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Menopausal Symptoms: In Depth

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What’s the Bottom Line?

What do we know about the effectiveness of complementary health approaches for menopause symptoms?

  • Phytoestrogens, herbs, and other natural products haven’t been clearly shown to relieve menopause symptoms.
  • Research on hypnotherapy and mindfulness meditation is in its early stages, but some studies have had promising results.
  • Acupuncture has not been shown to be more effective than simulated acupuncture for relieving hot flashes.
  • Yoga has not been shown to relieve hot flashes but may be helpful for some symptoms associated with menopause.
  • The evidence doesn’t support claims that custom-mixed (compounded) bioidentical hormones are more effective than conventional hormone therapy.

What do we know about the safety of complementary health approaches for menopause symptoms?

  • Natural products may have side effects or interact with drugs, and little is known about their long-term safety.
  • Mind and body practices such as acupuncture, hypnosis, meditation, and yoga generally have good safety records.
  • Custom-mixed bioidentical hormones haven’t been shown to be safer than other forms of hormone therapy, and their content may vary from batch to batch.

Some Basics About Menopause

Menopause is the time when a woman’s menstrual periods stop permanently. It usually occurs naturally, at an average age of 51, but surgery or the use of certain medications can make it happen earlier. During the years around menopause (a time called perimenopause or menopausal transition), some women have hot flashes, night sweats, difficulty sleeping, or other troublesome symptoms.

What the Science Says About Complementary Health Approaches for Menopause Symptoms

Natural Products

Many natural products have been studied for menopause symptoms. However, none has clearly been shown to be helpful. There’s little information on the long-term safety of natural products, and some can have harmful side effects or interact with drugs. The sections below give more detail about several natural products studied for menopause symptoms.

Mind and Body Practices

Only a small amount of research has been done on most mind and body practices for menopause symptoms. However, the limited evidence currently available suggests that some of these practices might help to relieve symptoms or make them less bothersome.

Other Complementary Approaches

Clinical Practice Guidelines for Treating Menopause Symptoms

Several professional organizations have issued guidelines for health care providers on how to treat menopause symptoms. The guidelines discuss certain complementary health approaches.

  • A 2015 position statement from the North American Menopause Society recommends hypnotherapy but acknowledges that the evidence favoring it is limited, conditionally recommends mindfulness-based therapies, and does not recommend acupuncture, yoga, or any natural products for managing hot flashes.
  • Guidelines from the American College of Obstetricians and Gynecologists say that conventional hormone therapy is preferred over custom-mixed bioidentical hormones, and that phytoestrogens and herbal supplements have not been shown to be helpful for treating hot flashes.
  • Guidelines from the American Association of Clinical Endocrinologists recommend against the use of custom-mixed bioidentical hormones and advise caution in the use of dietary supplements because of possible side effects and drug interactions. The guidelines also say that the effects of phytoestrogens are inconsistent and caution that women with a personal or strong family history of blood clots, cardiovascular disease, or breast, uterine, or ovarian cancer should not use soy-based treatments.
  • Guidelines issued by a task force from several professional societies recommend against the routine use of DHEA.

NCCIH-Funded Research

NCCIH-funded researchers are studying a variety of topics related to menopause, including:

  • The effects of acupuncture on hot flashes
  • Whether hypnotherapy is a practical way to improve sleep in women with menopause symptoms
  • The actions of phytoestrogens at the molecular and cellular level.

More to Consider

  • Keep in mind that although many dietary supplements come from natural sources, “natural” does not always mean “safe.” Also, a manufacturer’s use of the term “standardized” (or “verified” or “certified”) does not necessarily guarantee product quality or consistency. For more information, see NCCIH’s resources on dietary supplements.
  • Tell all your health care providers about any complementary or integrative health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

For More Information

NCCIH Clearinghouse

The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226

tty (for deaf and hard-of-hearing callers):

1-866-464-3615

Website: https://nccih.nih.gov/

Email: info@nccih.nih.gov (link sends e-mail)

PubMed®

A service of the National Library of Medicine, PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. For guidance from NCCIH on using PubMed, see How To Find Information About Complementary Health Approaches on PubMed.

Website: https://pubmed.ncbi.nlm.nih.gov/

MedlinePlus

To provide resources that help answer health questions, MedlinePlus (a service of the National Library of Medicine) brings together authoritative information from the National Institutes of Health as well as other Government agencies and health-related organizations.

Website: https://www.medlineplus.gov/

National Institute on Aging (NIA)

NIA is the NIH institute that focuses on supporting and conducting high-quality research on aging processes, age-related diseases, and special problems and needs of the aged. NIA publications include Hormones and Menopause: Tips from the National Institute on Aging.

Website: https://www.nia.nih.gov/

National Women's Health Information Center (NWHIC)

NWHIC, a service of the Office of Women’s Health in the U.S. Department of Health and Human Services (HHS), provides information to help advance women’s health research, services, and public and health professional education. NWHIC coordinates the efforts of all HHS agencies and offices involved in women’s health.

Website: https://www.womenshealth.gov

Key References

  • American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 141: management of menopausal symptoms. Obstetrics and Gynecology. 2014;123(1):202–216.
  • Carmody J, Crawford S, Salmoirago-Blotcher E, et al. Mindfulness training for coping with hot flashes: results of a randomized trial. Menopause. 2011;18(6):611–620.
  • Cramer H, Lauche R, Langhorst J, et al. Effectiveness of yoga for menopausal symptoms: a systematic review and meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine. 2012;2012:863905.
  • Dodin S, Blanchet C, Marc I, et al. Acupuncture for menopausal hot flushes. Cochrane Database of Systematic Reviews. 2013;(7):CD007410. Accessed at www.cochranelibrary.com on February 17, 2016.
  • Ee C, Xue C, Chondros P, et al. Acupuncture for menopausal hot flashes. A randomized trial. Annals of Internal Medicine. 2016;164(3):146–154.
  • Elkins GR, Fisher WI, Johnson AK, et al. Clinical hypnosis in the treatment of postmenopausal hot flashes: a randomized controlled trial. Menopause. 2013;20(3):291–298.
  • Files JA, Ko MG, Pruthi S. Bioidentical hormone therapy. Mayo Clinic Proceedings. 2011;86(7):673–680.
  • Goodman NF, Cobin RH, Ginzburg SB, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of menopause. Endocrine Practice. 2011;17(Suppl 6):1–25.
  • Kelley KW, Carroll DG. Evaluating the evidence for over-the-counter alternatives for relief of hot flashes in menopausal women. Journal of the American Pharmacists Association. 2010;50(5):e106–e115.
  • Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database of Systematic Reviews. 2012;(9):CD007244. Accessed at www.cochranelibrary.com on February 17, 2016.
  • Lethaby A, Marjoribanks J, Kronenberg F, et al. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database of Systematic Reviews. 2013;(12):CD001395. Accessed at www.cochranelibrary.com on February 17, 2016.
  • Scheffers CS, Armstrong S, Cantineau AEP, et al. Dehydroepiandrosterone for women in the peri- or postmenopausal phase. Cochrane Database of Systematic Reviews. 2015;(1):CD011066. Accessed at www.cochranelibrary.com on February 17, 2016.
  • The North American Menopause Society. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause. 2015;22(11):1155–1172.
  • Wierman ME, Arlt W, Basson R, et al. Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism. 2014;99(10):3489–3510.

Acknowledgments

NCCIH thanks Lanay Mudd, Ph.D., and David Shurtleff, Ph.D., NCCIH, for their technical expertise and review of the 2016 update of this publication.

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.

Last Updated: May 2017