Today, it’s used to treat:

• Eczema

• Arthritis

• PMS

• Menopause symptoms

• Several other conditions

The evidence: There’s no evidence that EPO works for menopause symptoms. Several studies have focused on using it for eczema or breast pain, but there’s just not enough evidence yet to support using EPO for any health condition — including menopause

In the few clinical trials that have specifically looked at its effects on menopause, EPO had the same effect as fake treatments (placebo) on reducing hot flashes. It didn’t seem to work any better than calcium for bone health.

Precautions: Evening primrose oil is probably safe for most people. It’s usually well tolerated, but can cause mild side effects like stomach pain or nausea. It should be used with caution if you’re taking blood thinners or certain types of antipsychotic medications.

Worth a try? Probably not.

15. Kava

What is it? Kava is a plant from the Pacific Islands, and has traditionally been used for ritual and healing purposes.

The claims: Kava has historically been used as an herbal supplement for anxiety, sleep problems, and other health conditions. It contains substances that reduce pain and relax muscles, and may work in a similar way to antidepressant and antianxiety medications.

The evidence: It’s not clear how helpful kava is for menopause symptoms. There haven’t been many studies on kava and menopause symptoms. Kava may have a small effect on anxiety during menopause, but there’s no evidence that it helps with hot flashes. And there isn’t enough evidence to prove that kava is helpful for other health conditions.

Precautions: Kava has been linked to severe or even fatal liver damage. In the U.S., the FDA has issued a warning about kava’s risks. Kava has also been banned in Canada, Australia, and parts of Europe because of the potential for liver damage. Long-term use may also cause skin changes, hearing problems, and trouble breathing.

Worth a try? Probably not.

16. Maca

What is it? Maca is an edible South American plant. Maca can be prepared as a food: baked, roasted, or used as a cooking ingredient. It’s also available as a powder that can be mixed into smoothies or recipes. It’s traditionally prepared as a fermented drink.

The claims: Maca has been traditionally used for infertility, to boost libido, and to balance hormone levels. Maca root contains essential fatty acids and other substances, but researchers don’t know exactly how it works. It may be an “adaptogen” (an herb that helps your body respond to stress), and could also have mild estrogen-like effects in the body.

The evidence: There’s some evidence that maca can reduce menopause symptoms. It may be especially helpful for depression, anxiety, and sexual function during menopause — though the benefits seem small. Larger research studies are needed to better understand maca and menopause.

Precautions: Maca seems to be safe when eaten as a food (in doses up to 3 g daily). It may be slightly riskier if taken in larger quantities as a pill. Raw maca should be cooked before consuming. Since maca may affect hormones, you should also talk with your healthcare professional before using it — especially if you have a hormone-sensitive health condition.

Worth a try? Possibly, especially when prepared as a food.

17. Pollen extract

What is it? Pollen extract (also called Swedish flower pollen) is made from grass and flower parts.

The claims: Pollen extract is marketed for menopause symptoms and PMS. Though researchers don’t fully understand how or if it works, it may act like an antioxidant in the body. It doesn’t have estrogen-like effects.

The evidence: Though more research is needed, pollen extract may be helpful during menopause. In one small clinical trial, pollen extract reduced hot flashes more than placebo did. It also had a mild positive effect on other menopause symptoms, including fatigue, dizziness, and mood changes, and led to an overall improved quality of life.

Precautions: Pollen extract doesn’t seem to have many risks or side effects. And because it doesn’t have estrogen-like effects, it may be a good alternative to hormone replacement therapy or phytoestrogens.

Worth a try? Possibly.

18. Vitamin E

What is it? Vitamin E (alpha-tocopherol) is a vitamin found in:

• Vegetable oils

• Nuts

• Seeds

• Green leafy vegetables

The claims: Vitamin E may have antioxidant effects in the body, keeps your immune system strong, and helps to keep your blood vessels healthy. It may also be helpful in preventing certain health conditions, like heart problems, dementia, and more.

