black_cohoshHave you heard that black cohosh alleviates hot flashes? Or that soy (isoflavones), gingko bilboa, and ginseng help improve sex drive, memory, and other related symptoms of menopause?

While Hormone Replacement Therapy (HRT) has long been considered the first line of defense, more and more women are turning to botanicals and dietary supplements for relief, probably because these treatments are “natural,” over the counter, and perhaps less intimidating that HRT. But how effective are botanicals?

The Natural Medicines Comprehensive Database divides botanicals used for menopause into two groups:

1) Those that are purportedly hormonally active, binding to the estrogen receptor and having actions similar or opposite to estrogen.

2) Those that alter the function of central neuroreceptors, thus mimicking the mode of action of selective serotonin reuptake inhibitors (more commonly known as antidepressants).

According to the Study of Women’s Health Across the Nation (SWAN), which is dedicated to improving health for mid-life and older women, the most commonly used botanical medicines are soy, glucosamine, flaxseed oil, gingko biloba, black cohosh, and ginseng.

Additionally, the following dietary supplements are also often used to alleviate a variety of physical menopausal symptoms including hot flashes, night sweats, vaginal dryness, etc.

Aniseed, Dill, Fennel, Fenugreek
Dong Quai
Evening Primrose
Gotu Kola
Green Tea
Milk Thistle
Red Clover
Wild Yam

And these botanicals are said to help with mood and memory:
St. Johns Wort
Valerian Root

Although there have been many studies about botanicals and natural remedies for menopause, there is not much conclusive evidence to support that most are much better than placebo.

Black cohosh is the most popular botanical for menopause symptoms, and the formulation most used in the U.S. is Remifemin. Numerous clinical trials have been published, but most reach the same conclusion — there is insufficient conclusive data documenting the efficacy of black cohosh for menopause symptoms. Red clover (found in Promensil) similarly found a decrease in hot flashes, but the decrease was not clinically relevant. Similarly, in a randomized trial of 71 postmenopausal women, Dong Quai did not reduce hot flashes and did not have any physiologic changes similar to estrogen (blood hormone levels, vaginal changes, and uterine changes). Evening primrose may help with perimenopause, but was no different than placebo for post-menopause hot flashes. Ginseng showed slightly better symptom relief and is considered safe and well tolerated by most people; nonetheless the decrease in hot flashes was also not statistically significant. Maca, a foodstuff from Peru, may also help with perimenopause by affecting hormone receptor dynamics, but it too is less helpful after the last menses.

A few studies, however, have shown some botanicals can be quite effective. The North American Menopause Society published a report on the efficacy of soy (isoflavones) for menopause. After reviewing hundreds of papers, the conclusions reached were that soy isoflavones are at best modestly effective— and that Genistein and S-Equol may be the best of these.

Siberian rhubarb contains molecules that do bind to the estrogen receptors. Studies suggest this botanical acts like a selective estrogen-receptor modulator (SERM) and may provide activity both estrogenic and anti-estrogenic. In Germany, this rhubarb is available as Phytoesterol, and studies show a reduction in hot flashes with few adverse side effects.

While I support the scientific data associated with studies, many women anecdotally report feeling better when they used botanicals to alleviate symptoms of menopause. If you want to try such dietary supplements, remember first to ensure that your kidney and liver functions are normal (this is especially important before using black cohosh). Also check the US Pharmacopeial Convention (USP) website for a listing of verified products. The USP sets the standard for the quality, purity, identity, and strength of medicines, food ingredients, and dietary supplements. You can also check This website performs independent testing at the manufacturer’s request and expense. Products from Europe, where the botanicals are more tightly regulated, may also offer more consistent quality.

And finally, if you are considering taking botanicals to alleviate symptoms of menopause, please be sure to tell us what you’re taking – dietary supplements might interact with medications, and it’s always smart to keep your doctor in the loop!