By Leila Martyn, Founder of MyOva

Most menopause supplements have weak evidence for hot flushes, and some of the best-known ones have been tested and failed. That's the honest answer. Of the 9 ingredients we looked at, vitamin D is the one with a clear UK recommendation, and that's for your bones, not your flushes. Red clover and sage have small, mixed results. Black cohosh, omega-3 and magnesium didn't beat placebo for hot flushes in the best trials. For symptoms that are wrecking your days, HRT and CBT have far stronger evidence than anything in a capsule.

You're not imagining it: the supplement aisle is loud, confusing and expensive. So we went ingredient by ingredient and rated each one against the research, not the marketing.

New to MyOva? Join our mailing list for 20% off your first order, plus evidence-led hormone guides in your inbox. If you want the bigger picture on what's happening in your body first, start with our complete guide to perimenopause. For single-ingredient deep dives, see red clover for menopause and sage for hot flushes.

In this guide

• Do menopause supplements actually work?
• How do the 9 ingredients rate?
• Which vitamins and minerals are worth taking in menopause?
• Do red clover and sage help hot flushes?
• Does black cohosh work, and is it safe?
• What about ashwagandha, maca and omega-3?
• How do you choose a menopause supplement safely?
• What works better than supplements for hot flushes?
• When should you see a GP?
• FAQ

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Do menopause supplements actually work?

The research on this is actually pretty clear, even if the adverts aren't. The British Menopause Society says few complementary and alternative treatments have proven evidence of effectiveness, that some individual women will benefit, and that the placebo effect in menopause studies "is not inconsiderable" [1]. The NHS says herbal remedies aren't tested or regulated like medicines, so it's not known how safe and effective they are [2].

That placebo point matters. In the big Cochrane review of plant oestrogens, the placebo response in individual trials ranged from 1% to 59% [3]. Hot flushes also tend to ease over time on their own. So "I tried X and felt better" isn't proof X worked, which is why we only rate ingredients on placebo-controlled trials and reviews.

NICE, which sets guidance for the NHS in England, says there's some evidence that isoflavones (plant oestrogens) and black cohosh may relieve hot flushes, but that the quality, purity, ingredients and safety of these products may be unknown, and preparations vary [4, 5]. That's a long way from "clinically proven".

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How do the 9 ingredients rate?

We picked the 9 ingredients you'll see most often on UK menopause labels and checked each one against systematic reviews and placebo-controlled trials, plus UK guidance from NICE, the NHS, the MHRA and the Food Standards Agency. Where the evidence is thin, we say so. Here's the scorecard. "Hot flush evidence" means placebo-controlled trials in menopausal women. "Authorised claim" means wording UK law allows on a food supplement.

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Which vitamins and minerals are worth taking in menopause?

Vitamin D: worth taking, for your bones

Vitamin D helps regulate calcium and phosphate, which keep bones, teeth and muscles healthy. The NHS says adults should consider 10 micrograms a day in autumn and winter, and all year round if you rarely get outside or usually cover most of your skin. Don't take more than 100 micrograms (4,000 IU) a day [6].

Why it matters now: bone loss speeds up around the final period. In the US SWAN study, bone density began falling faster in the run-up to the last period [7]. Vitamin D won't touch your hot flushes, but it's the one supplement on this list with clear, everyday UK advice behind it. UK law allows vitamin D to say it contributes to the maintenance of normal bones and to the normal function of the immune system [8].

Magnesium: useful nutrient, but not a hot flush answer

Magnesium gets sold hard for menopause. The best test we found was a double-blind trial of 289 women given 800 mg or 1,200 mg of magnesium oxide a day, or a placebo. Neither dose reduced hot flushes more than placebo, and the authors concluded their results "do not support the use of magnesium oxide for hot flashes" [9]. The magnesium groups also had more diarrhoea.

That doesn't make magnesium useless. UK law allows it to say it contributes to normal psychological function, normal function of the nervous system and the reduction of tiredness and fatigue [8]. Just don't buy it expecting cooler nights. There's no authorised sleep claim for magnesium either.

