Menopause supplements: what the evidence supports

Where there is reasonable evidence

Vitamin D. Not a menopause treatment, but genuinely important. Bone loss accelerates around menopause, and vitamin D supports calcium absorption. UK advice is that everyone should consider a daily supplement of 10 micrograms during autumn and winter, and year-round for people with little sun exposure. This one is worth taking on public health grounds regardless of menopause.

Calcium, primarily through diet, with supplements where intake is low. Again bone rather than symptoms.

Isoflavones and red clover have some evidence for a modest effect on hot flushes, though trials are mixed and effect sizes are small compared with HRT. Worth knowing: these are phytoestrogens, and women with hormone-sensitive cancer should take advice before using them rather than assuming plant-derived means risk-free.

Where the evidence is mixed or weak

Black cohosh. Widely sold for hot flushes, and trial results are inconsistent. There have been rare reports of liver problems, and UK regulators require a warning on the label for this reason.

St John's wort. Some evidence for low mood, but it interacts with a long list of medicines, including hormonal contraception, anticoagulants and some antidepressants. This is not a benign herb and should not be taken alongside other medication without advice.

Magnesium. Popular for sleep and cramps, with limited evidence in menopause specifically. Generally well tolerated. If you want to try it, it is unlikely to do harm.

Evening primrose oil. Commonly sold for breast tenderness and flushes; evidence for menopausal symptoms is weak.

Sage, ginseng, dong quai, wild yam. Frequently marketed, poorly supported by evidence for menopausal symptoms. Wild yam creams in particular are sometimes sold as though they deliver progesterone; the body does not convert them into hormones.

What supplements do not do

No supplement replaces oestrogen. Menopausal symptoms are caused by falling oestrogen, and only replacing it addresses that cause.

That is not an argument that everyone should take HRT. It is an argument against the framing that supplements are a gentler version of the same thing. They are a different thing, aimed at the edges of the problem.

Two things worth more than any of it

Exercise, particularly resistance training, has better evidence than most supplements for bone density, mood, sleep and body composition through this period.

Sleep, alcohol and caffeine. Reducing alcohol and late caffeine has a measurable effect on night sweats and sleep quality for many women, and neither costs anything.

If you are going to buy something

• Check for interactions with anything you already take, particularly St John's wort
• Look for a UK Traditional Herbal Registration mark, which indicates a regulated product
• Be sceptical of proprietary blends that do not state doses
• Tell your clinician, because supplements are medicines as far as interactions are concerned
• Give it a fair trial with an end date, rather than accumulating a shelf

The honest summary

Vitamin D is worth taking. A few others may help a little. Most of what is sold in this category has weak evidence, and none of it replaces the hormone that has gone.

If your symptoms are affecting your life, the more useful step is finding out whether treatment is appropriate for you, which is free and takes about five minutes.