Menopause Supplements: Evidence on Black Cohosh, Soy, Relizen, Amberen & More
Many women look for natural treatments for menopause symptoms before considering prescription medications or hormone therapy. Walk into any pharmacy or search online and you’ll find a wide range of supplements marketed for menopause relief.
Common products include Remifemin, Estrovera, Relizen, Equelle, and Amberen, along with many others promising relief from hot flashes, night sweats, sleep problems, and mood changes.
But the key question is: do these supplements actually work?
According to the 2023 Nonhormone Therapy Position Statement from The Menopause Society, most herbal and botanical supplements have limited or inconsistent evidence for treating menopausal symptoms. Certain botanical products have more promising data than others, but overall the data is far less robust than for hormone therapy or certain prescription non-hormonal medications.
Below is an overview of several commonly used supplements and what current research suggests about their effectiveness.
Supplements Menopause Guidelines Do Not Recommend
Black Cohosh (Brand example: Remifemin)
Black cohosh (Actaea racemosa) is one of the most widely recognized and commonly used herbal supplements for menopause symptoms. It is the primary ingredient in Remifemin, one of the longest-marketed menopause supplements.
Some studies suggest that black cohosh may modestly reduce hot flashes, while others show no meaningful benefit compared with placebo. Overall, results across trials are inconsistent.
In the 2023 The Menopause Society Nonhormone Therapy Position Statement, black cohosh is grouped with several supplements that currently have no evidence of benefit for vasomotor symptoms. These include:
Chasteberry
Dong quai
Evening primrose oil
Maca
Wild yam
Cannabinoids
Ginseng
Milk thistle
Omega-3 fatty acids
Vitamin E
Labisia pumila / Eurycoma longifolia
This classification reflects the fact that clinical trials have not consistently shown meaningful improvement in hot flashes.
Key considerations for black cohosh:
Widely known and commonly used supplement
Clinical trial results are inconsistent
Menopause guidelines categorize it among therapies with no evidence of benefit for vasomotor symptoms
Rare cases of liver injury have been reported
Supplements With Potential Benefit Based on Current Evidence
Other botanical therapies have shown more promising — though still limited — evidence in research studies. These include:
Soy Isoflavones and S-Equol (Brand example: Equelle)
Soy contains phytoestrogens, plant compounds that can weakly interact with estrogen receptors in the body. Because of this, soy has long been studied as a possible non-hormonal option for hot flashes. But research on soy isoflavone supplements has been mixed: some studies show small reductions in hot flashes, while others show little or no improvement over placebo.
One major reason may be that people metabolize soy differently. After ingesting soy isoflavones, only a subset of people—about 20–30% of North Americans—naturally convert them into equol, a metabolite that appears to have stronger biologic activity. In other words, taking soy isoflavones does not reliably lead to the same active byproduct in every woman.
That is why S-equol supplements may make more physiologic sense than soy isoflavones alone. Rather than relying on an individual’s gut bacteria to perform that conversion, supplements such as Equelle provide S-equol directly. This bypasses one of the main reasons soy supplements may work inconsistently from person to person.
Some research suggests that S-equol may help reduce hot flashes and other menopause symptoms, particularly in women who are not natural equol producers. However, the number of high-quality studies remains limited.
Important note: Women with a history of hormone receptor-positive breast cancer should discuss soy isoflavones and S-equol supplements with their physician before using them.
Siberian Rhubarb (Brand examples: Estrovera, Estroven Complete)
Siberian rhubarb—also called rhapontic rhubarb (Rheum rhaponticum)—is sold as a proprietary extract known as ERr 731 and marketed in the United States as Estrovera.
This supplement has received attention as a potential non-hormonal option for menopause symptoms, particularly hot flashes.
Early research suggests improvements in menopause symptom scores in some women taking the extract. However, the largest placebo-controlled trial had significant limitations, including a high dropout rate in the placebo group.
Ammonium succinate (Brand example: Amberen)
Amberen is another widely marketed menopause supplement. Its primary active ingredient is ammonium succinate, combined with a blend of amino acids, minerals, and vitamin E.
The manufacturer cites studies suggesting improvements in symptoms such as:
Hot flashes
Mood changes
Sleep disturbances
However, independent research remains limited, and the biological mechanism by which ammonium succinate might improve menopause symptoms is not well established. Some manufacturer-sponsored trials reported small increases in estradiol levels among women taking Amberen, but these findings come from a limited group of studies with potential conflicts of interest and have not been widely replicated. Still, caution should be exercised with a history of hormone-receptor positive breast cancer or other hormone driven cancers.
Pollen Extract (Brand example: Relizen)
Relizen contains a purified pollen extract and is marketed for menopause symptom relief, particularly hot flashes.
Several small studies suggest pollen extract may improve:
Hot flashes
Sleep quality
Overall menopause symptom scores
However, these studies are relatively small, and larger independent trials are limited. One advantage is that pollen extract does not appear to have estrogenic activity, which is why it is sometimes considered for women who cannot use hormone therapy.
Additional Menopause Supplements Worth Understanding
Combination Menopause Supplements (Brand example: Femmetrinol, Meta-Balance)
Many products marketed for menopause symptoms contain multiple ingredients in the same formula.