Vitamin B6: a real nutrient role, no menopause trials

Vitamin B6 is one of the few nutrients UK law allows to say it contributes to the regulation of hormonal activity. It also contributes to normal psychological function and the reduction of tiredness and fatigue [8]. We couldn't find placebo-controlled trials of B6 for hot flushes, so that's where its story ends for now.

The bigger issue is dose. Food Standards Scotland advises not taking more than 10 mg of vitamin B6 a day from supplements unless a medical professional advises it [10]. B6 turns up in a lot of menopause products, so add up every label before you stack them.

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Do red clover and sage help hot flushes?

Red clover

Red clover contains isoflavones, plant compounds that act a bit like weak oestrogen. A 2013 Cochrane review of 43 trials found no conclusive evidence that plant oestrogen supplements reduce hot flushes. For red clover specifically, five pooled trials showed no significant difference from placebo [3]. A 2021 review that pooled 8 trials did find about 1.7 fewer hot flushes a day, but the results varied a lot between studies and the authors called for better trials to confirm it [11].

On safety, the Cochrane review found no evidence that these products stimulated the womb lining or vagina for up to two years of use [3]. Because isoflavones act on oestrogen receptors, speak to your GP before using red clover if you've had a hormone-sensitive cancer or take hormonal medicines. Our red clover deep dive has the full picture.

Sage

Sage is a traditional remedy for sweating, and it's had more attention lately. A 2023 review pooled 4 small trials with 310 women. The hot flush frequency result leaned towards sage, but the confidence interval crossed zero, and there was no significant difference in how severe the flushes were [12]. That's interesting, not conclusive. See our sage article for the individual trials.

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Does black cohosh work, and is it safe?

Black cohosh is probably the most famous menopause herb, and it's had the most testing. A Cochrane review of 16 trials with 2,027 women concluded there's "insufficient evidence to support the use of black cohosh for menopausal symptoms". In the trials that compared it directly with placebo, the difference in hot flushes was tiny and not significant [13].

Safety is the bigger concern. The MHRA, the UK medicines regulator, reviewed reports of liver reactions including jaundice, hepatitis and liver failure. It judged that the evidence supports a link with liver toxicity, while noting the reactions are rare [14]. It advised that anyone who has had a liver problem or another serious health condition shouldn't take black cohosh without speaking to their doctor first [14].

If you still want to try it, look for the THR (Traditional Herbal Registration) logo. Products with a THR are registered with the MHRA, which checks their quality and safety information. Unlicensed products aren't checked the same way, and some have lacked the liver warning [15].

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What about ashwagandha, maca and omega-3?

Ashwagandha

One randomised, placebo-controlled trial gave 100 women aged 45 to 55 either 600 mg of ashwagandha root extract or placebo for 8 weeks. Menopause symptom scores and hot flushes improved more on ashwagandha, but the authors called the evidence "preliminary" and asked for bigger trials. A supplier of the extract commented on the results [16].

The UK Food Standards Agency advises people with liver conditions and pregnant women to avoid ashwagandha supplements while government scientists review its safety [17]. If you have a thyroid condition or take thyroid medication, check with your GP first too [17].

Maca

Maca is a Peruvian root sold for energy and libido. A systematic review found only four small trials for menopausal symptoms, of insufficient quality to support firm conclusions, and said its safety hasn't been established [18].

Omega-3

Fish oil is good for lots of things, but hot flushes aren't one of them. In a well-run US trial of 355 women, 12 weeks of omega-3 didn't improve hot flush frequency, how bothersome they were, sleep or mood compared with placebo. Flushes fell by 2.5 a day on omega-3 and 2.7 a day on placebo [19]. That's the placebo effect in action.

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How do you choose a menopause supplement safely?

