Herbs that may be helpful
Some, but not all, double-blind trials support the usefulness of black cohosh for women with hot flashes associated
with menopause.35 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.36 A review of eight trials concluded black cohosh to be both safe and
effective.37 However, one double-blind trial found that black cohosh is ineffective
as a treatment for menopausal symptoms.38 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
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.39
In a preliminary trial, supplementation with crushed flaxseeds for six weeks improved the average hot flash
score (a measure of the frequency and severity of hot flashes) by 57% in postmenopausal women
who were not receiving estrogen therapy. The treatment consisted of two tablespoons of
flaxseeds (along with at least 10 ounces of liquid) twice a day. About one-fifth of the women
discontinued treatment because of abdominal symptoms or other side effects.40
A variety of herbs with weak estrogen-like actions similar to the effects of soy have
traditionally been used for women with menopausal symptoms.41 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.42 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.43 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.44 An extract of red
clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind
study.45 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.46
Sage may reduce excessive perspiration due
to menopausal hot flashes during the day or at night.47 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.48
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.51 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.52
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
1. Baird DD, Umbach DM, Landsedell L, et al. Dietary intervention study
to assess estrogenicity of dietary soy among postmenopausal women. J Clin Endocrinol
2. Cassidy A, Bingham S, Setchell KD. Biological effects of a diet of soy
protein rich in isoflavones on the menstrual cycle of premenopausal women. Am J Clin
3. Knight DC, Eden JA. A review of the clinical effects of
phytoestrogens. Obstet Gynecol 1996;87:897–904 [review].
4. Albertazzi P, Pansini F, Bonaccorsi G, et al. The effect of dietary
soy supplementation on hot flushes. Obstet Gynecol 1998;91:6–11.
5. Albertazzi P, Pansini F, Bottazzi M, et al. Dietary soy
supplementation and phytoestrogen levels. Obstet Gynecol 1999;94:229–31.
6. Brezinski A, Adlercreutz H, Shaoul R, et al. Short-term effects of
phytoestrogen-rich diet on postmenopausal women. Menopause 1997;4:89–94.
7. Han KK, Soares JM Jr, Haidar MA, et al. Benefits of soy isoflavone
therapeutic regimen on menopausal symptoms. Obstet Gynecol 2002;99:389–94.
8. Kaari C, Haidar MA, Junior JMS, et al. Randomized clinical trial
comparing conjugated equine estrogens and isoflavones in postmenopausal women: a pilot study.
9. Welty FK, Lee KS, Lew NS, et al. The association between soy nut
consumption and decreased menopausal symptoms. J Womens Health
10. Casini ML, Marelli G, Papaleo E, et al. Psychological assessment of
the effects of treatment with phytoestrogens on postmenopausal women: a randomized,
double-blind, crossover, placebo-controlled study. Fertil Steril
11. Ivarsson T, Spetz AC, Hammar M. Physical exercise and vasomotor
symptoms in postmenopausal women. Mauritas 1998;29:139–46.
12. Hammar M, Berg G, Lindgren R. Does physical exercise influence the
frequency of postmenopausal hot flushes? Acta Obstet Gynecol Scand
13. Slaven L, Lee C. Mood and symptom reporting among middle-aged women:
the relationship between menopausal status, hormone replacement therapy, and exercise
participation. Health Psychol 1997;16:203–8.
14. Staropoli CA, Flaws JA, Bush TL, Moulton AW. Predictors of menopausal
hot flashes. J Womens Health 1998;7:1149–55.
15. Greenberg G, Thompson SG, Meade TW. Relation between cigarette
smoking and use of hormonal replacement therapy for menopausal symptoms. J Epidemiol
Community Health 1987;41:26–9.
16. Perloff WH. Treatment of the menopause. Am J Obstet Gynecol
17. Gozan HA. The use of vitamin E in treatment of the menopause. NY
State J Med 1952;52:1289.
18. Christy CJ. Vitamin E in menopause: Preliminary report of
experimental and clinical study. Am J Obstet Gynecol 1945:50:84.
19. Finkler RS. The effect of vitamin E in the menopause. J Clin
Endocrinol Metab 1949;9:89–94.
20. Rubenstein BB. Vitamin E diminishes the vasomotor symptoms of
menopause. Fed Proc 1948;7:106 [abstract].
21. Blatt MHG, Weisbader H, Kupperman HS. Vitamin E and climacteric
syndrome: failure of effective control as measured by menopausal index. Arch Intern
22. CJ Smith. Non-hormonal control of vaso-motor flushing in menopausal
patients. Chicago Med 1964;67:193–5.
23. Nielsen FH, Penland JG. Boron supplementation of per-menopausal women
affects boron metabolism and indices associated with macromineral metabolism, hormonal status
and immune function. J Trace Elements Exp Med 1999;12:251–61.
24. Stomati M, Rubino S, Spinetti A, et al. Endocrine, neuroendocrine and
behavioral effects of oral dehydroepiandrosterone sulfate supplementation in postmenopausal
women. Gynecol Endocrinol 1999;13:15–25.
25. Barnhart KT, Freeman E, Grisso JA, et al. The effect of
dehydroepiandrosterone supplementation to symptomatic perimenopausal women on serum endocrine
profiles, lipid parameters, and health-related quality of life. J Clin Endocrinol
26. Lee JR. Natural Progesterone. The multiple roles of a remarkable
hormone. Sebastipol, CA: BLL Publishing, 1993, 31–7.
