Search for "natural remedies for menopause" and you will find a long list of herbs, powders and promises. Some of these options have real support. Others have thin evidence, and a few carry real risks. This guide sorts them by what the major health agencies say, so you can decide what is worth asking your doctor about.
It is general education, not medical advice. If you live in Raleigh, Durham, Chapel Hill or Cary and are weighing options, bring this to your own doctor or pharmacist. For the wider picture of this stage of life, see our perimenopause symptoms guide.
What natural approaches help menopause symptoms?
The best-supported nonhormone options for hot flashes are weight loss when it applies, cognitive behavioral therapy (CBT) and clinical hypnosis. The Menopause Society lists these three as low-risk measures that can help manage hot flashes and night sweats.2 Other approaches have promising but limited evidence.
Here is how the main approaches look, in plain terms:
| Approach | What the sources say |
|---|---|
| Weight loss (when it applies) | Listed by The Menopause Society as a low-risk measure for hot flashes.2 The National Institute on Aging (NIA) says women who are overweight may have more frequent and severe hot flashes.1 |
| Cognitive behavioral therapy | Listed by The Menopause Society as a low-risk measure for hot flashes.2 The NIA says CBT for insomnia has been shown to help sleep in women with menopausal symptoms.9 |
| Clinical hypnosis | Listed by The Menopause Society as a low-risk measure.2 NCCIH describes a 2013 study in which five weekly sessions with a therapist reduced hot flashes in postmenopausal women.6 |
| Paced breathing | NCCIH reports that a 2019 review of 4 studies with 398 participants found evidence it could significantly improve hot flashes.6 The Menopause Society says there is limited solid data on it.2 |
| Mindfulness | In an NCCIH-funded study, mindfulness training reduced how bothersome hot flashes were and improved anxiety, stress and sleep quality, but hot flash intensity did not change.7 |
| Yoga | NCCIH reports a 2018 evaluation of 13 studies found yoga reduced physical and psychological symptoms, and seemed at least as effective as other exercise.7 The Menopause Society lists exercise and yoga among measures with limited solid data for hot flashes.2 |
| Acupuncture | NCCIH says studies comparing it with no treatment found it reduced the frequency and severity of hot flashes, but studies comparing it with simulated acupuncture showed no difference between the two.7 |
You can see the pattern. NCCIH says research on hypnotherapy and mindfulness meditation is in its early stages, though some studies have had promising results.7 It also says psychological and physical approaches such as hypnosis, meditation and yoga generally have good safety records, with a few cautions.7 For example, it says hypnosis might worsen some types of psychological problems, and that people with an ongoing health issue should talk with their health care provider before starting meditation.7
What does the evidence say about herbs and supplements?
For most herbs and supplements, the evidence for menopause symptoms is mixed, limited or inconsistent. NIA says it is unknown whether herbs and other "natural" products are helpful or safe for hot flashes or other menopausal symptoms, and that benefits and risks are still being studied.1 NCCIH's overview says none of the nutritional approaches studied has clearly been shown to be helpful.7
The three people ask about most:
Black cohosh. NCCIH says a substantial number of studies in people have looked at it for menopause symptoms. A 2023 review of 22 studies of products containing black cohosh extracts, alone or with other herbs, found them potentially beneficial for overall menopause symptoms, with improvements in hot flashes but not in anxiety or depressive symptoms.3 Other sources are more cautious. The Menopause Society lists black cohosh among supplements with limited evidence or that failed to show benefit in trials.2 NIA says black cohosh, DHEA and soy isoflavones have not been shown to be effective for hot flashes, and that some products carry risks such as liver damage.1 A fair summary: the evidence is mixed, and the safety question deserves attention.
Soy. NCCIH says soy isoflavone supplements or soy protein may help reduce how often and how severe hot flashes are, but the effect may be small and research results have not been completely consistent.4 Soy foods such as tofu, miso, tempeh, edamame and soy milk are common foods.4 NCCIH says effects may vary for different types of soy products.4
Red clover. NCCIH says research has not shown conclusive evidence of benefit for any health condition. Studies on hot flashes have had inconsistent results, and some had a high risk of bias.5
NCCIH also notes that phytoestrogens, plant substances with structures similar to estrogen, include the isoflavones in soy and red clover. Studies of them for menopause symptoms have had inconsistent results, and flaxseed products were found to be no more effective than a placebo for hot flashes.7 That page was last updated in 2017, so ask your doctor whether newer research changes the picture for you.
Other products. NCCIH's menopause page says very little research has been done on dong quai, evening primrose oil, ginseng, kava, melatonin and wild yam, so no conclusions can be reached about them. It says it is uncertain whether DHEA is useful for menopause symptoms, and that a few studies suggested vitamin E might help, but the effect was small, about one fewer hot flash per day in one study.7
Are there safety concerns?
Yes. "Natural" does not mean safe for everyone. The main concerns are liver effects, drug interactions, contaminated products and use by people who should not take estrogen-like substances. Always ask your doctor or pharmacist before trying any herb or supplement, especially if you take medicines.
