Quick answer: Menopause is a natural transition, not a disease, but symptoms such as hot flashes, night sweats, poor sleep, weight gain and brain fog can be disruptive. Strength training, steady blood sugar and cognitive behavioral therapy can help, and some women find ground flaxseed and paced breathing useful. Herbs such as black cohosh, maca and red clover, plus magnesium, are commonly used. Hormone therapy is also an option to discuss with your doctor.
Key takeaways
Menopause is a natural transition, but hot flashes, night sweats, poor sleep and brain fog can be very disruptive.
Strength training, steady blood sugar, cognitive behavioral therapy and paced breathing can help many women.
Herbs such as black cohosh and nutrients like magnesium are commonly used, and hormone therapy is also a reasonable option to discuss.
What changes in menopause
In menopause, estrogen and progesterone decline, and stress hormones can amplify symptoms. Inflammation and insulin resistance may rise, bone and muscle loss accelerate, and sleep and mood often shift.
Herbs and nutrients commonly used
Black cohosh has been studied for hot flashes, though rare liver problems have been reported. Maca is used for libido and mood, red clover isoflavones are plant estrogens studied for hot flashes, and pine bark extract has been studied for menopause symptoms.
Ashwagandha is used for stress and sleep, and magnesium glycinate for sleep and mood. DIM and calcium D-glucarate support estrogen metabolism (see estrogen dominance), and evening primrose oil is traditionally used for night sweats.
Amounts should be individualized. If you have a history of breast or other hormone-sensitive cancer, talk with your oncologist before using plant estrogens.
Habits that help
Strength training three times a week also protects bone, and ground flaxseed daily is a simple addition. Paced, slow breathing during hot flashes is something some women find calming, and cognitive behavioral therapy for sleep and hot flashes can help.
Some women also find acupuncture helpful, and it is worth limiting alcohol, spicy food and caffeine if they trigger hot flashes.
Is testing helpful?
Menopause is usually diagnosed by symptoms and cycle changes. Thyroid labs, bone density and, for some women, hormone or cortisol testing can add context. Functional labs are optional. They can be helpful in more complex cases. See also perimenopause or PCOS?.
Menopause and healthy aging
Estrogen helps regulate inflammation, mitochondria, bone renewal and communication between tissues. As it declines, those systems need more support, which is why menopause is a key window for protecting long-term health. Related: osteoporosis prevention and natural hormone balance.
When to see a naturopathic doctor
It may be time to see a naturopathic doctor if hot flashes, night sweats or sleep problems affect your life, or if you want natural options, or support alongside hormone therapy. The same is true if you have a history of hormone-sensitive cancer and want safe options, or if you want a plan to protect bone, heart and brain health after menopause.
See a medical provider promptly for any bleeding after menopause, a new breast lump, chest pain, or symptoms of depression.
What the research shows
Black cohosh is one of the most popular herbs for menopause, but the evidence is weak. A 2012 Cochrane review by Leach and Moore gathered 16 randomized trials with 2,027 perimenopausal and postmenopausal women, most using about 40 mg a day for an average of 23 weeks. In the trials that could be pooled, black cohosh did not reduce hot flash frequency or menopausal symptom scores more than placebo, while hormone therapy worked better than black cohosh. The authors rated trial quality as unclear because of poor reporting, so the question is not fully settled.
Soy isoflavones have somewhat better support. A 2012 meta-analysis by Taku and colleagues pooled 17 double-blind trials in which women took a median of 54 mg of soy isoflavones a day for 6 weeks to 12 months. Compared with placebo, isoflavones reduced hot flash frequency by about 21% and severity by about 26%, and products higher in genistein seemed to work better. The trials varied widely in results, and the effect is smaller than that of hormone therapy, so isoflavones are best viewed as a modest option to discuss with a clinician.
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Questions to bring to your clinician
These questions can help you get the most out of your next visit.
Given my symptoms and history, how do natural options and hormone therapy compare for me?
Which of my menopause symptoms would be most worth addressing first?
Which lifestyle changes might help with my hot flashes and sleep?
How would natural support fit alongside other options I have discussed with my doctor?
Frequently asked questions
What is the best natural remedy for hot flashes?
Black cohosh is the most studied herb, with mixed results. CBT also helps many women, and some find paced breathing calming.
Is black cohosh safe?
It is generally well tolerated, but rare liver problems have been reported. Stop it and call your provider if you notice yellow skin or dark urine.
Can diet help menopause symptoms?
Steady blood sugar, ground flaxseed and limiting triggers such as alcohol can help.
Should I consider hormone therapy?
It is effective for many women. Discuss the benefits and risks with your doctor.
Sources
- Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev 2012. PMID: 22972105. https://pubmed.ncbi.nlm.nih.gov/22972105/
- Taku K, Melby MK, Kronenberg F, et al. Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: systematic review and meta-analysis of randomized controlled trials. Menopause 2012. PMID: 22433977. https://pubmed.ncbi.nlm.nih.gov/22433977/
- Mahady GB, et al. United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause 2008. PMID: 18340277. https://pubmed.ncbi.nlm.nih.gov/18340277/
- Lethaby A, et al. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Syst Rev 2013. PMID: 24323914. https://pmc.ncbi.nlm.nih.gov/articles/PMC10247921/
- The NAMS 2023 Nonhormone Therapy Position Statement Advisory Panel. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause 2023. PMID: 37252752. https://pubmed.ncbi.nlm.nih.gov/37252752/
- The NAMS 2022 Hormone Therapy Position Statement Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause 2022. PMID: 35797481. https://pubmed.ncbi.nlm.nih.gov/35797481/
- MedlinePlus: Menopause
This article is for educational purposes only and is not medical advice. It does not replace an individual evaluation. Talk with your healthcare provider before starting supplements or changing medications, especially if you are pregnant, nursing, or managing a health condition.
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