Menopausal Symptoms: In Depth

• Hormone therapy, using either estrogen alone or estrogen and progestin, is the most effective therapy for menopausal hot flashes. However, hormone therapy may increase the risk of breast cancer, blood clots, and other serious medical problems. Therefore, if it’s used at all, it should be used at the lowest dose and for the shortest period that will control symptoms. Women with certain medical conditions (such as breast cancer, liver disease, or a history of blood clots) shouldn’t use hormone therapy.
• Non-hormonal medicines may also be used to treat menopause symptoms. In 2013, the U.S. Food and Drug Administration (FDA) approved a non-hormonal treatment for hot flashes and a treatment for vaginal symptoms associated with menopause.

Visit the National Institute on Aging’s webpage on menopause for more information.

• Phytoestrogens are substances from plants that have chemical structures similar to those of the female hormone estrogen. The isoflavones found in soy and red clover are examples of phytoestrogens. Flaxseed is another phytoestrogen source.
• Studies that tested isoflavones from soy or red clover for their ability to relieve menopause symptoms have had inconsistent results. Studies of flaxseed products found them to be no more effective than a placebo (an inactive substance) in reducing hot flashes.
• Phytoestrogens appear to be safe for short-term use, but their long-term safety hasn’t been established. Because phytoestrogen supplements may have effects like those of the hormone estrogen, they may not be safe for women who shouldn’t take estrogen.

See NCCIH’s website for more information on soy, red clover, and flaxseed.

• Black cohosh is an herb native to North America. The roots and rhizomes (underground stems) of the plant are used in dietary supplements.
• Studies that tested black cohosh for menopause symptoms have had inconsistent results. A 2012 research review concluded that there’s not enough evidence to support its use for menopause symptoms.
• Black cohosh generally has only mild side effects, if any. However, rare cases of liver damage—some of them very serious—have been reported in people taking commercial black cohosh products. It’s uncertain whether black cohosh was responsible for the liver damage. Nevertheless, people with liver disorders should consult a health care provider before taking black cohosh products. Anyone who develops symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice, while taking black cohosh should stop using it and consult a health care provider.

See NCCIH’s webpage on black cohosh for more information.

• Dehydroepiandrosterone (DHEA) is a substance that’s naturally made in the body, where it’s converted into the hormones testosterone and estrogen. DHEA production decreases as people grow older, but the significance of this change, including whether it affects aging and menopause symptoms, is unclear.
• It’s uncertain whether DHEA is useful in treating menopause symptoms.
• The long-term safety of taking DHEA supplements is unknown. Some evidence suggests that even short-term use of these supplements may have harmful effects, including liver damage.

• In traditional Chinese medicine, the herb dong quai is often used for women’s health problems, including menopause. However, very little research has been done on dong quai for menopausal symptoms, so no conclusions can be reached about its effects.
• Dong quai may interact with the anticoagulant (blood-thinning) drug warfarin (Coumadin).

• A few studies have suggested that vitamin E supplements might be helpful for menopause symptoms. However, the amount of research is small, and the effect is also small. For example, in one study, women taking vitamin E averaged one fewer hot flash per day.
• Vitamin E, in the high doses found in supplements, may increase the risk of bleeding (including strokes due to bleeding in the brain) and interact with anticoagulant (blood-thinning) medications such as warfarin (Coumadin).

• Other dietary supplements that have been studied for menopause symptoms include evening primrose oil, ginseng, kava, melatonin, and wild yam. However, very little research has been done on these products for menopausal symptoms, so no conclusions can be reached about their effectiveness. Kava supplements have been linked to a risk of severe liver disease.

See NCCIH’s Web site for more information on various herbal products.

• Acupuncture is a technique in which practitioners stimulate specific points on the body, most often by inserting thin needles through the skin.
• In studies that compared acupuncture to no treatment, acupuncture reduced the frequency and severity of hot flashes. However, studies that compared acupuncture with simulated acupuncture, including a 2016 study from Australia, showed no difference between the effects of the two treatments. Acupuncture appears to be less effective than hormone therapy in reducing the frequency of hot flashes.
• Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Improperly performed acupuncture can cause potentially serious side effects.

See NCCIH’s fact sheet for more information on acupuncture.

• Hypnotherapy is the use of hypnosis for health-related purposes. Hypnosis is a state in which a person’s attention is concentrated and focused. In this hypnotic state, people have a heightened responsiveness to verbal messages (suggestions).
• In a study funded by the National Center for Complementary and Integrative Health (NCCIH), hypnotherapy reduced the frequency of hot flashes in menopausal women who had hot flashes often. The women in the study also said that hot flashes didn’t interfere with their lives as much and they slept better.
• Hypnosis is generally safe when practiced by trained, licensed health care providers. Side effects are rare, but hypnosis might worsen some types of psychological problems.

See NCCIH’s website for more information about on hypnosis.

• Mindfulness meditation is a type of meditation that involves completely focusing on experiences on a moment-to-moment basis.
• In an NCCIH-funded study, mindfulness meditation training reduced the bothersomeness of hot flashes in menopausal women and led to improvements in anxiety, perceived stress, self-reported sleep quality, and quality of life. However, the intensity of hot flashes did not change.
• Meditation is generally considered to be safe for healthy people. However, there have been reports that it might worsen symptoms in people with certain chronic physical or mental health problems. If you have an ongoing health issue, talk with your health care provider before starting meditation.

See NCCIH’s website for more information about on meditation.

• Yoga has historical origins in ancient Indian philosophy. Various styles of yoga typically combine physical postures and movement, breathing techniques, and meditation or relaxation.
• A 2018 evaluation of 13 studies (more than 1,300 participants) of yoga for menopause symptoms found that yoga reduced physical symptoms, such as hot flashes, as well as psychological symptoms, such as anxiety or depression. It seemed at least as effective as other types of exercise for relieving menopause symptoms. 
• Overall, people who practice yoga have a low rate of side effects. However, injuries—some of them serious—have been reported. People with health conditions may need to modify or avoid some yoga poses.

See NCCIH’s website for more information about yoga.

• Bioidentical hormones are hormones from plant sources that are chemically similar or identical to hormones produced in the human body. Two kinds of bioidentical hormone products are used to treat menopause symptoms: (1) those that have gone through the same FDA approval process as other types of hormone therapy, and (2) custom-mixed preparations that compounding pharmacies prepare individually for patients. This fact sheet discusses only the custom-mixed products.
• It’s been claimed that custom-mixed bioidentical hormone preparations are more effective and safer than conventional hormone therapy, but scientific evidence to support this idea is lacking. Custom-mixed bioidentical hormones may actually be riskier than conventional treatment because less is known about their safety. Also, no regulatory agency oversees their preparation, and therefore their content may vary from batch to batch.