27. Gaby AR. Commentary. Nutr Healing
28. Wright JV. Hormones for menopause. Nutr Healing
29. Greendale GA, Reboussin BA, Hogan P, et al. Symptom relief and side
effects of postmenopausal hormones: results from the Postmenopausal Estrogen/Progestin
Interventions Trial. Obstet Gynecol 1998;92:982–8.
30. Leonetti HB, Long S, Anasti JM. Transdermal progesterone cream for
vasomotor symptoms and postmenopausal bone loss. Obstet Gynecol
31. Fitzpatrick LA, Pace C, Wiita B. Comparison of regimens containing
oral micronized progesterone or medroxyprogesterone acetate on quality of life in
postmenopausal women: a cross-sectional survey. J Women’s Health Gender-Based
32. Bullock JL, Massey FM, Gambrell RD Jr. Use of medroxyprogesterone
acetate to prevent menopausal symptoms. Obstet Gynecol 1975;46:165–8.
33. Morrison JC, Martin DC, Blair RA, et al. The use of
medroxyprogesterone acetate for relief of climateric symptoms. Am J Obstet Gynecol
34. Schiff I, Tulchinsky D, Cramer D, Ryan KJ. Oral medroxyprogesterone
in the treatment of postmenopausal symptoms. JAMA 1980;244:1443–5.
35. Liske E. Therapeutic efficacy and safety of Cimicifuga
racemosa for gynecological disorders. Advances Therapy 1998;15:45–53.
36. Nappi RE, Malavasi B, Brundu B, Facchinetti F. Efficacy of
Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose
transdermal estradiol. Gynecol Endocrinol 2005;20:30–5.
37. Lieberman S. A review of the effectiveness of Cimicifuga
racemosa (black cohosh) for the symptoms of menopause. J Womens Health
38. Newton KM, Reed SD, LaCroix AZ, et al. Treatment of vasomotor
symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a
randomized trial. Ann Intern Med 2006;145:869–79.
39. Uebelhack R, Blohmer JU, Graubaum HJ, et al. Black cohosh and St.
John's wort for climacteric complaints: a randomized trial. Obstet Gynecol
40. Pruthi S, Thompson SL, Novotny PJ, et al. Pilot evaluation of
flaxseed for the management of hot flashes. J Soc Integr Oncol
41. Crawford AM. The Herbal Menopause Book. Freedom, CA:
Crossing Press, 1996.
42. Hudson TS, Standish L, Breed C, et al. Clinical and endocrinological
effects of a menopausal botanical formula. J Naturopathic Med
43. Hirata JD, Swiersz LM, Zell B, et al. Does dong quai have estrogenic
effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil
44. Nestel PJ, Pomeroy S, Kay S, et al. Isoflavones from red clover
improve systemic arterial compliance but not plasma lipids in menopausal women. J Clin
Endocrinol Metab 1999;84:895–8.
45. Tice JA, Ettinger B, Ensrud K, et al. Phytoestrogen supplements for
the treatment of hot flashes: the Isoflavone Clover Extract (ICE) Study: a randomized
controlled trial. JAMA 2003;290:207–14.
46. van de Weijer PHM, Barentsen R. Isoflavones from red clover
(Promensil®) significantly reduce menopausal hot flush symptoms compared with placebo.
47. Duke JA. CRC Handbook of Medicinal Herbs. Boca Raton, FL:
CRC Press, 1985, 420–1 [review].
48. De Leo V, Lanzetta D, Cazzavacca R, Morgante G. [Treatment of
neurovegetative menopausal symptoms with a phytotherapeutic agent] [Article in Italian]
Minerva Ginecol 1998;50:207–11.
49. Grube B, Walper A, Wheatley D. St. John’s Wort extract:
efficacy for menopausal symptoms of psychological origin. Adv Ther
50. Wiklund IK, Mattson LA, Lindgren R, et al. Effects of a standardized
ginseng extract on quality of life and psychological parameters in symptomatic postmenopausal
women: a double-blind, placebo-controlled trial. Int J Clin Pharm Res
51. Warnecke G. Psychosomatic dysfunctions in the female climacteric.
Clinical effectiveness and tolerance of kava extract WS 1490. Fortschr Med
1991;119–22 [in German].
52. De Leo V, la Marca A, Morgante G, et al. Evaluation of combining kava
extract with hormone replacement therapy in the treatment of postmenopausal anxiety.
53. Toriizuka K, Okumura M, Iijima K, et al. Acupuncture inhibits the
decrease in brain catecholamine contents and the impairment of passive avoidance task in
ovariectomized mice. Acupunct Electrother Res 1999;24:45–57.
54. Wyon Y, Lindgren R, Hammar M, Lundeberg T. Acupuncture against
climacteric disorders? Lower number of symptoms after menopause. Lakartidningen
1994;91:2318–22 [in Swedish].
55. Popivanov P. Menopausal indices as criteria for the effectiveness of
acupuncture treatment of the climacteric syndrome. Vutr Boles 1983;22:110–3 [in
56. Kraft K, Coulon S. Effect of a standardized acupuncture treatment on
complaints, blood pressure and serum lipids of hypertensive, postmenopausal women. A
randomized, controlled clinical study. Forsch Komplementarmed 1999;6:74–9 [in
57. Lianzhong W, Xin Z. 300 cases of menopausal syndrome treated by
acupuncture. J Trad Chin Med 1998;18:259–62.