Menopausal Symptoms and
Complementary Health Practices

On this page:

• Key Points
• About Menopause
• Common Symptoms During the Menopausal Transition
• Menopausal Hormone Therapy
• What the Science Says About Complementary Health Practices for Menopausal Symptoms
• NCCAM Research on Complementary Health Practices for Menopausal Symptoms
• If You Are Considering a Complementary Health Practice for Menopausal Symptoms
• Selected References
• For More Information

Menopause is the permanent end of a woman’s menstrual periods. Menopause occurs naturally, or it can be caused by surgery, chemotherapy, or radiation. Natural products or mind and body practices are sometimes used in an effort to relieve menopausal symptoms such as hot flashes and night sweats. This fact sheet provides basic information about menopause, summarizes research on the efficacy and safety of complementary health practices for menopausal symptoms, and suggests sources for additional information. It builds on findings from a 2005 National Institutes of Health (NIH) State-of-the-Science conference on the management of menopause-related symptoms, with updates to reflect new developments. Information from the conference is available from NIH at www.consensus.nih.gov/2005/menopause.htm.

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Key Points

• Mind and body practices such as yogaA practice from Ayurvedic medicine that combines breathing exercises, physical postures, and meditation. It is intended to calm the nervous system and balance the body, mind, and spirit., tai chiA practice in traditional Chinese medicine that uses a series of slow, gentle movements coordinated with breathing and meditation. The goal is to enhance physical functioning, improve balance and concentration, and reduce stress., qi gongA component of traditional Chinese medicine that combines movement, meditation, and controlled breathing. The intent is to improve blood flow and the flow of qi., and acupunctureA family of procedures that originated in traditional Chinese medicine. Acupuncture is the stimulation of specific points on the body by a variety of techniques, including the insertion of thin metal needles though the skin. It is intended to remove blockages in the flow of qi and restore and maintain health. may help reduce the severity of menopausal symptoms.
• Researchers are studying herbal supplements sometimes used for menopausal symptoms in an effort to identify their different compounds and active ingredients and to understand their effects in the body. Some of these supplements can have serious side effects.
• “Bioidentical hormone replacement therapy” or “BHRT” is a marketing term used to describe medications that are prepared in specialized pharmacies and may contain any variation of hormones including, estrone, estradiol, progesterone, and testosterone. They are not approved by the U.S. Food and Drug Administration.
• Tell all your health care providers about any complementary health practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

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About Menopause

“Menopausal transition” refers to the time leading up to menopause, involving hormonal changes that can span several years. A woman is said to have completed natural menopause when she has not had a period for 12 consecutive months and for American women, this typically happens at around age 51 or 52. Menopause occurs immediately if both ovaries are surgically removed,¹ or if the ovaries are severely damaged in cancer treatment with radiation therapy or chemotherapy. For menopause-related information from NIH, visit www.health.nih.gov/topic/menopause/womenshealth.

¹ In performing a hysterectomy, which refers to the surgical removal of the uterus, a surgeon may or may not also remove the ovaries. Either way, periods stop immediately. If one or both ovaries remain, some hormone production may continue.

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Common Symptoms During the Menopausal Transition

Some symptoms that women experience as they age are related to menopause and decreased activity of the ovaries. Other symptoms may be related to aging in general. Scientific evidence of a link to menopause is strongest for the following symptoms:

• Hot flashes and night sweats (also called vasomotor symptoms, because they involve the expansion of the blood vessels)
• Vaginal dryness, which can lead to painful intercourse.

Some women also may experience problems with reasoning or remembering things. This may be related, in part, to changes in estrogen during the menopausal transition.

It is not certain whether the following symptoms are due to menopause, other factors that can come with aging, or a combination of menopause and age-related factors:

• Urinary incontinence
• Physical complaints, such as tiredness and stiff or painful joints
• Changes in mood, such as depression, anxiety, and/or irritability. These symptoms are similar to premenstrual syndrome.

The expert panel assembled for the NIH State-of-the-Science conference noted that menopause is a normal part of women’s aging and advised that menopause should not be “medicalized” (or viewed as a disease).

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Menopausal Hormone Therapy

For decades, hormone therapy was a widely used treatment for menopausal symptoms. Estrogen has been used alone as a menopausal hormone therapy in women who have had their uterus removed. Progestin, the synthetic form of an estrogen-related hormone called progesterone, is combined with estrogen as a menopausal hormone therapy in women who still have their uterus. Progestin stops the growth of cells in the lining of the uterus. Continued growth of these cells can lead to uterine cancer.

The Women’s Health Initiative (WHI), a 15-year research program launched in 1991, was designed to address the most common causes of death, disability, and poor quality of life in postmenopausal women. The research program examined the effectiveness of hormone replacement therapy in women, which at the time was considered to be a promising intervention. Findings from two WHI clinical trials examined:

• The use of estrogen plus progestin in women with a uterus
• The use of estrogen only in women without a uterus.