Black cohosh and the liver. NCCIH says black cohosh has been used safely in research studies lasting up to a year and is generally well tolerated, but concerns have been raised that it may cause liver damage in some people. Cases of liver damage, some very serious, have been reported in people taking products labeled as black cohosh. NCCIH says these problems are rare and it is uncertain whether black cohosh was responsible.3 If you take it, NCCIH advises consulting your health care provider if you develop symptoms of liver damage such as dark urine and fatigue.3 The menopause overview adds abdominal pain and jaundice, and says anyone who develops liver trouble signs should stop using it and consult a provider.7
Product quality. NCCIH says some commercial black cohosh products have been found to contain the wrong herb or mixtures not listed on the label.3 Unlike medicines, supplements are not approved by the FDA before they are sold, and the manufacturer is responsible for evaluating safety and labeling.3 ACOG adds that the way these products are made is not regulated, so there is no guarantee that a product contains safe ingredients or effective amounts.8
Interactions. NCCIH says some herbs and medicines interact in harmful ways.3 Its menopause page notes that dong quai may interact with the blood thinner warfarin, and that vitamin E in the high amounts found in supplements may raise the risk of bleeding and interact with blood thinners.7 Soy products high in tyramine, such as tofu and soy sauce, have been reported to interact with monoamine oxidase inhibitors, a group of antidepressants, causing dangerously high blood pressure.4
Hormone-sensitive conditions. NCCIH says it is uncertain whether black cohosh is safe for women who have had hormone-sensitive conditions such as breast or uterine cancer.3 Because phytoestrogen supplements may act like estrogen, NCCIH says they may not be safe for women who should not take estrogen.7
Pregnancy and breastfeeding. NCCIH says black cohosh and red clover supplements may not be safe during pregnancy or breastfeeding.35
Other cautions. NCCIH says kava supplements have been linked to a risk of severe liver disease, and that some evidence suggests even short-term DHEA use may have harmful effects, including liver damage.7 Sleep aids deserve care too. NIA says sleep aids, whether over the counter (such as melatonin) or prescription, should not be used long term.9
Compounded "bioidentical" hormones. ACOG says compounded drugs are not regulated by the FDA, and recommends FDA-approved hormone therapy over compounded hormone therapy.8 NCCIH says the evidence does not support claims that custom-mixed bioidentical hormones are more effective or safer than conventional hormone therapy.7
What lifestyle changes help hot flashes?
NIA suggests dressing in layers, carrying a portable fan, lowering your bedroom temperature, drinking small amounts of cold water before bed, and layering your bedding so it can be adjusted.1 It also suggests avoiding alcohol, spicy foods and caffeine, since these can make menopausal symptoms worse, and working toward a healthy weight.1
The Menopause Society is more cautious on some of these. It lists cooling techniques and trigger avoidance among measures that have limited solid data, or that failed to show significant benefit in trials, and adds that this does not mean none of them have value.2 It says healthy diet, regular exercise and stress management may play a vital role in a woman's overall health.2
My own approach follows that middle ground. Keep a short log for two weeks: when hot flashes hit, what you ate and drank, how you slept and how stressed you felt. NIA suggests noting what triggers your hot flashes and how much they bother you, so you can make better decisions.1 Then change one thing. Start with the one that is easiest to keep, not the one that sounds most impressive.
Stress and sleep belong on that list too. The CDC lists simple steps such as deep breaths, stretching, time outdoors, connecting with people you trust, and going to bed and waking at the same time each day.11 You can take the Garden Check-in to see whether Soil (food), Roots (stress), Rhythm (sleep and energy), Ground (time outside and movement) or Circle (the people around you) is the best place to begin. If tiredness is your main problem, read about perimenopause fatigue. For the stress side, see our article on high cortisol symptoms in women.
How do these options compare with hormone therapy and prescription options?
For bothersome hot flashes, hormone therapy is the most effective option according to major medical groups, and it is a choice to make with your own doctor. This guide does not argue for or against it. It is worth knowing so you can compare fairly.
The Menopause Society says hormone therapy is FDA-approved as a first-line therapy for relief of hot flashes and is shown to be the most effective option for bothersome hot flashes. It also says only two nonhormone medicines are FDA-approved for hot flashes, low-dose paroxetine and fezolinetant.2 NCCIH likewise says hormone therapy is the most effective therapy for menopausal hot flashes, and that it may raise the risk of breast cancer, blood clots and other serious problems, so if it is used it should be at the lowest dose and for the shortest period that controls symptoms. Women with certain medical conditions should not use it.7
NIA says many women find they do not need anything for menopause symptoms, and that those who want help can choose among lifestyle changes, nonhormone medicines and hormones, after talking about symptoms, family and medical history and preferences with their doctor.10 That is the right order of questions: what bothers you most, what your history allows, and what you would be comfortable with.
When should you see your own doctor?
See your own doctor before you start any herb or supplement, and sooner if symptoms are unbearable or interfere with your life. Bring a list of everything you take, including vitamins and over-the-counter products, so your doctor or pharmacist can check for interactions.
Also see your doctor about:
- Bleeding that is unusual. NIA says to see your doctor if periods happen very close together, bleeding is heavy, you bleed or spot after sex or between periods, periods last more than a week, or you bleed again after a year without a period.10
- Symptoms of liver trouble while taking any supplement, such as dark urine, abdominal pain or yellowing of the skin or eyes. NCCIH says anyone who develops these signs while taking black cohosh should stop it and consult a health care provider.7
- Low mood that does not lift. The NIA says to talk with your primary care provider or a mental health professional, because there are options to help.10
- Hot flashes or night sweats that disturb your sleep night after night.19
Emergency, call 911: chest pain, severe shortness of breath, fainting, or bleeding that soaks through your clothes and will not slow down.
Crisis, call or text 988: if low mood comes with thoughts of harming yourself, call or text 988, the 988 Suicide & Crisis Lifeline, free and open all day and night. If your life is in danger, call 911.11
Dr. Werness works alongside your own doctor and does not ask anyone to stop a medicine. This page is for education. It does not replace advice from your own doctor or pharmacist.