Vitamins that may be helpful
Many years ago, researchers studied the effects of vitamin E supplementation in reducing symptoms of
menopause. Most,14 15 16 17 18 but not
all,19 studies found vitamin E to be helpful. Many doctors suggest that women going
through menopause take 800 IU per day of vitamin E for a trial period of at least three months
to see if symptoms are reduced. If helpful, this amount may be continued. Using lower amounts
for less time has led to statistically significant changes, but only marginal clinical
In 1964, a preliminary trial reported that 1,200 mg each of vitamin C and the flavonoid hesperidin taken over the course of the day
helped relieve hot flashes.21 Although placebo effects are strong in women with hot
flashes, other treatments used in that trial failed to act as effectively as the
flavonoid/vitamin C combination. Since then, researchers have not explored the effects of
flavonoids or vitamin C in women with menopausal symptoms.
The mineral boron is known to affect
estrogen metabolism. In one double-blind trial using 2.5 mg of boron per day for two months,
hot flashes and night sweats worsened in 21 of 43 women, but the same symptoms improved in ten
others.22 Women who are experiencing hot flashes or night sweats that have been
diagnosed as menopausal symptoms and who are also supplementing boron (sometimes found in
significant amounts in osteoporosis formulas
and multivitamin-mineral supplements) should
consider discontinuing use of boron-containing supplements to see if the severity of their
symptoms is reduced.
Aging in women is characterized by a progressive decline in blood DHEA
(dehydroepiandrosterone) and DHEA-sulfate (DHEAS) levels. These levels can be restored with DHEA supplementation. This process also improves
the response of some brain chemicals, called endorphins, to certain drugs.23 These
endorphins are involved in sensations of pleasure and pain; improving their response may explain why DHEA
has an effect on mood symptoms associated with menopause. In one double-blind trial, however,
menopausal women who took 50 mg of DHEA per day for three months had no improvement in
symptoms compared with women taking placebo.24 Further study is needed to validate
a role for DHEA in the management of menopausal symptoms.
Natural progesterone supplementation has
been anecdotally linked to reduction in symptoms of menopause.25 26
27 In one trial, natural progesterone was found to have no independent effect on
symptoms, and synthetic progestins were found
to increase breast tenderness.28 However, a double-blind trial found that topical
administration of natural progesterone cream led to a reduction in hot flashes in 83% of
women, compared with improvement in only 19% of those given placebo.29 Preliminary
research has found that oral, micronized progesterone therapy is associated with improved
quality of life among postmenopausal women. However, oral micronized progesterone is available
only by prescription in the United States.30 Hot flashes, anxiety,
depression, sleep problems, and sexual functioning were among the symptoms improved in a
majority of women surveyed. Synthetic progestins, also available only by prescription, have
reduced symptoms of menopause.31 32 33
Progesterone is a hormone and, as such, concerns about its inappropriate use (i.e., as an
over-the-counter supplement) have been raised. The amount of progesterone in commercially
available creams varies widely, and the progesterone content is not listed on the label
because the creams are legally regulated as cosmetics, not dietary supplements. Therefore, a
physician should be consulted before using these hormone-containing creams as supplements.
Although few side effects have been associated with topical progesterone creams, skin
reactions may occur in some users. Effects of natural progesterone on breast cancer risk remain unclear; research has
suggested both increased and reduced risk.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
Double-blind trials support the usefulness of
black cohosh for women with hot flashes associated with menopause.34 In a
three-month study of postmenopausal women, 40 mg per day of an extract of black cohosh was as
effective as estrogen therapy in the treatment of hot flashes.35 A review of eight
trials concluded black cohosh to be both safe and effective.36 Many doctors
recommend 20 mg of a highly concentrated extract taken twice per day; 2 to 4 ml of tincture
three times per day may also be used.
In a double-blind study of postmenopausal women who were experiencing psychological
symptoms, a combination of black cohosh and St. John's wort was significantly more effective
than a placebo in improving both menopausal symptoms and depression. The product used in this study contained
(per tablet) black cohosh standardized to 1 mg of triterpene glycosides and St. John's wort
standardized to 0.25 mg of hypericin. The amount taken was two tablets twice a day for eight
weeks, followed by one tablet twice a day for eight weeks.37
A variety of herbs with weak estrogen-like actions similar to the effects of soy have
traditionally been used for women with menopausal symptoms.38 These herbs include
licorice, alfalfa, and red clover. In a double-blind trial, a formula
containing tinctures of licorice, burdock, dong quai, wild yam, and motherwort (30 drops three times daily) was found to
reduce symptoms of menopause.39 No effects on hormone levels were detected in this
study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times
daily in capsules) had no effect on menopausal symptoms or hormone levels.40 A
double-blind trial using a standardized extract of subterranean clover (Trifolium
subterraneum), a relative of red clover,
containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot
flashes, though it did improve function of the arteries.41 An extract of red
clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind
study.42 In another double-blind study, however, administration of 80 mg of
isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal
women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after
a total of 12 weeks.43
Sage may reduce excessive perspiration due
to menopausal hot flashes during the day or at night.44 It is believed this is
because sage directly decreases production of sweat. In a preliminary study, supplementation
with a product containing extracts of the leaves of sage and alfalfa resulted in complete
elimination of hot flushes and night sweats in 20 of 30 women, with varying degrees of
improvement in the other ten cases.45
Blue vervain (Verbene hastata). is a traditional herb for menopause; however,
there is no research to validate this use. Tincture has been recommended at an amount of
5–10 ml three times per day.
Preliminary evidence suggests that supplementation with St. John’s wort extract (300 mg three times
daily for 12 weeks) may improve psychological symptoms, including sexual well-being, in
A double-blind trial found that Asian
ginseng (200 mg per day of standardized extract) helped alleviate psychological symptoms
of menopause, such as depression and anxiety, but did not decrease physical symptoms, such
as hot flashes or sexual dysfunction, in postmenopausal women who had not been treated with
Warning: Kava should only be taken with medical supervision. Kava is
not for sale in certain parts of the world.
In a double-blind trial, a standardized
kava extract was found to be effective at reducing anxiety and other symptoms associated with
menopause.48 The study used 100 mg of kava extract standardized to contain 70%
kava-lactones, three times per day. Most commercially available kava extracts contain up to
35% kava-lactones. In another study, administration of kava enhanced the anti-anxiety effect
of hormone replacement therapy in postmenopausal women.49
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
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