In both studies, women were randomly assigned to receive either the hormone medication or placebo. The findings of the studies raised serious concerns about the long-term safety of menopausal hormone therapy. For example, in both studies, when compared with placebo, the hormone medication (whether estrogen plus progestin or estrogen only) resulted in an increased risk of stroke and blood clots. In addition, the estrogen plus progestin medication resulted in an increased risk of heart attack and breast cancer. Through this long-term, well-designed series of studies, the WHI showed how rigorous research can lead to answers of difficult and important questions affecting health and health care. These concerns are one reason that many women are turning to mind and body practices and natural products to help with menopausal symptoms.

For menopausal hormone therapy-related information from NIH, visit www.nih.gov/PHTindex.htm.

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What the Science Says About Complementary Health Practices for Menopausal Symptoms

The NIH State-of-the-Science conference panel noted the overall shortage of well-designed research on complementary health practices for menopausal symptoms. Many studies have had limitations (such as the way the research was done or treatment periods that may not have been long enough). As a result, the findings from these studies have not been strong enough for scientists to draw any conclusions. Also, many studies of botanicals have not used a standardized product (i.e., one that is chemically consistent).

Since the 2005 NIH panel’s findings, scientists are continuing to build an evidence base on complementary therapies for menopausal symptoms. Although questions remain, research is progressing. For example, NCCAM is sponsoring studies on mind and body approaches that have shown promise for reducing menopausal symptoms, and on botanicalA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. products that are both well characterized (i.e., their ingredients have been carefully studied) and well standardized.

Mind and Body Therapies for Menopausal Symptoms

A growing body of evidence suggests that mind and body practices such as yoga, tai chi, qi gong, and acupuncture may benefit women during menopause. Research is under way to explore these preliminary findings.

• A 2010 review of 21 papers assessed mind and body therapies for menopausal symptoms. The researchers found that yoga, tai chi, and meditation-based programs may be helpful in reducing common menopausal symptoms including the frequency and intensity of hot flashes, sleep and mood disturbances, stress, and muscle and joint pain.
• Another 2010 review assessed studies that examined the use of acupuncture for hot flashes related to natural or induced menopause. The studies that the researchers included in their review were limited to acupuncture studies performed using needles stimulated by hand or electrically. The researchers found that acupuncture may reduce the frequency and severity of hot flashes; they also concluded that the effect may occur regardless of where the acupuncture needle is placed on the body. However, some studies did not provide sufficient evidence to support the use of acupuncture for hot flashes due to their small size and poor quality. Further research is needed in order to provide more conclusive results.

Natural Products and Menopausal Symptoms

Because natural products used for menopausal symptoms can have side effects and can interact with other botanicals or supplements or with medications, research in this area is addressing safety as well as efficacy. Some findings from this research are highlighted below.

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Botanicals

• Black cohosh (Actaea racemosa, Cimicifuga racemosa). This herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. has received more scientific attention for its possible effects on menopausal symptoms than have other botanicals. Studies of its effectiveness in reducing hot flashes and other symptoms have had mixed results. A study funded by NCCAM and the National Institute on Aging (NIA) found that black cohosh, whether used alone or with other botanicals, did not relieve hot flashes and night sweats in postmenopausal women or those approaching menopause. In the same study, black cohosh also had no effect on gynecological problems such as vaginal dryness and abnormal bleeding. Other research suggests that black cohosh does not act like estrogen, as once was thought. Recent reviews of the clinical research literature on black cohosh for menopausal symptoms conclude that its efficacy has yet to be demonstrated.

  United States Pharmacopeia experts suggest that women should discontinue use of black cohosh and consult a health care practitioner if they have a liver disorder or develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice. There have been several case reports of hepatitis (inflammation of the liver), as well as liver failure, in women who were taking black cohosh. It is not known if black cohosh was responsible for these problems. Although these cases are very rare and the evidence is not definitive, scientists are concerned about the possible effects of black cohosh on the liver.

• Dong quai (Angelica sinensis). Only one randomized clinical study of dong quai has been done. The researchers did not find it to be useful in reducing hot flashes. Dong quai is known to interact with, and increase the activity in the body of, the blood-thinning medicine warfarin. This can lead to bleeding complications in women who take dong quai.
• Ginseng (Panax ginseng or Panax quinquefolius). The 2005 NIH panel concluded that ginseng may help with some menopausal symptoms, such as mood symptoms and sleep disturbances, and with one’s overall sense of well-being. However, ginseng has not been found helpful for hot flashes.
• Kava (Piper methysticum). According to the 2005 NIH panel, there is no evidence that kava decreases hot flashes, although it may decrease anxiety. Furthermore, it is important to note that kava has been associated with liver disease. The U.S. Food and Drug Administration (FDA) has issued a warning to patients and providers about kava because of its potential to damage the liver.
• Red clover (Trifolium pratense). The 2005 NIH panel found no consistent or conclusive evidence that red clover leaf extract reduces hot flashes. A large clinical trial and several reviews of the research literature concluded that red clover had no significant beneficial effects on menopausal symptoms. A review of the research literature also found no apparent evidence of adverse events from short-term use (up to 16 weeks). However, the same review noted the lack of data on the safety of long-term use. There are some concerns that red clover, which contains phytoestrogens, might have harmful effects on hormone-sensitive tissue (for example, in the breast and uterus). (See box below for more information on phytoestrogens.)
• Soy. The scientific literature includes mixed results on soy extracts for hot flashes. Some studies find benefits, but others do not. Although information on adverse effects is limited, soy extracts appear to be generally safe when taken for short periods of time. However, long-term use of soy extracts (which also contain phytoestrogens) has been associated with thickening of the lining of the uterus.