This is what I wish someone had told me before the supplement aisle got this crowded. Use this checklist:

1. Ask what it's for. If a product promises to "balance hormones" or "stop hot flushes", be sceptical. Food supplements can't legally claim to treat menopause symptoms.
2. Look for the THR logo on herbal medicines such as black cohosh [15].
3. Add up your B6. Keep supplements to 10 mg a day or less in total [10].
4. Check interactions. NICE warns that St John's wort, sometimes sold for low mood in menopause, can interact with medicines including tamoxifen, anticoagulants and anticonvulsants [5].
5. Tell your GP or pharmacist what you're taking, especially with HRT, the pill, thyroid medicines, antidepressants or a history of breast cancer. The NHS advises asking a GP or pharmacist before using a complementary therapy [2].
6. Give it a fair trial, then stop. If nothing has changed after a couple of months, it probably isn't working for you.

It's not a magic fix. But it gives your body what it's often missing. That line only works for nutrients you're actually short of, like vitamin D in a UK winter.

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What works better than supplements for hot flushes?

If your symptoms are affecting your sleep, work or relationships, don't let a supplement shelf be your only plan. NICE's menopause guideline, updated in 2024, sets out the benefits and risks of HRT so you can decide with your clinician, and recommends menopause-specific cognitive behavioural therapy (CBT) for hot flushes, night sweats and sleep problems, alongside or instead of HRT [4, 20].

The British Menopause Society also lists non-hormonal prescription treatments, including newer medicines designed for hot flushes [1]. Your diagnosis is a starting point, not a verdict: if you've been told "it's just your age", you're allowed to ask about every option.

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When should you see a GP?

Book an appointment if:

• Hot flushes, night sweats, low mood, anxiety or poor sleep are affecting your daily life.
• You're under 45 and your periods are changing. Menopause usually happens between 45 and 55, but it can happen earlier [21].
• You want to discuss HRT, CBT or non-hormonal medicines [4].
• You're taking, or planning to take, a herbal remedy alongside other medicines [2].

Take a list of what you're taking, with doses. It makes the conversation faster. If you've felt brushed off before, our guide to advocating for yourself with your GP has tips that work for any condition.

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Frequently asked questions

What is the best supplement for menopause?
There isn't one that reliably reduces hot flushes. Vitamin D is the one with clear UK advice: the NHS says adults should consider 10 micrograms a day in autumn and winter [6]. For hot flushes, HRT and CBT have far stronger evidence [4].

Do perimenopause supplements work differently from menopause supplements?
Not much. Most products are the same ingredients with different labels, and the trials we looked at mostly included women in both stages. The same evidence ratings apply.

Can I take menopause supplements with HRT?
Some may be fine, but herbal products like red clover, black cohosh and St John's wort can interact with medicines or act on hormone pathways [2, 5]. Always check with your GP or pharmacist first.

Is magnesium good for menopause?
Magnesium contributes to normal psychological function and the reduction of tiredness and fatigue [8]. But in a trial of 289 women, it didn't reduce hot flushes more than placebo [9].

Is there a supplement for menopause anxiety or brain fog?
No supplement has good evidence for either. Vitamin B6 and B12 contribute to normal psychological function [8], which is a general nutrient role, not a treatment. NICE recommends menopause-specific CBT for hot flushes, night sweats and sleep problems, and CBT was already recommended for anxiety and low mood linked to menopause [20]. It's worth asking your GP about.

Are menopause supplements safe?
Many are, for most people, but "natural" doesn't mean risk-free. The NHS points out that product quality and purity can't always be guaranteed [2], the MHRA has linked black cohosh to rare liver reactions [14], and the Food Standards Agency advises some groups to avoid ashwagandha [17]. Check every label and tell your GP or pharmacist what you take.

How long should I try a menopause supplement?
There's no official answer. Most trials ran for 8 to 12 weeks, so if nothing has changed after that, it's reasonable to stop and talk to your GP about other options.

