Last checked September 2026 against 21 sources · Editorial policy
Best menopause supplements: what the evidence says
No menopause supplement matches HRT, and most have weak evidence. A 2026 review of 158 studies for the International Menopause Society found moderate-certainty evidence that black cohosh may help hot flashes and that vitamin D lowers fracture risk; most other herbs and nutrients rest on low-quality studies. Soy isoflavones cut hot flashes by 20.6% in one meta-analysis. The North American Menopause Society doesn't recommend supplements for hot flashes, and none is FDA-approved.
Menopause supplements rated by evidence: black cohosh and soy isoflavones help hot flashes modestly, vitamin D protects bones, and most others don't beat placebo.
Menopause supplements: expectation vs reality
What people often expect
“A natural menopause supplement will work like HRT, without the risks”
What the evidence shows
NCCIH says no dietary supplement has clearly been shown to relieve menopause symptoms, and little is known about their long-term safety. In a Cochrane review of sixteen trials with 2,027 women, black cohosh didn't reduce hot flashes more than placebo, while HRT did better than black cohosh. Some supplements also interact with medicines.
Best menopause supplements: what the evidence says
Which menopause supplements have the best evidence?
In the International Menopause Society's 2026 evidence review, moderate-certainty evidence supported black cohosh for hot flashes and overall symptoms, Chinese herbal medicine for symptoms and sleep, and vitamin D for lower fracture risk. High-certainty evidence supported vitamin D's safety. Everything else, including many popular herbs and nutrients, rested on low or very low certainty evidence.
Black cohosh: mixed results
Black cohosh is the most studied menopause herb, with conflicting results. A 2012 Cochrane review of sixteen trials found no difference from placebo in hot flash frequency, while a 2023 review of 22 studies and the 2026 IMS review found possible benefit. Rare but serious liver damage has been reported with products labeled black cohosh.
Learn more →Soy isoflavones and red clover
Soy isoflavone supplements reduced hot flash frequency by 20.6% and severity by 26.2% vs placebo in a meta-analysis of trials. Red clover, another isoflavone source, hasn't shown conclusive benefit, and the Promensil extract didn't beat placebo in pooled trials. NCCIH notes that phytoestrogen supplements may not be safe for women who shouldn't take estrogen.
Learn more →Brand-name menopause supplements
Estroven Complete uses rhapontic rhubarb extract, which reduced menopause symptom scores vs placebo in a 12-week trial of 109 women. Bonafide's Relizen uses a purified pollen extract; in a 2024 meta-analysis, gains disappeared when only controlled studies were pooled. Amberen, a succinate-based formula, improved 16 of 21 symptoms vs placebo in pooled trials with 114 women on the supplement and 113 on placebo.
Learn more →Vitamins and minerals for menopause
Calcium and vitamin D matter for bones as estrogen falls: women 51 and older need 1,200 mg of calcium a day and 600 IU of vitamin D, rising to 800 IU after 70. But the USPSTF recommends against low-dose supplements, 400 IU of vitamin D or less and 1,000 mg of calcium or less, to prevent fractures in healthy postmenopausal women, and they raise kidney stone risk.
Learn more →Supplements that didn't work in trials
Omega-3 fish oil, 1.8 g a day, didn't reduce hot flashes in the MsFLASH trials. Flaxseed didn't beat placebo in a trial of 188 women. Magnesium oxide didn't reduce hot flashes in a placebo-controlled trial. Wild yam cream didn't change hormones or symptoms. Evening primrose oil, ginseng and dong quai have too little research to draw conclusions.
What menopause experts recommend instead
The North American Menopause Society's 2023 statement doesn't recommend supplements or herbal remedies for hot flashes. It recommends hormone therapy as the most effective treatment and, without hormones, CBT, clinical hypnosis, SSRIs or SNRIs, gabapentin, fezolinetant and oxybutynin, plus weight loss where relevant.
