Menopause can bring a range of physical and emotional changes, from hot flashes and night sweats to disrupted sleep, changes in attention and focus, and other symptoms. For many women, the discomfort of hot flashes, along with concerns about the potential risks and side effects of estrogen therapy, leads them to seek dietary supplements or other nonhormonal approaches for relief.

Candy Tsourinis, PharmD, professor in the Department of Clinical Pharmacy with expertise in medication use, discusses what people should know about these options, including what the evidence shows, what “hormone balancing” really means, and why it’s important to consider your individual medical and family history before starting a supplement.

What menopause symptoms are most likely to lead people to look for dietary supplements or alternative therapies?

The one thing that probably motivates women the most is the vasomotor symptoms — the hot flashes and night sweats, especially when they are worried about taking estrogen. Patients either talk to their provider or seek something over the counter or a supplement to help them relieve those symptoms.

What should people know about the evidence behind dietary supplements for menopause symptoms?

There are a lot of dietary supplements that are marketed for this transition period. And the way to think about them is that there are multiple ingredients that we can get from plants.

These ingredients go by a lot of different names, the broadest category of which is called “phytoestrogens.” These are plant-based estrogens that we find in nature.  

Some supplements containing phytoestrogens have been studied for hot flashes. They’ve been shown to help reduce the frequency of hot flashes, but not so much the severity. They can help reduce the frequency at a much less effective level than estrogen.  

How do these supplements compare with more established treatments?  

The supplements may provide some mild benefits, but estrogen is the only option that seems to work particularly well for hot flashes. Other non-hormonal prescription options have also emerged as reasonable alternatives, which include medicines like SSRIs/SNRIs, gabapentin, and fezolinatant.

Hot flashes can also vary over time, which can make supplements difficult to study. It’s not like every hot flash is exactly the same every time, lasting for the same amount of time. The severity can wax and wane.

What about products marketed as “hormone balancing” or “natural”?  

Hormone balancing sounds great, but it’s really not doing that at all. We’re not replacing what’s lost, we’re just trying to minimize the symptoms that are associated with the decline in estrogen.

In general, the concept of “hormone balancing” is mostly marketing. The same is true for the term “natural.” I sometimes worry that a woman will indiscriminately go out and buy a supplement and start using it without fully knowing if it’s right for her.  

What safety considerations should people keep in mind when taking supplements?  

The single most important thing consumers can do is to read the label and follow the instructions. Pay particular attention to serving size. When you’re looking at a label, it’ll say something like 30 milligrams of the ingredient, but maybe the serving size is two soft gels, that means you have to take two to get 30 milligrams, not one.  

Whenever you are starting a dietary supplement of any type, it’s always important to run it by either your pharmacist or your health care provider so that they can do a check and just make sure there’s no interactions.  

What questions should people ask before starting a supplement or alternative therapy?  

The first question is, is this appropriate for me? Or is a prescription medicine more appropriate? With hot flashes, because they can change from day to day, week to week, and month to month, what I would say is keep a daily diary. Or on your phone, see if you have an app to track your hot flashes. And then when you start the supplement, you can see if it made a difference. This is important because you’re not going to remember how many times you flushed two weeks ago. The daily diary can also help you track any side effects that may develop over time.

What’s the most important thing for people to understand when evaluating these options?  

Individualizing care is the most important thing. Menopause is all over social media right now, and what people see online may not be appropriate for you as an individual. What’s being marketed may sound really appealing, but what really matters is your medical, family, and genetic history, especially in this area.

Understanding those things first is most important for understanding whether a treatment is right for you. The marketing is very compelling, but whether or not a treatment is right for you specifically is the more important question.

I really want to empower women to get the care they need, because this area of care traditionally has not been taught adequately across all professions. A lot of times menopause is the reason for a problem, but because many of our health care providers have not been trained to understand that, it’s often dismissed as, “oh, you’re just depressed, or you’re just stressed. I want to make sure that I’m advocating for women, telling them if they reach out to a health care provider who dismisses their concerns, they need to find someone else who is trained in caring for women who are going through menopause.