The emails arrive in my in-box every week – women wanting to know if I promote supplements for menopause – [no I don’t, because I’m not a Naturopath] – or asking why they are still getting hot flushes, anxiety and insomnia, even though they are taking a variety of menopause supplements. This was me as well. But spending hundreds of dollars on supplements that were marketed to me in menopause, did not solve any of my symptoms into the long term, nor did they help my weight, sleep, blood pressure, gut health or joint pain.
At the time, I didn’t understand (nor was I being told by health practitioners), the science behind their efficacy. I had no idea how they worked, what plants they were sourced from (and in many cases, not even plants, but synthetic materials) and how many of them differ in their effect depending if women are in peri-menopause or post-menopause. Both these stages of menopause differ considerably because in peri-menopause, women still have oestrogen production, although this is declining, whereas, in post-menopause (when periods have ended for a year or more), all of the reproductive hormones, including the pituitary hormones, are at their lowest.
As I scrambled to understand why I was feeling hot and bothered, overweight, anxious, exhausted and depressed and I was already on menopause HRT, my pantry also resembled a health-supplement shop or pharmacy. There were so many different bottles of menopause supplements and yet, none really made any difference or they might only help one symptom and not another symptom.
I now understand why.
Positioning our menopause transition in women’s healthy ageing research allowed me to explore and better understand the numerous changes that go on around the body. These changes don’t just affect our reproductive hormones, but other hormones too. Our muscles, liver, gut, blood vessels, nerves and heart lose the effect of oestrogen and progesterone too. As such, our menopause transition can impact on the build-up of inflammation around the body … especially if we don’t change our lifestyle and ADAPT to this powerful life-stage that we are all going through.
Depending on the stage of menopause women are in, their current lifestyle, which includes nutrition, their stress levels, exercise and any underlying medical conditions, and/or are on other medications, all of these factors affect whether menopause supplements may work or not. This is an important point.
One of the first studies to explore whether botanical and dietary supplements work for women in menopause was undertaken by Associate Professor Stacie Geller and Laurie Sturdee from the University of Illinois and reported in the Journal of Women’s Health in 2005. [Botanical and Dietary Supplements for Menopausal Symptoms: What Works, What Doesn’t]
I would like to thank these researchers. Because their studies helped to point me in the direction of changing my nutrition in peri-menopause to include powerful plant-based nutrients instead of taking too many artificial supplements (and yes, all supplements in a bottle or packet are ‘man-made’).
Their studies also helped me to understand that many supplements marketed to us contain powerful herbs such as Black Cohosh, Red Clover, St John’s Wort and/or other herbs that have either anti-inflammatory effects, which improves blood vessel elasticity or anti-anxiety effects that help to slow down the nervous system activity. Yes, our nerves are losing the role of oestrogen too and as we move through menopause, you can feel increased anxiety because your lack of sleep impacts on your stress levels and when you feel more stressed, your heart rate and anxiety levels increase. I remember those days well.
Black Cohosh is an herb which has anti-inflammatory effects. The roots/rhizomes of black cohosh have been used traditionally by Native Americans for a variety of complaints, and Black Cohosh has also been used as a treatment of menopausal disorders in Germany for over 50 years. Does it work? Well, I will let you decide that if you are taking it, but in Geller and Sturdie’s studies, it was evidenced to help reduce hot flushes and for some women, anxiety – not other symptoms. As the study states,
“The evidence to date suggests that black cohosh is safe and effective for reducing menopausal symptoms, primarily hot flashes and possibly mood disorders.”
Multiple clinical investigations have also suggested that black cohosh extracts are effective in reducing the frequency and intensity of hot flashes among perimenopausal and postmenopausal women, whereas other randomized controlled trials have reported no vasomotor symptom (hot flush) benefits at all. [Geller, Shuman et al, 2009]. So, it’s your call, – supplements containing Black Cohosh may or may not, therefore, have an effect on your sleep, sore joints, weight, depression, itchy skin or any other symptom that you have been experiencing. As well, because there is a powerful link between all of the different hormones, not just our reproductive hormones, then not sleeping affects your hot flushes and regulation of your temperature too.
