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Perimenopause supplements: what the evidence says

By Anna Winbrown · Published October 18, 2026

The Menopause Society reviewed the evidence in 2023 and listed supplements and herbal remedies as not recommended for hot flashes and night sweats. [1] The NIH's own summaries of black cohosh, soy and the rest say the same thing in more words: inconsistent results, not enough evidence, and in a few cases a liver warning. [3] We sell nothing. Here is what each one has behind it.

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What the Menopause Society's evidence review says

The 2023 Nonhormone Therapy Position Statement graded every non-hormone option on three levels of evidence. Recommended on Level I, good and consistent evidence: cognitive behavioral therapy, clinical hypnosis, selective serotonin and serotonin-norepinephrine reuptake inhibitors (classes of antidepressant), gabapentin and fezolinetant; oxybutynin on Levels I to II. [1] Not recommended: supplements and herbal remedies (Levels I to II); soy foods, soy extracts and the soy metabolite equol, cannabinoids and acupuncture (Level II); and dietary modification (Level III). [1] The society's patient page spells out which supplements it means: ammonium succinate, black cohosh, cannabinoids, chasteberry, dong quai, evening primrose, ginseng, Lactobacillus acidophilus, maca, milk thistle, omega-3 fatty acid, pollen extract, rhubarb, vitamin E and wild yam, all under the heading of measures that have limited solid data or have failed to show significant benefits in clinical trials. [2]

Black cohosh

The most-sold menopause herb. The National Center for Complementary and Integrative Health says studies testing it for menopause symptoms have had inconsistent results, and that a 2012 research review concluded there is not enough evidence to support its use. [3] It generally has only mild side effects, if any, but rare cases of liver damage, some very serious, have been reported in people taking commercial black cohosh products; it is uncertain whether black cohosh was responsible. [3] The NIH's advice: people with liver disorders should consult a provider first, and anyone who develops abdominal pain, dark urine or jaundice while taking it should stop and seek care. [3]

Soy, red clover and flaxseed

These are phytoestrogens, plant substances with chemical structures similar to estrogen. [3] Studies of isoflavones from soy or red clover for menopause symptoms have had inconsistent results, and studies of flaxseed products found them no more effective than a placebo for hot flashes. [3] The Menopause Society puts soy foods, soy extracts and equol on its not-recommended list for hot flashes on Level II evidence. [1] Eating soy foods as food is a separate question from taking them as a treatment; the evidence against is about the treatment claim.

Evening primrose, ginseng, kava, melatonin, wild yam, DHEA

The NIH groups the first five together: very little research has been done on them for menopausal symptoms, so no conclusions can be reached about their effectiveness. [3] Two carry safety notes. Kava supplements have been linked to a risk of severe liver disease. [3] DHEA's long-term safety is unknown, and some evidence suggests even short-term use may have harmful effects, including liver damage. [3] On melatonin, which many women reach for because of the 3 a.m. wake-ups, the NIH says there is not enough strong evidence for chronic insomnia and that in one analysis 22 of 25 melatonin gummy products were inaccurately labeled. [5] Our sleep guide covers that in detail.

"Bioidentical" hormones from a compounding pharmacy

These are often marketed as natural and sold alongside supplements, so they belong here. The NIH says it has been claimed that custom-mixed bioidentical hormone preparations are more effective and safer than conventional hormone therapy, but scientific evidence to support the idea is lacking; they may actually be riskier because less is known about their safety, and no regulatory agency oversees their preparation, so content may vary from batch to batch. [3] Hormone therapy itself is a prescription decision: the Menopause Society's 2022 statement calls it the most effective treatment for hot flashes and night sweats, with a favorable benefit-risk ratio for women under 60 or within 10 years of menopause who have no contraindications. [4] That conversation belongs with your clinician, not a supplement aisle.

Before you buy anything

Check it against the Menopause Society's two lists above; if it is on the not-recommended list, the people who read all the trials have already answered. [1] Tell your clinician and pharmacist everything you take, because supplements can interfere with lab tests: the FDA warns that biotin, common in hair and nail products, can cause falsely low results on troponin, the heart-attack blood test. [6] And if symptoms bother you, the Office on Women's Health says the useful step is a conversation with your provider about treatment, which may include medicines. [7]

What does have evidence

It is worth repeating because it is less marketed. The Menopause Society's Level I list for hot flashes is cognitive behavioral therapy, clinical hypnosis, SSRIs and SNRIs, gabapentin and fezolinetant; the first two are not drugs at all. [1] The NIH notes that hypnosis is generally safe when practiced by trained, licensed providers. [3] If you want something that is not a prescription, those are where the evidence points.

When to talk to your clinician

Before starting any supplement if you have a liver condition, take other medications, or have a history of hormone-sensitive cancer. [3] Right away if you develop abdominal pain, dark urine or yellowing of the skin or eyes while taking black cohosh or kava. [3] And whenever symptoms are bothering you enough to spend money on them: the Menopause Society frames the hormone therapy decision as one to have within 10 years of your final period, and the clock does not stop while you try the aisle. [1]

Sources

  1. The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society. Menopause, 2023;30(6):573-590. Abstract retrieved 2026-10-18.
  2. The Menopause Society, Hot flashes (patient education), section "Treatments for hot flashes." Retrieved 2026-10-18.
  3. National Center for Complementary and Integrative Health, Menopausal symptoms: in depth. Retrieved 2026-10-18.
  4. The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause, 2022;29(7):767-794. Abstract retrieved 2026-10-18.
  5. National Center for Complementary and Integrative Health, Melatonin: what you need to know. Retrieved 2026-10-15.
  6. US Food and Drug Administration, Biotin interference with troponin lab tests. June 21, 2022. Retrieved 2026-10-18.
  7. Office on Women's Health, Menopause treatment. Page last updated March 11, 2025. Retrieved 2026-10-18.

Every statement above was checked against the linked source on the date shown. This article is education, not individual medical advice. Related: How long does menopause last? · The 7-Day Midlife Sleep Reset.