Learn more →Are menopause supplements safe?
Many are well tolerated in short trials, but supplements aren't approved by the FDA before sale, and makers are responsible for their own safety and labeling. Black cohosh has rare liver cases, and some black cohosh products contained the wrong herb. Kava has been linked to severe liver disease. Supplements can also interact with prescription drugs.
Menopause supplements by the numbers
From the studies on this page
fewer hot flashes with soy isoflavone supplements vs placebo in a meta-analysis
20.6%
158
0.07
1,200 mg
Many supplement trials are small, short or industry-funded; prices were checked in September 2026.
We may earn a commission if you buy through links on this page. It doesn't change what we recommend. How this works →
Menopause supplements compared
Black cohosh
Learn more →Good for
Moderate-certainty evidence for hot flashes in the 2026 IMS review.Watch
Cochrane found no benefit over placebo; rare serious liver damage; some products mislabeled.Our pick: Remifemin. A standardized black cohosh extract that names its dose on the label.
Check price on Amazon →Soy isoflavones
Learn more →Good for
About 20.6% fewer hot flashes in a meta-analysis; extracts used safely for up to 6 months.Watch
Modest, inconsistent effect; not recommended by The North American Menopause Society.Estroven Complete (rhapontic rhubarb)
Learn more →Good for
Reduced symptom scores vs placebo in a 12-week trial of 109 women; $19.99 for 28 caplets.Watch
Check price on Amazon →
Evidence comes from a small number of trials on one extract.Relizen (pollen extract)
Learn more →Good for
No significant side effects in studies.Watch
Check price on Amazon →
When controlled studies were pooled, the benefit was no longer significant; $58 a box.Vitamin D and calcium
Learn more →Good for
Vitamin D is safe, with moderate evidence for fracture risk; calcium needs rise after 51.Watch
Low-dose supplements didn't prevent fractures in healthy postmenopausal women and raise kidney stone risk.
How to choose a menopause supplement
- Check the label for the ingredient and dose used in trials, such as mg of isoflavones or the named extract.
- Avoid black cohosh if you have liver disease, and stop any supplement that causes dark urine or yellow skin.
- Tell your doctor about every supplement, especially with blood thinners, antidepressants or cancer treatment.
- Skip phytoestrogen supplements if you've been told not to take estrogen.
- Give a supplement a fixed trial and stop if it doesn't help; trials usually ran 12 weeks.
When to talk to a doctor before taking menopause supplements
Dark urine, yellow skin or belly pain on a supplement
Stop it and see a doctor; these can be signs of liver damage.
Breast cancer or another estrogen-sensitive condition
Talk to your oncology team before taking phytoestrogens or herbs.
Hot flashes or sleep problems affecting daily life
Ask about HRT or proven non-hormonal medicines.
You take blood thinners
Check before using dong quai, vitamin E or other supplements that affect bleeding.
Menopause supplements: questions women ask
What are the best supplements for menopause?
None is proven to work like HRT. The strongest evidence, still only moderate, is for black cohosh for hot flashes and vitamin D for fracture risk; soy isoflavones modestly reduce hot flashes. Most other supplements rest on low-quality studies.
Do menopause supplements work?
Some show modest benefits in trials, but results are inconsistent. NCCIH says no supplement has clearly been shown to relieve menopause symptoms, and The North American Menopause Society doesn't recommend them for hot flashes.
What are the best herbal supplements for menopause?
Black cohosh has the most evidence, though it's mixed. Chinese herbal medicine showed moderate-certainty benefit for symptoms and sleep in the 2026 IMS review. Red clover, dong quai and evening primrose oil lack convincing evidence.
Related →What are the best vitamin supplements for menopause?
Vitamin D and calcium support bones, and vitamin D had high-certainty evidence for safety in the IMS review. Get calcium from food first: low-dose supplements didn't prevent fractures in healthy postmenopausal women.
Related →Are over-the-counter menopause supplements safe?
