Which supplements genuinely help with menopause?

Soy isoflavones (from soy or red clover) have the strongest evidence for hot flushes. A meta-analysis of 54 studies shows that these plant-based supplements significantly reduced hot flushes and general menopausal symptoms compared with placebo. The quality of the individual studies varied, but the overall picture points in the same direction. Black cohosh, also popular for menopause, lacks sufficient evidence that it actually works, and its safety is also disputed.

For bones and muscles, vitamin D and calcium are the best-supported supplements. Vitamin D is certainly worth considering if you are deficient or at increased risk of fractures. Taking calcium alone for fracture prevention is not routinely recommended for all postmenopausal women, as side effects can occur. You should therefore tailor this to your own situation, preferably in consultation with your GP. Vitamin K2 is sometimes combined with calcium and vitamin D, but the evidence for this is too thin for a firm recommendation.

Creatine is less well known as a menopause supplement, but there is a reasonable amount of support for its use in active postmenopausal women. A higher dose (0.3 grams per kilogram of body weight per day) appears to be beneficial for muscle mass, bone health and mental health. This is particularly relevant if you exercise regularly.

Magnesium may help reduce menopausal symptoms, but the available data are limited and have not been systematically collected in a robust way. For bone health, the results of magnesium supplementation are mixed. It is not a useless intervention, but do not expect striking results from it.

Probiotics (specifically Lactobacillus species) show promising results in early studies for vaginal dryness and atrophy, complaints that are common after menopause because the vaginal flora changes. However, there are still too few good clinical studies to consider this proven.