Wondering if supplements can help with hot flashes, night sweats, or other menopausal symptoms? Learn what the science says about popular botanicals and why it’s important to talk with your doctor before trying alternative treatments. Get the facts to make informed choices for your health.
In this article:
- Hormone Replacement Therapy (HRT) remains the most effective treatment for menopausal symptoms like hot flashes and night sweats, but should be individualized and discussed with a doctor due to potential risks.
- Many supplements and botanicals—such as black cohosh, flaxseed, red clover, and ashwagandha—are commonly used for menopause, but scientific evidence for their effectiveness is limited or inconclusive, and some may have safety concerns or interact with medications.
- It’s important to consult your healthcare provider before starting any supplement for menopausal symptoms, as individual responses and health risks vary.
“Open the window!” “Turn down the heat!” “Where’s my fan?”
If this sounds like you, you could be suffering from hot flashes and night sweats, the most common and bothersome symptoms of menopause.
Other symptoms include:
- Sleep issues, fatigue, and low energy
- Mood swings, anxiety, depression, or irritability
- Joint and/or muscle pain
- Headaches
- Heart palpitations
- Menstrual irregularities
- Breast pain
- Hair loss
- Vaginal dryness, lower libido, or pain during sex
With the removal of black box warnings on Hormone Replacement Therapy (HRT), many women are reconsidering this option, which remains the most effective way to address vasomotor and other menopausal symptoms. The American College of Obstetricians and Gynecologists and OBGYNs across the country currently recommend HRT for significant symptoms, with these considerations:
- Treatment should be individualized with regular medical follow-up
- The lowest effective dose should be used; patches or gels may be preferred if clot risk is a concern
- If the main concern is urogenital symptoms, vaginal estrogen is effective, with minimal systemic effects
- Treatment should start before age 60 or within 10 years of your last period, the timeframe during which the benefits outweigh the risks.
Choosing HRT is a personal decision you should make with your doctor. Oral and transdermal HRT can significantly reduce hot flashes and night sweats and may improve sleep, mood, and libido. Vaginal estrogen is particularly helpful for dryness and painful intercourse. However, the risks associated with HRT should be considered:
- Blood clots (higher with oral estrogen, lower with transdermal forms)
- Slightly increased stroke risk with oral HRT
- Slightly increased breast cancer risk with long-term combined estrogen–progestogen therapy
- Possible increased heart disease risk when started after age 60 or more than 10 years post-menopause
What About Alternative Treatments?
The Food and Drug Administration (FDA) regulates dietary supplements differently than prescription and over the counter drugs. Supplements are NOT vetted for safety or effectiveness before they are sold. It’s up to the manufacturer to ensure their products are safe, accurately labeled, and produced in a consistent and sanitary manner. Moreover, safety and efficacy research on alternative medicines and supplements ranges from limited or inconclusive to unavailable. There are several reasons for this:
- Many of these products fall into a regulatory grey area because they are not exactly a food or a drug
- Alternative therapies can’t be patented so drug companies see no profit in researching them and government-funded research tends to focus on drugs for high-burden diseases
- Western medicine tends to be skeptical of so-called “natural” treatments
Botanicals for Menopausal Symptoms
Most supplements taken to reduce menopausal symptoms contain phytoestrogens -- natural, estrogen-like compounds found in soybeans, lentils, and yams. While not identical to human estrogen, phytoestrogens can bind to estrogen receptors, albeit with weaker effects. Supplements with phytoestrogens typically include one or more of the below compounds:
- Isoflavones, found in soy and soy extracts
- Lignans, found in flaxseed
- Coumestans, found in red clover, kudzu, black cohosh, dong quai, and other herbs
Adaptogens are another category of botanicals sometimes used for menopausal symptoms. These botanicals help support your body's natural stress response and promote metabolic balance. Adaptogens are not necessarily useful for curbing the incidence or severity of hot flashes.
Some over the counter supplements for menopausal symptoms have formulas that combine phytoestrogens and adaptogens as well as additional vitamins and nutrients.
Below are some of the supplements most used for menopausal symptoms. Keep in mind that most have only small or inconclusive studies to support their claims, and many of them can interact with other medications. Just because they are botanicals doesn’t mean they are safe for everyone. It’s vital that you speak with your doctor before trying any of these supplements.
Ashwagandha is a key herb in Ayurvedic medicine. It is associated with a reduction in hot flashes and night sweats, anxiety, mood swings, and “brain fog”. It also helps the body reduce stress and cortisol. Studies indicate it may alleviate menstrual discomfort by increasing estrogen levels and reducing levels of the hormone FSH.
Black Cohosh is a member of the buttercup family that may provide some relief for hot flashes and night sweats. However, most studies find that it doesn’t work any better than a placebo. If you decide to try Black Cohosh, don’t use it for more than six months as it can be toxic for the liver. People with a known liver disorder should not take Black Cohosh.
Dong Quai is a traditional Chinese herb said to ease hot flashes and help with sleep issues. It does not contain phytoestrogens or act like estrogen in the body and has not been shown to significantly reduce menopausal symptoms.
Evening Primrose Oil’s efficacy has not been scientifically proven, although anecdotally, some women say it helps. It has been associated with blood clots, and you should avoid it if you take blood thinners or have a history of seizures or schizophrenia.
Flax Seed contains the phytoestrogen lignans. Some clinical trials demonstrated a reduction in the severity of hot flashes, fatigue, and sleep issues. Other studies found no significant benefits.
Ginseng may have a positive effect on mood, energy, and libido but studies have not found it to be of much help for menopausal symptoms.
Licorice Root has been found to help reduce hot flashes in several control trials. However, licorice can interfere with medicines and even increase blood pressure, so as always, talk with your physician before trying it.
Maca, a plant used in traditional Peruvian folk medicine, does not contain phytoestrogens. However, a few small studies indicate that it may help reduce hot flashes and boost libido, energy, and mood.
Pine Bark is often used for general antioxidant support; evidence for menopausal symptom relief is limited.
Red Clover has shown positive results in several studies, significantly reducing menopausal symptoms and improving vaginal cell health compared with placebo. Other studies, however, found little or no symptom reduction.
Rhodiola does not appear to help with hot flashes and night sweats, although several studies reveal a positive effect on menopausal symptoms such as cognitive, psychological, cardiovascular and bone density health.
Sage, a familiar herb used in cooking, may help reduce the number of daily hot flashes a woman experiences. It also appears to improve mood.
Schisandra may help with anxiety and brain fog. One study found that schisandra may also support reductions in heart palpitations, sweating, and hot flashes.
Wild Yam is safe and well tolerated. Unfortunately, there’s no evidence that it works. It is not recommended by The North American Menopause Society, and other expert panels.
Talk to Your Doctor First!
Every woman has her own combination of menopausal symptoms. Some are barely affected while others are besieged by vasomotor symptoms. Similarly, every woman has her own set of health issues, risk factors, and feelings regarding HRT and/or supplements. In addition, as studies show, different women respond differently to supplements. For all these reasons, it’s essential to talk to your doctor before trying any of the botanicals listed here. For help finding a doctor, click here.
This article first appeared in the February 2026 edition of the HealthPerks newsletter.
