Do herbal remedies for menopause really work?

Natural remedies for menopause

Menopause is a big transitional phase for any woman. It signals the end of menstrual cycles, and a decline in the production of reproductive hormones such as oestrogen and progesterone.

Menopause is defined as when you have not had a period for 12 months - this is usually between the age range of 45 to 55, and at the average age of 51.

However, perimenopausal and premenopausal symptoms - traditionally associated with menopause, but seen before or after your last period - can last several months to several years. That means it's not uncommon for symptoms to start in your early 40s, or even your late 30s.

Many women find they have the following symptoms:

Every woman will experience symptoms differently. Some may be able to ease their symptoms through lifestyle adjustments alone, while others may use hormone replacement therapy (HRT).

Around 1 on 2 of women in Western countries choose to use complementary and alternative therapies, including mind and body practices such as hypnosis. Herbal (plant-based) remedies are another popular natural treatment option. There are several on the market, but is their effectiveness backed by science?

The evidence that natural remedies for menopause work is mixed, and scientific research is limited. According to the charity Women's Health Concern, herbal remedies may provide some symptom relief, but are unlikely to improve bone health or heart function.

Effectiveness

Research is still ongoing to determine how effective herbal remedies for menopause are at easing symptoms. A review of studies¹ found modest reductions in the occurrences of hot flushes and vaginal dryness, although the need for further evidence was also identified. The quality of current evidence is a big limitation - as many as 3 out of 4 of these studies had a high likelihood of bias that may influence their results.

Adverse effects of herbal remedies

While reports of side effects for herbal remedies are relatively rare, there are some mild symptoms that may occur. For example, black cohosh² can cause stomach upset, skin rashes, headache, vaginal bleeding, and weight gain. Some herbal remedies may also interact with drugs and cause side effects.

One such example is St John's wort, which can increase the chance of side effects in people also taking certain antidepressants. Always consult your pharmacist, who will be able to advise on the safe natural and drug therapy combinations.

Regulation

Safety concerns regarding the lack of regulation are another important factor. The National Institute for Health and Care Excellence (NICE) warns that herbal remedies which are not regulated by a medicine authority shouldn't be considered safe. This is because different products have different ingredients and concentrations, which may increase the odds of more serious side effects.

There have been reports of contamination in certain natural remedies for menopause. For example, some commercial black cohosh supplements contain the wrong herb or other herbs not listed on the label² which has led to adverse reactions.³

There are many herbal remedies for menopause on the market and most are used to treat a wide range of menopause symptoms. The following are some of the most popular plant-based products.

Black cohosh for menopause

What: A species of buttercup native to North America.

Benefits: Some studies have found that black cohosh can help to ease menopause symptoms when compared to a placebo. It also has a low chance of interacting with other medicines.

Considerations: Like all herbal remedies, it's not as effective as HRT at reducing symptoms such as hot flush frequency. There is also conflicting evidence about whether black cohosh is more effective than a placebo.⁴ While adverse reactions are relatively rare, occasional instances of serious side effects with unlicensed versions include liver damage and low blood pressure. Black cohosh shouldn’t be taken by people who have liver and kidney problems.

Red clover for menopause

What: A flowering plant in the legume family, native to Europe, Western Asia, and Northwest Africa.

Benefits: This remedy appears to have natural oestrogen-like properties that can help with hot flushes.⁵ There are currently no identified safety concerns for its use.

Considerations: Nonetheless, as with all herbal remedies the scientific evidence is relatively weak, and there's little data on long-term use.

St John's wort for menopause

What: A flowering plant native to Europe, North Africa and West Asia.

Benefits: Some studies⁶ suggest that St John’s wort may ease symptoms better than a placebo, although there's not enough evidence to know for certain. In particular, some studies suggest it may be as good as prescribed antidepressants at relieving low mood.⁷

Considerations: It has a high chance of adverse effects from interactions with other drugs, and checking with a healthcare professional before use is advisable. St John's wort should not be taken by women on hormone therapy for breast cancer, as it makes treatment less effective.

Ginseng for menopause

What: A plant root originating in China and used in traditional Chinese medicine.

Benefits: Studies show mixed evidence for the use of ginseng to treat menopausal symptoms in comparison to placebo drugs. A review of research concluded that most have a high chance of bias.

Considerations: Ginseng has been shown to decrease the effectiveness of certain medicines - including chemotherapeutic drugs, HIV drugs, and antidepressants. There is also some evidence that ginseng might affect blood sugar levels.

Evening primrose oil for menopause

What: The seeds of evening primrose, native to North America.

Benefits: There is some limited evidence⁸ for the effectiveness of primrose oil, although it should be noted that most studies conclude it is no more effective than a placebo. It is generally considered safe and is well tolerated by most people.

Considerations: Although it's widely used, there's insufficient scientific evidence to support its use for menopause treatment. Primrose oil may also interact negatively with certain HIV drugs and, as with all supplements, it's worth checking with a professional if you're on other medicines.