Supplements

A supplement here means anything sold over the counter to take alongside, or instead of, your food: vitamins and minerals, fish oils, herbal remedies and plant extracts, and products marketed for the menopause.

Women's Health Concern, the patient arm of the British Menopause Society, draws the line that matters. Herbal remedies that are not regulated by a medicines authority should not be considered safe, it says, because their strength and effect vary widely and they can cause side effects or clash with other medicines. It gives the same warning about compounded bioidentical hormones, sometimes sold as natural HRT, which are not regulated or held to the same quality control as conventional HRT. The word natural on the label does not change that.

NICE NG23

NICE asks doctors to explain three things to women who are thinking of trying complementary therapies:

• the effectiveness and safety of unregulated hormone preparations are unknown (1.4.5)
• for unregulated preparations, "the safety, quality and purity of constituents in unregulated preparations may be unknown" (1.4.6)
• there is some evidence that isoflavones or black cohosh may relieve hot flushes and night sweats, but many preparations exist, they vary, their safety is uncertain, and interactions with other medicines have been reported (1.4.7).

Isoflavones are one group of phytoestrogens, which have their own page.

For women with a history of breast cancer or at high risk of it, NICE says there is some evidence St John's wort may help hot flushes, but uncertainty about the right amount, how long any effect lasts, how preparations differ, and potential serious interactions with other medicines, including tamoxifen, blood thinners and epilepsy medicines (1.4.8).

The Pakistan Menopause Society

Section 6.5 of the 2026 recommendations says over-the-counter supplements should be used with caution, because robust evidence on their safety and effectiveness is limited. It then names several, with the cautions that go with them:

• high-dose turmeric needs caution with blood thinners
• sage should be avoided by women with epilepsy and used with caution by women with estrogen-sensitive cancers
• milk thistle can interact with medicines processed by the liver, blood thinners included, and is not recommended for women with hormone-sensitive cancers or on endocrine therapy
• Asian (Panax) ginseng has estrogen-like activity and should be avoided by women with hormone-sensitive conditions
• high-dose turmeric, vitamin E and omega-3 supplements may each reduce tamoxifen's protective effect on breast tissue.

The recommendations print amounts for several of these. We leave them out: an amount is your doctor's decision, not a label's.

The NHS

The NHS website names evening primrose oil, black cohosh, angelica, ginseng, St John's wort and red clover as herbal remedies some women take. It says some contain plant hormones, and that any benefit for menopause symptoms is not supported by scientific evidence. It warns that St John's wort especially can cause serious side effects when taken with other medicines.

The British Menopause Society

The BMS tool on nutrition says the only dietary supplement it recommends for women in perimenopause and after is vitamin D, and that other supplements should be taken only where there is a clinical need. The Pakistan Menopause Society links vitamin D needs in Pakistan to indoor lifestyles and purdah (Table 5). The amounts are for your doctor; our page on vitamin D and calcium explains the rest.

The BMS consensus statement on non-hormonal treatments adds that black cohosh interferes with tamoxifen and should be avoided by women taking it.

The Menopause Society

The Menopause Society, in the US, reviewed the evidence in 2023 and does not recommend supplements or herbal remedies for hot flushes, because the evidence is negative or too thin. Its list includes black cohosh, wild yam, dong quai, evening primrose oil, maca, ginseng, chasteberry, milk thistle, pollen extract, omega-3 and vitamin E. On black cohosh it goes further than NICE, whose view is above.

On wild yam it is blunt. The body has no way to turn the plant's diosgenin into progesterone, so a yam cream cannot act as one. Tested yam creams often held no yam at all, and many had hormones added that were not on the label, estrogen and progesterone among them.

For bones, its 2021 statement on osteoporosis finds no convincing evidence that boron, zinc, black cohosh, berberine or DHEA help bone density or prevent fractures after the menopause.

If you are looking for something for hot flushes or sleep and HRT is not for you, the guidelines list prescribed options too. See non-hormonal treatments.

Tell your doctor and your pharmacist about everything you take, herbal products and home remedies included. The NHS suggests asking a GP or pharmacist before you start a complementary therapy.

This matters most if you have had breast cancer or another hormone-sensitive condition, take tamoxifen or another hormone treatment, take a blood thinner, or have epilepsy. Those are the situations NICE and the Pakistan Menopause Society single out.

If you take black cohosh, The Menopause Society passes on the warning US labels must carry: stop and see a doctor if you have a liver problem, or notice signs of one, such as tummy pain, dark urine or yellowing of the skin or eyes.

Remedies often come with love attached: a mother's recipe, a relative's gift from abroad. Turning one down can feel like turning down the person. Saying you will check with your doctor first takes the care without the risk.