The evidence: There’s not enough evidence to say if vitamin E is helpful for menopause. A few small studies have suggested that vitamin E may have benefits for menopause symptoms, but the effects are small. People taking vitamin E had one to two fewer hot flashes per day.

Precautions: Most people get enough vitamin E from food. Taking high doses as a supplement may interfere with other medications you take, or increase your risk of bleeding.

Worth a try? Eating foods that are rich in vitamin E is a good idea, but it’s probably not worth it to take a supplement.

19. Valerian root

What is it? Valerian root is a plant that has been used as a medicine since ancient times.

The claims: Valerian may have a calming effect on the brain. It has been used throughout history for many things, including:

• Insomnia

• Mood changes

• PMS

• Headaches

• Menopause

The evidence: It’s not clear whether valerian is helpful with menopause symptoms. Only a small amount of research has been done so far. Two small studies suggest that valerian might be helpful during menopause, but there’s just not enough evidence to say for sure.

Precautions: Valerian seems to be safe for short-term use (up to a month) — but there isn’t a lot known about whether it’s safe to use for longer periods of time. Valerian can also have some side effects, such as:

• An upset stomach

• Heart palpitations

• Headache

• Fatigue

Worth a try? Probably not.

20. Asian ginseng

What is it? Ginseng is a plant that comes from Asia. The ginseng root has been used as a medicine for thousands of years.

The claims: Ginseng has traditionally been used for many different health problems. Ginseng is also used to help with overall energy, stamina, and well-being.

The evidence: There’s evidence that ginseng may be helpful during menopause, including cutting down on hot flashes, and boosting libido. In one research study, women who took ginseng had an improvement in menopause symptoms and an overall better quality of life.

Precautions: According to the National Institutes of Health (NIH), Asian ginseng is generally safe for most people to try for short periods of time (up to 6 months). Its long-term safety isn’t as clear. Keep in mind that ginseng can also cause insomnia, which can be a problem for some people during menopause.

Worth a try? Yes, especially if you’re experiencing sexual problems like low libido.

Is it safe to use OTC treatments for menopause?

It’s important to remember that none of the treatments listed here are approved by the FDA. That means that supplements, vitamins, and home remedies may not always meet quality standards.

If you do decide to try an OTC remedy, consider using a product with a good reputation, or that’s recommended by a third-party quality testing site (like Labdoor).

Also keep in mind that some OTC products may actually contain several different ingredients, including:

• Relizen

• Femarelle

• Amberen

• Estroven

• Madame Ovary

Make sure to read the labels of these products carefully, so you understand what ingredients they include.

In addition, just because a treatment is “natural” doesn’t mean it’s risk-free. Many of the treatments listed here can have a significant impact on your health and your other medical conditions, and could interfere with other medications that you take. Talk with your healthcare professionals to make sure you have all the information you need before starting something new.

Other natural remedies for menopause symptoms

“It’s important for all women who experience bothersome symptoms of menopause to start with lifestyle changes,” said Dr. Amanda Horton, a board-certified OB-GYN who works in Annapolis, Maryland. For hot flashes, she recommends:

• Dressing in layers

• Avoiding triggers (spicy foods, caffeine, alcohol)

• Maintaining a moderate weight

“Exercise itself hasn’t been shown to decrease hot flashes,” she said. “But it has other benefits, which may help improve quality of life, cognitive function, and sleep, among other things.”

Dr. Horton also advised giving any lifestyle changes or supplements at least 3 months to work, as improvements tend to be gradual.

In addition to lifestyle measures and supplements, these natural treatments for menopause symptoms have decent evidence:

• Cognitive behavioral therapy

• Weight loss, when medically indicated

• Clinical hypnosis

• Maintaining lean muscle through strength-training exercises and adequate dietary protein

• Avoiding tobacco use

• Limiting alcohol use