These “mixed supplements” generally combine many ingredients, often from the list the menopause society has noted as the least promising (chasteberry, ashwagandha, milk thistle, black cohosh, wild yam, evening primose oil etc).
Because the formulations vary widely, it can be difficult to determine which ingredient—if any—is responsible for symptom improvement.
For this reason, Evermore Women’s Health recommends trying single-ingredient supplements with the best evidence first, which makes it easier to evaluate whether a specific ingredient is helping.
Probiotics and Gut Health Supplements (Examples: Menofit, Provitalize)
Another growing category of menopause supplements focuses on probiotics and gut health. Products such as Menofit and Provitalize are marketed with claims that improving the gut microbiome may help support hormone balance, metabolism, weight management, and menopause symptoms.
The scientific rationale comes from research on the gut microbiome and estrogen metabolism, sometimes referred to as the estrobolome. Gut bacteria can influence how estrogen is metabolized and recycled in the body, which has led to interest in whether probiotics might affect menopause symptoms.
However, at this time there is little direct clinical evidence that probiotic supplements reduce hot flashes or other menopause symptoms. Most available studies focus on general gut health, metabolic outcomes, or inflammatory markers rather than vasomotor symptoms specifically.
Because of this, major menopause guidelines do not currently recommend probiotic supplements as a treatment for menopause symptoms, though the Menopause Society notes one promising study demonstrating reduced menopause symptoms over 12 weeks with Lactobacillus acidophilus.
That said, probiotics may still be helpful for digestive health or other gastrointestinal conditions, and ongoing research may help clarify whether specific strains have a role in menopause care in the future. As with many menopause supplements, the marketing around microbiome-based products has moved faster than the scientific evidence.
Why Evidence for Menopause Supplements Is Mixed
One challenge in studying herbal and botanical treatments is lack of standardization.
Unlike prescription medications, dietary supplements in the United States:
Are not required to prove effectiveness before being sold
May vary in purity, dosing, and ingredient concentration
Often contain different formulas under the same brand name
In addition, placebo responses in menopause trials can be high, sometimes reaching 30–40% improvement in hot flashes, which makes it harder to demonstrate true treatment effects.
Key Takeaway
Supplements can help some women—but clinical studies show they are less likely to produce meaningful symptom relief for most people compared with evidence-based menopause treatments.
What Patients Should Know
Many women are interested in natural approaches to menopause symptoms, and some supplements may provide modest relief for certain individuals.
However, according to The Menopause Society, most supplements have limited or inconsistent evidence for treating hot flashes.
This doesn’t mean supplements never help. It means that clinical trials show less consistent or less meaningful improvement compared with treatments like hormone therapy or certain prescription non-hormonal medications.
At the same time, this evidence gap should not diminish the experiences of women who do feel better using supplements. Individual responses vary widely, and many women do report benefit.
For that reason, it is not wrong or inappropriate to try supplements, especially if symptoms are mild and there are no safety concerns. If a supplement is helping you and you feel well on it, continuing it can be reasonable.
In practice:
Some women experience benefit
Some women experience little or no change
Evidence remains stronger for hormone therapy and certain prescription non-hormonal treatments
Supplements may be one part of a broader strategy that also includes lifestyle changes, sleep optimization, stress management, and medical therapies when appropriate.
For patients who want to review safety data in more detail, Memorial Sloan Kettering Cancer Center maintains an excellent public database on herbs and supplements that summarizes potential benefits, side effects, drug interactions, and cancer-specific considerations.
Because dietary supplements are not regulated as strictly as prescription medications, it is reasonable to look for products that have independent third-party certification, such as USP, NSF, or ConsumerLab testing, which helps verify that the supplement contains the ingredients and doses listed on the label and is free from certain contaminants.
When to Consider Medical Treatment
If menopause symptoms are significantly affecting sleep, mood, work performance, or quality of life, it may be helpful to explore additional treatment options.
There are now several evidence-based treatments for hot flashes and other menopause symptoms, including both hormonal and non-hormonal therapies. The best approach depends on your symptoms, health history, and personal preferences.
At Evermore Women’s Health, we focus on delivering thoughtful, evidence-based care for women navigating perimenopause and menopause—so they can feel well, stay strong, and continue thriving in midlife and beyond.
Frequently Asked Questions
1. Do menopause supplements actually work?
Some supplements may help certain women, but most have limited or inconsistent evidence in clinical trials. Hormone therapy and several prescription non-hormonal medications have stronger evidence for reducing hot flashes.
2. What is the best natural supplement for menopause?
No supplement consistently works for everyone. Some ingredients that have shown more promising but still limited evidence include soy isoflavones, S-equol, rhapontic rhubarb extract, and pollen extract.
3. How long should you try a menopause supplement?
A reasonable approach is to try one supplement with one ingredient at a time for about three months, track symptoms, and stop if there is no clear benefit.
4. Are menopause supplements safe?
Most supplements are generally well tolerated, but they are not regulated like prescription medications, and safety can vary depending on the ingredient and individual health history.
Women with a history of hormone receptor-positive breast cancer should speak with their physician before using soy or equol supplements.