St John’s Wort and Red Clover:
If you are taking supplements, then why don’t you take a moment to look at the ingredients list? … because they might also contain phytoestrogen extracts, including soy compounds (phyto-oestrogens), St John’s Wort and/ or Red Clover.
The botanicals St John’s Wort and Red Clover (Trifolium pratense L.) are also popular among women seeking alternative therapies for the management of menopausal symptoms, especially vasomotor symptoms (hot flushes).
If they do, the researchers state that they may not have an effect on menopause symptoms, but the good news is that they may help to reduce heart disease.
“Phytoestrogen extracts, including soy foods and red clover appear to have at best only minimal effect on menopausal symptoms but have positive health effects on plasma lipid concentrations and may reduce heart disease.”
For women going into post-menopause, this is a good thing. Heart disease is the number 1 health concern for women globally who are moving into post-menopause. How we look after our hearts matter and it’s why the 12 week online MyMT™ programmes are focused on our improved health as we age. Any supplements I suggest for women on my programme are evidenced against women’s healthy ageing studies and not necessarily menopause, because menopause is the gateway to our ageing.
St John’s Wort is another herbal product that is marketed heavily to women during their menopause transition. Women think that this is designed to help with hot flush management, but according to numerous studies, there is inconsistent evidence to support the efficacy and safety for hot flushes, but the news is better for help with depression. The good news is that St John’s Wort has been shown to improve mild to moderate depression in the general population and appears to show efficacy for mood disorders related to the menopausal transition.
What I don’t think that many women understand is that we must all be careful about over-the-counter supplements. It’s the same for sports supplements too. There are numerous studies to show that we have to be cautious about their efficacy and more importantly, the interaction of powerful herbs or other substances with other medicines. Women taking menopause supplements who are on any medications whatsoever, must report this to their Doctors. And lots don’t. I know this, because a brand new report from Alisa Johnson and colleagues in America, following a large literature review of alternative therapies in menopause, concluded that,
“the majority of women using Complementary Alternative Medicine (CAM) do not discuss it with their health care providers …(and) women often report feeling confused about their options and rely on the internet as their primary source of information.” (p. 1).
So, what does work?
There is interesting research in the 2019 review by Johnson et al, that the following practices and strategies show promise to help with hot flush management. These include:
- mind-body practices such as yoga and mindfulness training,
- stress management techniques,
- cognitive behavioral therapy,
- homeopathy, including essential oils
- phytoestrogens (e.g. soy derivatives)
- Vitamin E
- Evening Primrose Oil
Hot flush management is just one component of our symptoms in menopause and I found that whilst some strategies worked for some symptoms, there were other symptoms that remained.
It doesn’t matter whether you are on supplements or HRT or Anti-depressants or not, as this is between you and your health provider. But what I do encourage you to also understand, is that as you move through menopause, there are changes occurring to your cardiac muscle, blood vessels, skin, bones, tendons, ligaments, liver and gut. Yes all of these structures. As such, we need to change how we look after ourselves in mid-life and focus on our improved health as we age through understanding the lifestyle solutions that are evidenced for our menopause transition too.
That’s why I designed the MyMT™ programmes for you as well.
Because menopause isn’t just about hot flushes.
It’s about our sleep, weight management, blood pressure, sore joints, nutrition, stress management, exercise choices and other symptoms too. When you are ready, I hope you can spend some time exploring what’s in the two different programmes – based on whether you are overweight or not.
Wendy Sweet, PhD/ Member: Australasian Lifestyle Medicine Society
Johnson, A., Roberts, L., Elkins, G. (2019). Complementary and Alternative Medicine for Menopause. Journal of Evidence-Based Integrative Medicine, Volume 24: 1-14
Geller, S. Lee P. Shulman, M. et al (2009). Safety and Efficacy of Black Cohosh and Red Clover for the Management of Vasomotor Symptoms: A Randomized Controlled Trial. Menopause,16(6): 1156–1166.
Geller, S. & Studee, L. (2005). Botanical and Dietary Supplements for Menopausal Symptoms: What Works, What Doesn’t. J. Womens Health, 14(7): 634–649.