Quick answer
Most perimenopause supplements marketed for hot flushes, including black cohosh and other herbal remedies, soy isoflavones and equol, are not recommended by The North American Menopause Society because the evidence does not support them. Hormone therapy remains the most effective treatment, and CBT, clinical hypnosis and some prescription medicines also help. Supplements are better aimed at bone, muscle and nutrient needs.
Key takeaways
- The 2023 Menopause Society statement does not recommend supplements or herbal remedies for hot flushes.
- Hormone therapy is the most effective treatment for vasomotor symptoms for suitable women.
- CBT, clinical hypnosis and several prescription non-hormonal options are recommended.
- Midlife supplement priorities are better focused on bone health, muscle and correcting measured deficiencies.
- Heavy or irregular bleeding can lower iron stores, so testing ferritin is worthwhile.
What is perimenopause?
Perimenopause is the transition leading up to menopause, which is confirmed after 12 months without a period. It often begins in the 40s and can last several years. Fluctuating hormones can bring hot flushes and night sweats (vasomotor symptoms), disrupted sleep, mood changes, brain fog and changes in periods.
Do menopause supplements work for hot flushes?
In 2023, The North American Menopause Society (now The Menopause Society) published an updated, evidence-graded review of non-hormonal treatments for vasomotor symptoms. Its conclusions on supplements were clear 1:
- Not recommended: supplements and herbal remedies, soy foods and soy extracts, and the soy metabolite equol.
- Also not recommended for hot flushes specifically: paced breathing, cooling techniques, avoiding triggers, exercise, yoga, mindfulness, acupuncture and cannabinoids.
- Recommended: cognitive behavioural therapy (CBT), clinical hypnosis, certain SSRI/SNRI medicines, gabapentin, fezolinetant, and oxybutynin, with weight loss and stellate ganglion block also supported at lower levels of evidence.
The statement also affirms that hormone therapy remains the most effective treatment for vasomotor symptoms and should be considered for menopausal women within 10 years of their final period, when appropriate 1.
Note that exercise and mindfulness being “not recommended” refers only to treating hot flushes. They remain valuable for heart, bone, muscle and mental health.
Where supplements can genuinely help in midlife
Bone health
Oestrogen decline accelerates bone loss. Adequate calcium, mostly from food, alongside vitamin D and regular strength training, supports bone health. The Endocrine Society does not recommend routine vitamin D blood testing for most healthy adults, so discuss your individual risk with your doctor 2.
Muscle and strength
Muscle mass declines faster in midlife. Resistance training and sufficient protein are the foundation, and creatine is a well-studied option that supports strength gains when combined with training.
Iron
Heavy or irregular bleeding during perimenopause can deplete iron stores, causing fatigue. A ferritin test shows whether iron is actually needed. Avoid taking iron without testing.
Sleep
Magnesium is widely used for sleep, but trial evidence for insomnia is limited and low quality 3. It is low-risk to try within safe limits, but it is not a treatment for night sweats.
Why blanket “menopause blends” fall short
Many menopause products combine herbs with vitamins in fixed doses. Given the evidence, you may be paying mainly for ingredients that do not reduce hot flushes, while missing what your body actually needs, such as iron if you are depleted. A measured, individual approach is both safer and more likely to help.
Frequently asked questions
Does black cohosh work for menopause?
The Menopause Society’s 2023 position statement does not recommend supplements or herbal remedies, a category that includes black cohosh, for vasomotor symptoms, because the evidence does not show consistent benefit.
What is the most effective treatment for hot flushes?
Hormone therapy is the most effective treatment for suitable women. For women who cannot or prefer not to use it, recommended options include CBT, clinical hypnosis, certain antidepressants (SSRIs/SNRIs), gabapentin, fezolinetant and oxybutynin.
Should I take vitamin D during perimenopause?
Vitamin D supports bone health, but routine testing is not recommended for most healthy adults. Your doctor can advise based on your bone health, diet, sun exposure and other risk factors.
When should I see a doctor about perimenopause symptoms?
Speak to a clinician if symptoms affect your sleep, work or wellbeing, or if you have very heavy bleeding, bleeding between periods or after sex, or any bleeding after menopause.
Sources
- The North American Menopause Society. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573–590. doi.org/10.1097/GME.0000000000002200
- Demay MB, et al. Vitamin D for the prevention of disease: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2024;109(8):1907–1947. doi.org/10.1210/clinem/dgae290
- Mah J, Pitre T. Oral magnesium supplementation for insomnia in older adults: a systematic review & meta-analysis. BMC Complement Med Ther. 2021;21(1):125. doi.org/10.1186/s12906-021-03297-z
Medical disclaimer: This article is for general information and education only and is not medical advice. It does not replace diagnosis or treatment by a qualified clinician. Talk to your doctor or pharmacist before starting supplements, especially if you are pregnant, take medicines or have a medical condition. Evidence reviewed as of 16 September 2026.
