Written by Kerenza Dickie, Nutrition Student
Edited by Laura Clark, The Menopause Dietitian
If you are reading this, then I’m sure you’re aware of some of the symptoms experienced during the menopause and are eager to find ways to ease them. Everyone will have different experiences of the menopause with the severity and range symptoms varying greatly between individuals (BNF, 2022), however common symptoms include: hot flushes, sleep disorders, lack of sexual desire, mood swings, memory loss, anxiety, depression and the list goes on (BNF, 2022).
If you’re currently struggling with any of these symptoms, then you have likely heard of hormone replacement therapy (HRT) as it is currently the most commonly used treatment for managing menopausal symptoms (D’alonzo et al., 2019). HRT contains hormones that stop being made by the body during menopause. It can either be oestrogen-only or combined HRT, which contains both oestrogen and progesterone, and it can be taken in a range of ways, including tablets, skin patches, gels, creams, and implants (NHS, 2022). Despite its efficacy in improving menopausal symptoms, some women are reluctant to take HRT as they have found it to be ineffective or have concerns over its safety (Lambert et al., 2017).
One form of alternative therapy that has become increasingly popular over the last 20 years is dietary supplements (Moore et al., 2017). There is now a huge range of dietary supplements being marketed for menopause, comprising vitamins and minerals along with botanical ingredients believed to have beneficial effects on menopausal symptoms (Moore et al., 2017).
The market for these supplements has become so big that it can be extremely overwhelming and confusing as there are so many ingredients, many of which people haven’t heard of, being sold in different combinations in bottles with vague health claims. These supplements can be expensive and there is controversy surrounding their efficacy, but the huge impact that menopausal symptoms can have on our lives can lead to desperation to find anything that may help. This blog aims to shed a bit of light on the research behind some of the most popular botanicals currently being used in menopause supplements.
First, I just want to touch on the regulations for these ingredients, or lack thereof. Dietary supplements in the UK are regulated under Food Law (FSA, 2021). This means they are not required to undergo the same rigorous testing as drugs and do not require approval from regulatory agencies for safety and efficacy (Grazina et al., 2020). Therefore, dietary supplements vary in their dosage, purity, content, and standardisation (NIH, 2020a). This also makes researching them and comparing different studies quite hard, as there are so many variables.
A member of the buttercup family, black cohosh, is a plant that was traditionally used by indigenous peoples for menstrual pain and childbirth. It’s one of the most widely studied botanicals for menopausal symptoms.
Black Cohosh could show great promise as an alternative therapy for menopausal symptoms (Mohapatra et al., 2022).In two recent reviews of the available data produced from clinical trials, it was concluded that it is a safe and effective treatment, particularly for hot flushes and night sweats (Castelo-Branco, 2020; Mohapatra et al., 2022). Combined HRT was still shown to be more effective, however black cohosh has no oestrogenic effects (i.e. it doesn’t mimic oestrogen in the body) so it can be used by those with hormone-dependent diseases (Mohapatra et al., 2022).
However, there is some conflicting research and another recent review of alternative therapies concluded that the current evidence is not sufficient to support its use (Djapardy and Panay, 2022). Scientists are still unclear on how black cohosh works and the ingredients in it responsible for improving symptoms, therefore further research is needed to identify its mechanisms in order to produce effective black cohosh products (Mohapatra et al., 2022).
One theory is it affects our neurotransmitters, such as serotonin and dopamine in the brain (Burdette et al. 2003) so watch this space on that.
Red clover is a popular ingredient in menopause supplements. It is a herb that belongs to the same legume family as peas and beans.
It contains isoflavones which are phytoestrogens, meaning that they can mimic oestrogenic activity, therefore reducing menopausal symptoms which are linked to declining oestrogen levels (Geller and Studee, 2006). Due to these isoflavones, most studies indicate that red clover is effective in reducing the frequency and severity of menopausal symptoms, particularly hot flushes and night sweats. (Ghazanfarpour et al., 2015; Lambert et al., 2017; Shakeri et al., 2015). It has also been suggested that combining red clover supplements with probiotics may improve their efficacy (Lambert et al., 2017). However, there is some conflicting research where red clover was found to be no different to a placebo (Ehsanpour et al. 2012). As with black cohosh, further in-depth studies are required to confirm its efficacy (Ghazanfarpour et al., 2015).
Sage leaf is the most common botanical ingredient found in menopause supplements. This is likely because of the recent research supporting its efficacy in treating a wide range of menopausal symptoms.
Like red clover, it can mimic oestrogen activity, as it contains phytoestrogens in the form of flavonoids (Zeidabadi et al., 2020). It is also believed to influence neurological pathways involved in thermoregulation, cognitive function, and mood (Tober and Schoop, 2019), therefore giving it the ability to reduce hot flushes, poor cognitive function, and mental health issues.
A small Swiss study on women who experienced at least five hot flushes a day found that taking a daily tablet of fresh sage leaves helped. After 4 weeks their hot flushes decreased by 50%, and 64% after 8 weeks. It had a significant effect on severe flushes. The women also reported that it helped with symptoms like vaginal dryness, as well as improving their mental wellbeing.
Evening Primrose Oil
This oil is extracted from the seeds of the flower. Many women have been using the supplement to help manage symptoms of PMS and menopause for years.
Some research supports this, particularly night sweats, however results are conflicting (Kazemi et al., 2021) and although it has oestrogenic properties, its mechanisms for symptom relief are unclear (Dastenaei et al., 2017). When compared to Black Cohosh, Black Cohosh seems more effective in reducing severity and frequency, whereas EPO only impacted severity. Generally, there is insufficient evidence to support its use and further research is required.
Ashwagandha root was also shown to be effective in relieving menopausal symptoms in a recent clinical trial (Gopal et al., 2021) of 91 women. After eight weeks, their menopause-specific quality of life scores significantly improved and symptoms like hot flushes, insomnia, vaginal dryness, and urinary problems decreased. However, there are limited studies on this, so yes you guessed it, we need more research!
St John’s Wort
St John’s Wort has been found to have antidepressant effects (Geller and Studee, 2005) and some studies have also supported it as an effective treatment for hot flushes (Eatemadnia et al., 2019). However, there are concerns over its safety due to its interaction with other drugs, therefore it should be taken with caution and its use discussed with your healthcare professional. (Djapardy and Panay, 2022).
In summary, there is a wide range of botanical ingredients included in dietary supplements which show some promise as alternative therapies for menopausal symptoms. However, the research is still lacking and, in some cases, of poor quality. We really need further studies to determine their efficacy and the most appropriate formulations and dosages.
In the meantime, HRT is still the most effective treatment to date (D’alonzo et al., 2019).
However, you may well find some benefits from botanical supplements, as many of the people in these trials did, even if it’s just the power of the placebo!
If you’d like to discuss any of the above in more detail, please do feel free to contact me.