Menopause supplements: Effective relief or empty promises?

photo of a woman holding a blister pack of pills in one hand and a piece of paper with instructions in the other hand

Pop quiz: what do a major drugstore brand and "America's sweetheart" Drew Barrymore have in in common?

Both are hawking dietary supplements claiming to help American women who crave relief from the often-disruptive symptoms of menopause. And both carry credibility that can sway midlife women hovering over pharmacy shelves to believe that "natural" remedies can ease hot flashes, maintain libido, clear brain fog, or smooth mood shifts, among other benefits.

Dozens of over-the-counter supplements are now being advertised to menopausal women as part of a $17 billion global market that's expected to grow more than 5% each year until at least 2030. The phenomenon has been dubbed "menowashing" for its propensity to convince consumers that menopause relief is as simple as popping a pill.

But the growing market for "natural" therapies skirts over the fact that supplements don't require FDA approval, Harvard experts say. Many supplements also haven't undergone rigorous testing. That means there's no evidence they actually work — or even that they're safe.

"These products are touted by movie stars, but every woman who swallows them needs to know who's making money from this," says Dr. Jan Shifren, director of the Midlife Women's Health Center at Harvard-affiliated Massachusetts General Hospital. "Women with bothersome symptoms are being preyed upon by profiteering marketers."

Dr. Pieter Cohen, an internist with Harvard-affiliated Cambridge Health Alliance, agrees. "It's predatory," says Dr. Cohen, whose research focuses extensively on dietary supplements. "Many menopause symptoms can profoundly affect your life, but by promoting a quick fix, supplement companies are misleading women about how these symptoms can best be managed in a healthy and safe way."

Fueling demand

Much data reinforces the notion that marketers are targeting a massive cluster of midlife women with impressive buying power. Nearly 63 million women were 50 or older in 2021 — roughly 19% of the U.S. population. They boast a combined spending power of $15 trillion and control 95% of purchasing decisions in their house-holds, according to AARP.

About 6,000 women in the United States reach menopause every day, totaling two million each year. But this transition — which marks 12 consecutive months without a menstrual period — typically begins years before and can linger for years after.

"Marketers have all realized there's a large number of well-educated women out there with money to spend," Dr. Shifren says. "Many women between 45 and 65 have spare income and are experiencing very bothersome menopause symptoms."

But women are doing their part to fuel the demand for "menopause support" products, Dr. Shifren says. "Women now have high expectations for healthy aging," she says. "They're saying, 'Wait a minute, I'm going to spend a third of my years beyond midlife?' They want these years to be truly terrific."

Iffy ingredients

The key question is if ingredients in menopause supplements can indeed help women achieve their goals for a smoother transition. Like the major drugstore-branded version, many such products combine a variety of herbal or botanical ingredients such as dong quai, milk thistle, and black cohosh.

The supplement backed by Barrymore purportedly "supports hormonal harmony" with a blend of chromium — a trace element naturally found in foods — and compounds such as Korean thistle, thyme, saffron, L-theanine, and maca root powder.

Some products are single-ingredient herbal supplements traditionally tapped for hot flash relief, including the aforementioned black cohosh as well as red clover and evening primrose.

But none of these ingredients—and indeed, no dietary supplements or herbal remedies—are considered effective for menopause relief by the Menopause Society, which released a position statement in 2023 on non-hormonal therapies.

And because supplements aren't regulated by the FDA, there are no guardrails ensuring how much of each ingredient you're consuming—or whether the supplement even contains the stated ingredients.

"If these supplements really had the purported effects — if tomorrow you took this pill and your libido actually increased or your hot flashes resolved — that would be a very potent compound," Dr. Cohen says. "And that sort of potent chemical should not be taken in the form of a supplement, which lacks any FDA scrutiny."

"It's sort of a Catch-22," he adds. "If they're working, I'd worry about what's in those supplements; and if they're not working, then women are just being misled to spend money on something that's ineffective."

Skepticism warranted

If hot flashes and night sweats are your curse — as they are for an estimated 80% of women in the menopause transition — taking a menopause supplement is just as likely to bring relief as using a sugar pill. That's because no one has identified a dietary supplement for hot flashes that's more effective than a placebo, Dr. Shifren says.

On the other hand, "the placebo response is really powerful," she says. "Placebos reduce hot flashes by 30%, even when measured objectively with temperature sensors on the skin. They're real effects — they're just not due to what you're swallowing."

It's smart to be skeptical, however. "If it sounds too good to be true, then it usually is," Dr. Shifren says. "Wouldn't we all love a little pill we could take once a day to treat our sleep problems, irritability, disordered mood, low libido, hot flashes, and night sweats? If you could actually put this in a pill and prove it was effective, we would already have it available in a tested formulation together with a highly profitable pharmaceutical company."

Early menopause = early retirement?

The burden of menopause symptoms such as hot flashes and brain fog isn't just personal—it seeps into the professional realm, according to a new study suggesting that women who experience early menopause — before age 46 — may be more likely to retire earlier, too.

The analysis, published in the April 2024 issue of Menopause, involved nearly 2,700 women from Finland. Researchers investigated how their menopause status at age 46 was linked to how they viewed their ability to work, as well as their job status in subsequent years.

The study found that women whose periods had ceased by age 46 were 1.5 times more likely to perceive their job skills poorly compared to other women, which appeared to make them more likely to retire early on a disability pension.

But many factors may account for a woman's decision to leave the work force earlier than 65, says Dr. Jan Shifren, director of the Midlife Women's Center at Massachusetts General Hospital. Also, early menopause — which occurs in an estimated 5% to 10% of women — isn't always a natural process, she notes. It may happen due to treatment for cancer or another condition, also influencing a woman's decision making about her professional life.

Women who reach menopause before 50 — and especially before 45 — should discuss hormone therapy with their health care practitioner, Dr. Shifren advises. "For women who can safely take estrogen, there's strong evidence supporting its having important health benefits when menopause happens early," she says.

Advice to consider

Dr. Cohen advises women to steer clear of any supplement marketed for menopausal symptoms. But if you decide to consider any, Harvard experts offer this guidance.

Check the label. Make sure it says "USP" or "NSF," which indicates the supplement has been tested by a third-party organization that confirms it meets science-based quality standards.

Avoid blended products. If you want to try black cohosh, for example, choose a supplement containing only that herb, not as part of a "menopause support" mix. "That's the only way to truly know you're getting black cohosh, but even those companies aren't ensuring the concentrations used are appropriate or safe," Dr. Cohen says.

Watch for side effects. If you experience any unusual or alarming symptoms after taking a supplement, stop taking it immediately and talk to your doctor. Even if a symptom is short-lived, that doesn't mean it's not harmful, Dr. Cohen says.

Try healthy lifestyle changes instead. It's much harder to eat healthfully, exercise regularly, and control weight than to pop a supplement, Dr. Shifren acknowledges, but these lifestyle measures are far likelier to improve your sense of well-being during menopause. "A half-hour walk with a friend three times a week will do so much more for your midlife symptoms and health than swallowing any supplement," she says.