Do black cohosh or red clover help with hot flushes during menopause?
Red clover may slightly reduce hot flushes; for black cohosh the evidence is contradictory. Both products may be an option if you want to avoid hormone therapy, but discuss it with your doctor, as the effects are small and study quality is moderate.
Red clover contains plant-based compounds that resemble oestrogen (known as isoflavones). Several pooled analyses show that these compounds modestly reduce the number of hot flushes per day: roughly one to one and a half fewer hot flushes per day compared with a placebo. An older analysis found no significant difference; a more recent analysis from 2021 did. The effect is therefore real, but not large, and the results still partly contradict one another.
For hot flushes during menopause, placebo performed remarkably well in almost all studies: women who received a dummy treatment already reported 1 to 59 percent fewer symptoms on their own. That makes it difficult to say how much of the effect of red clover is 'real'. No reliable effect on night sweats has been demonstrated. In the available studies, red clover did not appear to stimulate the endometrium with use of up to two years, which is a relevant safety consideration.
Black cohosh presents a mixed picture. Research into the most studied extract (40 mg per day of a specific extract) suggested that hot flushes decreased, particularly in women with severe symptoms, and that mood also improved somewhat. However, a separate review article published by an American professional association of family physicians concluded that there is no reliable evidence that black cohosh works better than a placebo. That contradiction has not been resolved.
The quality of research in this entire area is moderate to poor. Three quarters of the studies included in the largest analysis had a high risk of bias on three or more points, something the researchers themselves explicitly established. This means that the positive findings should be read with a degree of scepticism. Long-term safety has not yet been sufficiently studied for either product.
This answer draws on several pooled analyses and review articles, including two large analyses comprising 62 and 10 randomised studies respectively. The evidence is, however, weak in quality: the researchers themselves established that three quarters of the 62 included studies had a high risk of bias in three or more quality domains. In addition, the results for red clover and black cohosh partly contradict one another, and the placebo effect in the studies was very large (1 to 59 percent reduction in symptoms without an active treatment). This makes it difficult to separate genuine efficacy from the placebo effect.
What helps against menopause symptoms like hot flushes and mood swings?
Hormone therapy works best against hot flushes and night sweats. Those who cannot or do not wish to use it can choose from proven non-hormonal medications and psychological therapy. Herbal supplements have no demonstrable effect.
Which supplements actually help with menopause?
Red clover isoflavones and black cohosh have the strongest evidence for reducing hot flashes; soy isoflavones also help to some extent. For bone health, vitamin D is well supported. The effects are modest, and for severe complaints it is best to discuss the options with your doctor.
What complaints are most common during menopause?
The most common menopausal complaints are joint and muscle pain, fatigue and sleep problems; hot flushes are the most characteristic but do not top the prevalence rankings. If you recognise several of these complaints, it is worthwhile discussing them with your GP, who can consider what may help for each one.
Can you delay menopause with lifestyle or diet?
Avoiding smoking, eating less red meat, and eating more citrus fruit and oily fish appear to have a favourable influence on the age of menopause. However, evidence from controlled experiments is still entirely lacking.
Does the menopause disrupt my sleep, and what can help?
The menopause genuinely disrupts your sleep, primarily through hot flashes and hormonal changes. Cognitive behavioural therapy for insomnia (CBT-I) is the best first step; hormone therapy or melatonin may come into the picture after that.
What does menopause do to your risk of cardiovascular disease?
Menopause demonstrably increases your risk of cardiovascular disease, primarily through unfavourable changes in fat distribution, cholesterol, and blood pressure. If you experience early menopause or are considering hormone therapy, discuss your personal risk profile with your doctor.