Usually well tolerated short term, but they aren't FDA-approved before sale, long-term safety is largely unknown, and some interact with drugs. Black cohosh and kava have been linked to liver problems.
Related →Are plant-based menopause supplements better?
Not necessarily. Plant-based doesn't mean tested: flaxseed and red clover didn't beat placebo, while soy isoflavones and rhapontic rhubarb extract showed some benefit in trials.
What supplements should I avoid in menopause?
Kava, linked to severe liver disease; black cohosh if you have liver problems; and phytoestrogens if you shouldn't take estrogen. High-dose vitamin E may raise bleeding risk.
Can I take menopause supplements with HRT?
Ask your doctor first. Supplements can interact with medicines, and phytoestrogens may have estrogen-like effects. Vitamin D and calcium from food are fine alongside HRT for bone health.
How long do menopause supplements take to work?
Most trials ran about 12 weeks; for example, rhapontic rhubarb extract reduced hot flashes by week 4. If a supplement hasn't helped after a trial of that length, the evidence doesn't favor continuing.
Sources
- Maunder A, Mardon AK, Rao V, et al. Complementary therapies for management of menopausal symptoms: a systematic review to inform the update of the International Menopause Society recommendations on women's midlife health. Climacteric. 2026;29(2):165-209.
- Taku K, Melby MK, Kronenberg F, et al. Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: systematic review and meta-analysis of randomized controlled trials. Menopause. 2012;19(7):776-90.
- The North American Menopause Society. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590.
- US Food and Drug Administration. Dietary supplements.
- National Center for Complementary and Integrative Health. Menopausal symptoms: in depth.
- Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012;2012(9):CD007244.
- National Center for Complementary and Integrative Health. Black cohosh: usefulness and safety.
- National Center for Complementary and Integrative Health. Red clover: usefulness and safety.
- Lethaby A, Marjoribanks J, Kronenberg F, et al. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Syst Rev. 2013;2013(12):CD001395.
- Estroven. Estroven Complete Multi-Symptom Menopause Relief product page (checked September 2026).
- Heger M, Ventskovskiy BM, Borzenko I, et al. Efficacy and safety of a special extract of Rheum rhaponticum (ERr 731) in perimenopausal women with climacteric complaints: a 12-week randomized, double-blind, placebo-controlled trial. Menopause. 2006;13(5):744-59.
- Bonafide. Relizen product page (checked September 2026).
- Acquarulo EL, Hernandez EC, Kodzodziku F, et al. The efficacy of purified pollen extract for reducing vasomotor symptoms in women: a systematic review and meta-analysis. Menopause. 2024;31(2):154-159.
- Radzinsky VE, Uspenskaya Y, Shulman LP, et al. Succinate-Based Dietary Supplement for Menopausal Symptoms: A Pooled Analysis of Two Identical Randomized, Double-Blind, Placebo-Controlled Clinical Trials. Obstet Gynecol Int. 2019;2019:1572196.
- Office on Women's Health, US Department of Health and Human Services. Menopause and your health.
- US Preventive Services Task Force; Grossman DC, Curry SJ, Owens DK, et al. Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(15):1592-1599.
- Guthrie KA, LaCroix AZ, Ensrud KE, et al. Pooled Analysis of Six Pharmacologic and Nonpharmacologic Interventions for Vasomotor Symptoms. Obstet Gynecol. 2015;126(2):413-422.
- Pruthi S, Qin R, Terstreip SA, et al. A phase III, randomized, placebo-controlled, double-blind trial of flaxseed for the treatment of hot flashes: North Central Cancer Treatment Group N08C7. Menopause. 2012;19(1):48-53.
- Park H, Qin R, Smith TJ, 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;22(6):627-32.
- Komesaroff PA, Black CV, Cable V, et al. Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women. Climacteric. 2001;4(2):144-50.
- National Center for Complementary and Integrative Health. Soy: usefulness and safety.
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