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The bottom line

Most menopause supplements don't have strong evidence for hot flushes. Vitamin D is worth taking for your bones, magnesium and B6 have real but modest nutrient roles, and red clover and sage show small, inconsistent effects. Black cohosh, omega-3 and magnesium failed in the best hot flush trials. Hormonal literacy isn't complicated, it's just rarely taught: if your symptoms are running your life, the most effective options are on prescription or in a therapist's room, not a supplement aisle.

Related Reading

• Perimenopause: The Complete Guide
• Red Clover for Menopause: Does It Work for Hot Flushes?
• Does Sage Actually Help With Hot Flushes?
• Ashwagandha for Women: Benefits, Safety and Dosage
• Vitamin D and Your Hormones: What the Research Shows
• Best Magnesium for Sleep: 5 Forms Compared for Women

This article is for general information only and isn't medical advice. MyOva products are food supplements, not medicines, and aren't intended to diagnose, treat, cure or prevent any disease. Speak to your GP or pharmacist before taking supplements if you're pregnant, breastfeeding, taking medication or managing a diagnosed condition.

References

1. British Menopause Society. Non-hormonal-based treatments for menopausal symptoms: consensus statement. Reviewed November 2025, amended July 2026.
2. NHS. Herbal remedies and complementary medicines for menopause symptoms. Reviewed 7 February 2023.
3. Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database of Systematic Reviews. 2013;(12):CD001395.
4. NICE. Menopause: identification and management (NG23). Updated November 2024.
5. NHS Bristol, North Somerset and South Gloucestershire ICB (Remedy). Menopause: alternatives and adjuncts to HRT, summarising NICE NG23. Checked December 2024.
6. NHS. Vitamin D.
7. Greendale GA, Sowers M, Han W, et al. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women's Health Across the Nation (SWAN). Journal of Bone and Mineral Research. 2012;27(1):111-118.
8. Department of Health and Social Care. Great Britain nutrition and health claims (NHC) register.
9. Park H, Qin R, Smith TJ, et al. North Central Cancer Treatment Group N10C2 (Alliance): a double-blind placebo-controlled study of magnesium supplements to reduce menopausal hot flashes. Menopause. 2015;22(6):627-632.
10. Food Standards Scotland. Vitamin B6 (pyridoxine).
11. Kanadys W, Barańska A, Błaszczuk A, et al. Evaluation of clinical meaningfulness of red clover (Trifolium pratense L.) extract to relieve hot flushes and menopausal symptoms in peri- and post-menopausal women: a systematic review and meta-analysis of randomized controlled trials. Nutrients. 2021;13(4):1258.
12. Moradi M, Niazi A, et al. The effect of Salvia officinalis on hot flashes in postmenopausal women: a systematic review and meta-analysis. International Journal of Community Based Nursing and Midwifery. 2023;11(3):160-172.
13. Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database of Systematic Reviews. 2012;(9):CD007244.
14. Medicines and Healthcare products Regulatory Agency. Black cohosh: UK public assessment report (liver injury). 2006.
15. Chemist and Druggist. MHRA warns against herbal remedy black cohosh.
16. Gopal S, et al. Randomised, double-blind, placebo-controlled trial of ashwagandha root extract in perimenopausal women. Journal of Obstetrics and Gynaecology Research. 2021. doi:10.1111/jog.15030.
17. Which? Ashwagandha: stress buster or health risk? 1 June 2026 (reporting Food Standards Agency advice).
18. Lee MS, Shin BC, Yang EJ, Lim HJ, Ernst E. Maca (Lepidium meyenii) for treatment of menopausal symptoms: a systematic review. Maturitas. 2011;70(3):227-233.
19. Cohen LS, Joffe H, Guthrie KA, et al. Efficacy of omega-3 for vasomotor symptoms treatment: a randomized controlled trial. Menopause. 2014;21(4):347-354.
20. The Pharmaceutical Journal. NICE recommends cognitive behavioural therapy for treatment of menopause symptoms. 8 November 2024.
21. NHS. Menopause.

References