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Walk into any pharmacy and you will find a shelf of supplements promising to ease perimenopause: black cohosh, soy, red clover, evening primrose oil, magnesium and more. Some have a little evidence, many have none, and a few can interact with medicines. This guide sets out what Australian and international menopause societies say about the common options, where nutrients like calcium and vitamin D fit, and what to check before you choose one.
At a glance
- The Australasian Menopause Society says there is currently insufficient evidence to support herbal therapies, and none is as effective as oestrogen therapy.
- Cochrane reviews found no conclusive evidence that phytoestrogen (soy and red clover) supplements or black cohosh reduce hot flushes.
- Some products can interact with prescribed medicines, so tell your doctor or pharmacist what you take.
- Supplements with an AUST L number are not individually evaluated by the TGA for whether they work.
- Calcium needs rise to 1,300 mg a day after 50. Food first, with a supplement only if intake is low.
What the menopause societies say
The Australasian Menopause Society’s 2025 information sheet on complementary therapies concludes there is currently insufficient evidence to support the use of herbal therapies, that no complementary therapy is as effective as oestrogen therapy for menopausal symptoms, and that so-called natural products may cause harm and interact with prescribed medicines. Jean Hailes says much the same: there isn’t enough evidence that supplements and herbal remedies improve menopausal symptoms, and you should talk to your doctor before using them.
The North American Menopause Society’s 2023 position statement on non-hormone treatments goes further, listing supplements and herbal remedies, and soy foods and extracts, as not recommended for hot flushes and night sweats.
Common menopause supplements, one by one
| Supplement | What the evidence says |
|---|---|
| Black cohosh | A Cochrane review of 16 trials found insufficient evidence it helps. The AMS notes specific extracts may improve symptoms in some short, small studies. Earlier liver concerns were reviewed and the data did not support a direct causal link. |
| Soy and red clover (phytoestrogens) | A Cochrane review of 43 trials found no conclusive evidence they reduce hot flushes. The AMS describes the findings as mixed, possibly depending on whether your gut bacteria make a compound called equol. |
| Evening primrose oil | Very few studies, and the AMS reports no benefit in the one it found. It may lower the seizure threshold in people with epilepsy. |
| St John’s wort | May help mood when combined with black cohosh, but interacts with many prescription medicines. |
| Magnesium | Listed by the AMS as having little or no evidence for hot flushes. A trial in 289 women found magnesium did not reduce hot flushes and caused more diarrhoea. |
| Omega-3 | A review cited by the AMS found no difference from placebo for hot flushes. |
| Ashwagandha | The TGA issued a 2024 safety advisory about liver damage. |
Placebo effects are large in hot flush research. In the Cochrane review of phytoestrogens, people taking placebo reported reductions of anywhere from 1% to 59%, which is one reason single success stories can mislead.
Nutrients that do matter
The clearer evidence is for nutrients linked to bone health. After 50, the recommended calcium intake for women rises from 1,000 to 1,300 mg a day, because bone loss speeds up for about 5 to 10 years around menopause. Healthy Bones Australia recommends getting calcium from food where possible, with a supplement only when intake is not enough, and advises against excessive calcium. For vitamin D, sunlight is the main source in Australia, and doctors usually test only people with risk factors. Our guide to calcium without dairy in menopause covers food sources.
Before you choose a supplement
- Check the AUST L number, but know what it means. The TGA says listed medicines are not individually evaluated for quality, safety and efficacy before they are sold.
- Tell your doctor and pharmacist about every supplement, especially if you take antidepressants, blood thinners, epilepsy medicines or hormone therapy.
- Look at your symptoms first. Hot flushes, sleep problems, low mood and joint aches have different causes and different treatments. Your GP can talk you through menopausal hormone therapy and non-hormone options.
Try it yourself: Check the nutrients that matter most at this stage, like calcium, protein and fibre. Open the perimenopause nutrition checker →
Food first, then the right extras
Whether any supplement is worth it for you depends on your symptoms, what you already eat, your bone health, your medicines and whether you are using hormone therapy. Felicity can review your diet and supplements, flag interactions to raise with your GP, and help you put the money where the evidence is.
Felicity Bull is an Accredited Practising Dietitian. She sees clients in person in Mount Hutton (Newcastle and Lake Macquarie) and by telehealth across Australia. About menopause nutrition support.
Book with Felicity →Common questions
What is the best supplement for perimenopause?
No supplement has strong evidence for perimenopause symptoms. The Australasian Menopause Society says there is insufficient evidence to support herbal therapies, and none is as effective as oestrogen therapy. Calcium and vitamin D matter for bones if your intake is low.
Does black cohosh work for hot flushes?
A Cochrane review found insufficient evidence that it helps. Some specific extracts showed benefit in small, short studies.
Do soy or phytoestrogens help menopause symptoms?
Evidence is mixed. A Cochrane review of 43 trials found no conclusive evidence that phytoestrogen supplements reduce hot flushes.
Does magnesium help hot flushes?
The evidence says probably not. A trial in 289 women found magnesium did not reduce hot flushes, and the AMS lists it as having little or no evidence.
Are menopause supplements safe?
Some can interact with prescribed medicines, and the TGA does not check listed supplements for whether they work. Tell your doctor or pharmacist what you take.
Where this comes from
General information only, not personal advice. It does not replace advice from your doctor or dietitian.
- Australasian Menopause Society. Complementary medicines and therapies for hot flushes (information sheet, updated April 2025). menopause.org.au/images/stories/infosheets/docs/AMS_Complementary_Medicines_and_Therapies_for_Hot_Flushes.pdf
- Jean Hailes for Women’s Health. Treatments for menopause. www.jeanhailes.org.au/health-topics/menopause/treatments-for-menopause/
- The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590. pubmed.ncbi.nlm.nih.gov/37252752/
- Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database of Systematic Reviews. 2012;(9):CD007244. pubmed.ncbi.nlm.nih.gov/22972105/
- Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database of Systematic Reviews. 2013;(12):CD001395. pubmed.ncbi.nlm.nih.gov/24323914/
- Park H, Qin R, Smith TJ, Atherton PJ, et al. North Central Cancer Treatment Group N10C2 (Alliance): a double-blind placebo-controlled study of magnesium supplements to reduce menopausal hot flashes. Menopause. 2015;22(6):627-632. pubmed.ncbi.nlm.nih.gov/25423327/
- Therapeutic Goods Administration. Listed medicines. www.tga.gov.au/products/medicines/non-prescription-medicines/listed-medicines
- National Health and Medical Research Council, Nutrient Reference Values for Australia and New Zealand. Calcium. www.eatforhealth.gov.au/nutrient-reference-values/nutrients/calcium
- Healthy Bones Australia. Calcium and bone health. healthybonesaustralia.org.au/your-bone-health/calcium/
- Healthy Bones Australia. Vitamin D and bone health. healthybonesaustralia.org.au/your-bone-health/vitamin-d-bone-health/
