Do I Actually Need To Take Menopause Supplements?

More than half of women who go through menopause find its symptoms distressing.

According to the British Menopause Society, not all women going through menopause will experience menopausal symptoms, but the majority will, and over 25% describe theirs as being ‘severe’.

The symptoms include everything from hot flushes to night sweats, sleeping problems and anxiety.

Sleeping problems are common not just in menopause, but perimenopause, too, with a recent study by nutrition science experts at ZOE finding that sleep disturbances were the most common symptoms reported by a whopping 82% of 8,000 women studied. Yes, 82%!

At times, these conditions can be debilitating. In fact, 10% leave their jobs because of the burden.

And this coupled with HRT shortages has some women turning towards supplements, such as black cohosh, flaxseed, ginseng, St John’s wort and red clover to turn down the heat on hot flushes.

Expected to reach $22.7 billion by 2028 according to Forbes, the menopause supplement industry is booming as women seek out alternative therapy to Hormone Replacement Therapy (HRT) and antidepressants.

But do they actually work? And are they backed up by science or just woo-woo fads? 

In a podcast episode for ZOE, hosts Dr Sarah Berry and ZOE’s co-founder Jonathan Wolf discussed the topic at length, and looked at the scientific evidence on supplements for menopause symptoms.

“If you search the evidence around menopause supplements and symptoms, what you see is there’s about 500 clinical trials that have looked at a whole array of different supplements in menopause symptoms,” explains Dr Berry. 

“But despite this, there’s actually not a lot of good evidence showing that dietary supplements can relieve menopause symptoms and there’s no consensus of the evidence,” she says.

She goes on to explain that black cohosh, which is derived from a herb, has really inconsistent results, and there’s uncertainty around the effects of vitamin E, evening primrose oil, ginseng, melatonin, wild jam and many other popular wellness supplements purporting to aid symptoms.

Surprising effects of ‘isoflavones’

However, one area that Dr Berry and Wolf agree there are some promising findings, is in isoflavones — in other words, a type of phytoestrogen that can “mimic the effects of estrogen by binding to the many estrogen receptors that we have in our body.”

Isoflavones are found in many plants, but they’re found in particularly high concentrations in soy, as well as being found in flaxseed and red clover. 

She explains that in countries where there are higher soy intakes, like China and Japan, there are much lower reported menopause symptoms, due to the amount of soy isoflavones that are consumed there.

“To put this into context, the average intake of soy isoflavones in the UK and the US is less than half a milligram a day, whilst in China and Japan is anywhere between 20 to 70 milligrams a day,” she explains.

But, according to Dr Berry, some trials show that isoflavones have an impact on menopause symptoms and others don’t.

She explains that there are two main forms of isoflavones — genistein and daidzein. “Some of the evidence shows that a dose of more than 15 milligrams of genistein a day is the most effective at reducing symptoms,” she says.

But, interestingly, some individuals respond more than others to isoflavones, due to — you guessed it — our differing gut microbiomes.

Like with most other things it seems, our gut health could be the key to reducing some symptoms of menopause. Dr Berry says that the gut microbiome is involved in metabolising isoflavones into their very active form, which is called ‘equol’, and it’s this really active form that binds strongly to the estrogen receptors.

She says that equol is higher in women in south-east Asia: “We know that people in Asia produce equol, so about 40 to 60% of people have the gut microbiome that enables them to produce equol from isoflavones. 

“This compares to the UK and the US where only about 20 to 30% of people have the gut bacteria that converts the isoflavones into this really active equol form,” she explains.

So, how can we increase equol in our gut bacteria here in the UK? She says that people in countries like Japan and China get it naturally through the food we eat, but in the UK and US, we may want to supplement with around 15mg of genistein a day.

How else can we tackle menopausal symptoms? 

Dr Berry says a Mediterranean-style diet with plenty of fruits, vegetables, unprocessed plants, and a variety of different plants is going to improve your symptoms and maintain a healthy weight.

“I think that the evidence for most of the supplements that are marketed is incredibly weak and the only evidence that’s good enough to suggest that there might be an improvement is from isoflavones,” she says.

“My personal opinion is that if there’s a supplement that’s got Meno in front of it, a skincare product that’s got Meno in front of it, a hair shampoo that’s got Meno in front of it, it’s simply ‘meno-washing’ and it’s washing money down the drain that could be better spent elsewhere.”