Do menopause supplements work? An honest look at black cohosh, soy and the rest

Walk down any pharmacy aisle and you will find a wall of menopause supplements promising cooler nights and calmer days. We get why they are tempting: no appointment, no prescription, and the word "natural" on the label. We do not sell supplements, so we have nothing riding on this answer. Here is what the guidelines and the research actually say.

The short answer

The Menopause Society's 2023 position statement on nonhormone therapy is the most thorough recent review. It does not recommend supplements and herbal remedies for hot flashes and night sweats. It also specifically does not recommend soy foods, soy extracts or equol (a soy byproduct) for hot flashes. The NIH Office of Dietary Supplements notes that ACOG has also concluded the data do not show herbal supplements like black cohosh work for hot flashes.

That does not mean every study is negative. It means the evidence is mixed, inconsistent or weak, and a product in a bottle may not match what was studied.

Supplement by supplement

Black cohosh: the most studied, and still unproven

Black cohosh is the best-known menopause herb, so it has the most research. The results do not add up to a clear yes. The NIH Office of Dietary Supplements summarizes a 2006 trial of 351 women and a 2009 trial of 88 women in which black cohosh did no better than placebo for hot flashes. A 2012 Cochrane review of 16 trials found "insufficient evidence" to say whether it helps, and a 2016 analysis found no significant reduction in hot flashes. On the other side, the NIH's complementary health center (NCCIH) describes a 2023 review that found black cohosh products potentially helpful for overall menopause symptoms, including hot flashes, though not for anxiety or low mood. NCCIH also notes most research has been on one specific extract, and results for other products are inconsistent.

The liver question. This is the part we most want you to know. The NIH Office of Dietary Supplements reports at least 83 cases of liver injury worldwide associated with black cohosh, some very serious. It has not been proven that black cohosh itself caused them, and some products have been found to contain the wrong herb or unlisted mixtures. Still, in 2008 the US Pharmacopeia recommended a cautionary label telling people with liver disorders to avoid it, and anyone who develops abdominal pain, dark urine or jaundice (yellowing skin or eyes) to stop and see a clinician. Australia has required a liver warning since 2007. The FDA does not require one in the US, so you may never see it on the bottle.

Also: blue cohosh is a different plant with its own risks, including high blood pressure and chest pain, according to NCCIH. The names are easy to mix up.

Soy: food is fine, pills are a weak bet

NCCIH says soy isoflavone supplements or soy protein may reduce hot flashes slightly, but the effect is small and study results are not consistent. The Menopause Society's review weighed the same kind of evidence and chose not to recommend it. Interestingly, NCCIH notes soy isoflavones probably benefit bone density after menopause. Soy foods are a normal part of many diets. If you take an MAOI antidepressant, NCCIH notes that soy foods high in tyramine, like tofu and soy sauce, have been reported to interact dangerously, so ask first.

Red clover

NCCIH describes red clover's effect on hot flashes as inconsistent, with some analyses suggesting a possible benefit for vaginal dryness. Because it contains plant estrogens, there are open questions about its effect on hormone-sensitive tissue.

Why "natural" is not the same as "tested"

The NIH Office of Dietary Supplements explains that medicines need FDA approval before they are sold, but supplements do not, and the FDA does not decide whether supplements work before they reach shelves. A few more points from the NIH worth remembering:

• "Natural" does not always mean safe.
• Supplements can interact with medicines. St. John's wort, for example, speeds up the breakdown of many drugs.
• Tell every clinician and pharmacist what you take, and mention supplements before any surgery, since some can raise bleeding risk or affect anesthesia.

What does work for hot flashes

Here is the encouraging part. Hormone therapy remains the most effective treatment for many healthy women; see what changed with HRT in 2025. For women who cannot or prefer not to use hormones, The Menopause Society's 2023 statement found the strongest evidence for cognitive behavioral therapy, clinical hypnosis, SSRIs and SNRIs, gabapentin and fezolinetant, with oxybutynin also recommended. Our guide to hot flash relief without hormones walks through each one.

When to call your clinician

• You take black cohosh or any herbal product and notice dark urine, abdominal pain, unusual tiredness, or yellowing of your skin or eyes
• You have a liver condition, or a history of breast or uterine cancer, and are considering any supplement; NCCIH says black cohosh safety in hormone-sensitive conditions is uncertain
• You take prescription medicines and want to add a supplement
• Your symptoms are not improving and are affecting your sleep, work or mood

Questions to ask your clinician

1. I am taking (or thinking about) this supplement. Is there evidence it helps, and is it safe with my medicines?
2. Could it affect my liver, and should anything be monitored?
3. Am I a candidate for hormone therapy?
4. If not, which nonhormone treatments with good evidence would fit my health history?
5. Would CBT or clinical hypnosis for hot flashes be available to me?

Questions

Does black cohosh work for hot flashes?

The evidence is mixed. Several clinical trials found it did no better than placebo, and The Menopause Society does not recommend herbal remedies for hot flashes. A 2023 review found possible benefit for overall symptoms, so the jury is still out.

Is black cohosh bad for your liver?

Rare but sometimes serious liver injury has been reported in people taking black cohosh products, though it has not been proven that the herb caused it. Stop and contact a clinician if you notice dark urine, abdominal pain or yellowing skin.

Does soy help with menopause symptoms?

Only a little, if at all. NCCIH says soy isoflavones may slightly reduce hot flashes but results are inconsistent, and The Menopause Society does not recommend soy for hot flashes. Soy as part of a normal diet is fine for most people.

Are menopause supplements regulated by the FDA?

Not like medicines. The NIH notes supplements do not need FDA approval before they are sold, and the FDA does not decide whether they work. Quality and ingredients can vary between products.

What actually works for hot flashes?

Hormone therapy is the most effective option for many healthy women. The Menopause Society's 2023 review also found strong evidence for CBT, clinical hypnosis, SSRIs and SNRIs, gabapentin and fezolinetant.

Keep reading

• Perimenopause symptoms: the full list and red flags
• Am I in perimenopause? The stages, explained
• What changed with HRT after the FDA label change
• Hot flash relief without hormones
• How to talk to your doctor about menopause
• Perimenopause anxiety: why it can start out of nowhere, and what helps

Education and personal experience, not medical advice. Talk with your own clinician before making health decisions.