Can an over-the-counter supplement really ease menopause symptoms? Experts reveal the ones that work… and which to avoid

Menopausal women are being ripped off – was the conclusion of a recent analysis of supplements posing as a ‘natural’ remedy for the dreaded symptoms.

Consumer group Which? scrutinised 26 popular products, containing a total of 78 active ingredients, and found that, overall, the ‘specialised’ supplements were no more beneficial than a bog-standard multivitamin.

Not a single product analysed was found to contain the right combination of nutrients at scientifically-proven doses for helping menopausal symptoms like hot flushes and mood changes.

In their scathing conclusion, the researchers urged consumers not to fall for ‘quasi-medical claims’ or waste eye-watering amounts (some products cost more than £400 a year) on bogus ingredients.

But with millions of women seeking natural remedies, is there anything worth investing in?

Here, experts reveal the supplements with genuine evidence behind them, and the ones best left on the shelf.

The supplements that actually can make a difference 

Hundreds of pills, powders and herbal concoctions claim to help an array of symptoms related to the hormonal change.

In fact, the list of supplements experts recommend is surprisingly short.

First, vitamin D. 

When women hit menopausal age they see a dramatic decline in the sex hormone oestrogen, which is vital for helping our bones absorb strength-building calcium.  

As around one in five Britons are estimated to be deficient in the so-called ‘sunshine pill’, experts say it’s likely many menopausal women may not have enough.

Dr Paula Briggs, consultant in sexual and reproductive health at the Liverpool Women’s NHS Foundation Trust and Chair of the British Menopause Society would recommend vitamin D supplements – ‘but that also goes for everyone in the UK,’ she adds.

The vitamin is mostly created via the skin’s exposure to the sun, which is lacking for several months of the year in Britain.

Dr Briggs says that everyone, regardless of menopausal status, needs 1000 international units – or 25 micrograms – a day.

The other nutrient worth paying attention to is calcium, another essential building block for healthy bones.

 But Dr Briggs doesn’t recommend automatically reaching for a supplement simply because you’ve hit menopause.

Whether or not a woman needs additional calcium ‘depends on their bone density’, she says. 

For some women – particularly those at greater risk of osteoporosis – bone health may be assessed using a DEXA scan, which measures density. Doctors will advise if a supplement is needed, adds Briggs.

Meanwhile other supplements that could help relieve some common symptoms, like low mood and anxiety, include folate and vitamin B12 – but only if a woman has a deficiency.

 Studies have shown that lacking these nutrients – found in liver, eggs and some dairy – can influence brain processes involved with mood, Briggs says. 

Research suggests that up to 52 per cent of vegans and 40 per cent of vegetarians are deficient in B12. 

Iron deficiency can also be an issue, particularly for women experiencing heavy or abnormal bleeding during perimenopause.

However, Briggs adds: ‘Iron is a supplement that should be prescribed by a doctor following a blood test, rather than bought over the counter.’

This is because of the risks involved with overdosing on iron, which includes gut problems and, in severe cases, liver damage and even failure.

The vitamin pills that probably WON’T work 

Unless products contain one of the above ingredients, and you are aware of a deficiency, the chances are a menopause supplement will do nothing but cost you money, according to Joyce Harper, Professor of Reproductive Science at University College London. 

Prof Harper recently authored a study that involved analysing the health benefits of 201 menopause supplements.

Her conclusion is: ‘Women should be wary of products making broad claims that are not supported by good-quality evidence.’

One popular ingredient is extracts from the American-grown herb black cohosh, which is widely promoted for easing hot flushes and night sweats.

Dr Joyce warns that, despite being one of the more widely studied ingredients, ‘the evidence is mixed and not strong enough to support benefits’.

There is some evidence, the scientists add, that black cohosh could even be harmful for liver health.

The supplement has been linked to rare cases of liver damage. Scientists aren’t certain why, but it appears that the herbal remedy can trigger inflammation and injury to liver cells in a small number of susceptible people.

Red clover and other supplements containing plant chemicals called isoflavones are also popular because they contain phytoestrogens – compounds that can have weak oestrogen-like effects in the body.

Yet the evidence they relieve menopause symptoms is mixed. In one year-long trial, hot flushes and night sweats fell by 57 per cent among women taking red clover – but by an even greater 63 per cent among those given a dummy pill. 

Only HRT performed significantly better than placebo. 

Dr Briggs is also cautious about products said to act like oestrogen in the body.

The concern regards women who have had breast cancer, or are genetically susceptible, as some types of the disease are fuelled by oestrogen. 

Isoflavones can bind to the same receptors in the body as the hormone, prompting concerns about whether concentrated supplements could affect hormone-sensitive tissue. The British Menopause Society advises women who have had breast cancer to avoid soy and red-clover isoflavones because of their oestrogenic activity.

Dr Joyce Harper’s research also highlighted potential risks from other common ingredients: excessive vitamin B6 can cause nerve damage, while too much vitamin D can trigger vomiting and confusion through a dangerous build-up of calcium in the blood. 

Ashwagandha, found in almost a third of the products analysed, and black cohosh have also been linked in rare cases to liver injury.

The fundamental problem, Briggs says, is that supplements do not have to undergo the same rigorous testing as medicines.

‘There’s no necessity for them to undergo the same kind of testing as drugs would have – clinical trials to show that they’re actually any more effective than placebo.

Should all menopausal women be taking HRT?

In contrast to supplements, Dr Briggs says hormone replacement therapy (HRT) has been subjected to randomised controlled trials demonstrating its effectiveness.

However, the experts caveat that the treatment – usually a combination of oestrogen and progesterone – has been conclusively proven to prevent hot flushes and night sweats, as well as help vaginal dryness and other genitourinary symptoms.

But the evidence that it helps other hormone-related problems like brain fog, mood problems and aches and pains is not as conclusive.

Dr Briggs stresses HRT isn’t something every menopausal woman should automatically take. 

‘It should be there for women who are symptomatic, who aren’t at any increased risk by taking it, and who want to take it,’ she says.