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DHEA

DHEA is a naturally occurring substance that is changed in the body to the hormones estrogen and testosterone. DHEA is manufactured and sold as a dietary supplementA product that contains vitamins, minerals, herbs or other botanicals, amino acids, enzymes, and/or other ingredients intended to supplement the diet. The U.S. Food and Drug Administration has special labeling requirements for dietary supplements and treats them as foods, not drugs.. A few small studies have suggested that DHEA might possibly have some benefit for hot flashes and decreased sexual arousal, although small randomized controlled trials have shown no benefit. Because levels of natural DHEA in the body decline with age, some people believe that taking a DHEA supplement can help treat or prevent conditions related to aging; however, there is no scientific evidence to support this notion.

Concerns have been raised about whether DHEA is safe and effective. Its long-term effects, risks, and benefits have not been well studied, and it remains unclear whether it might increase the risk for breast or prostate cancer. There is the possibility that even short-term use of DHEA supplements might have detrimental effects on the body. Before using DHEA for any purpose, people should talk to their health care provider about potential benefits and risks.

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Bioidentical Hormone Replacement Therapy

“Bioidentical hormone replacement therapy,” or BHRT, is a marketing term that is not recognized by the FDA. It is a term used to describe medications that are prepared in specialized pharmacies. BHRT may contain any variation of hormones including estrone, estradiol, estriol, progesterone, and testosterone.

Compounded bioidentical hormones are often marketed as natural and safe alternatives to conventional hormone therapy prescription medications. However, compounded formulas are often inconsistent and can vary depending on the batch or the pharmacist. While FDA-approved hormone preparations have been tested for efficacy, purity, safety, and potency, there is a lack of scientific evidence surrounding BHRT and the safety and efficacy of these compounds. As a result, compounded bioidentical hormones are not approved by the FDA. For additional information, see the FDA publication Bio-Identicals: Sorting Myths from Facts.

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NCCAM Research on Complementary Health Practices for Menopausal Symptoms

NCCAM supports a number of studies on complementary health practices (such as natural products and mind and body practices) for menopausal symptoms, as do some of the other institutes and centers at NIH. Examples of NCCAM-funded projects include:

• A trans-NIH initiative to improve scientific measures of hot flashes, which will lead to more productive clinical studies and a better understanding of hot flashes
• Research to identify natural plant-based compounds as promising alternatives to traditional menopausal hormone therapy
• Investigations of the safety and efficacy of black cohosh, red clover, soy supplements, and other botanicals for menopausal symptoms, as well as the mechanisms of action involved
• Studies of mind and body therapies—e.g., yoga, mindfulness-based stress reductionA type of meditation that focuses attention on breathing to develop increased awareness of the present. The intent is to reduce stress and control emotion in order to improve health. (a form of meditation), hypnotherapy, and acupuncture—for reducing hot flashes.

In addition, an NIH initiative led by NIA in collaboration with NCCAM, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the Office of Research on Women’s Health is looking at potential new treatments for menopausal symptoms.

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If You Are Considering a Complementary Health Practice for Menopausal Symptoms

Although there is little scientific evidence to support the effectiveness of complementary health practices for menopausal symptoms, it is possible that some approaches may provide relief to women during the menopausal transition. Here are a few important points to remember if you are considering these practices:

• Keep in mind that although many dietary supplements (and some prescription drugs) come from natural sources, “natural” does not always mean “safe.” For example, the herb kava may cause serious harm to the liver. Also, a manufacturer’s use of the term “standardized” (or “verified” or “certified”) does not necessarily guarantee product quality or consistency.
• Be aware that an herbal supplementA type of dietary supplement that contains herbs, either alone or in mixtures. may contain several compounds and that its active ingredients may not be known. Researchers are studying many of these products to identify those ingredients and understand their effects in the body. Also consider the possibility that what’s on the label may not be what’s in the bottle. Analyses of dietary supplements sometimes find differences between labeled and actual ingredients. For additional information, see the NCCAM fact sheet Using Dietary Supplements Wisely.
• Tell all your health care providers about any complementary health practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about complementary and alternative medicineA group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine., see NCCAM’s Time to Talk campaign.

In addition to some of the practices mentioned in this fact sheet, the NIH State-of-the-Science conference report (see “Selected References”) also discusses a variety of other interventions commonly used for relief of menopause-related symptoms. Women should keep in mind that certain lifestyle changes can contribute to healthy aging, including during the menopausal transition. For example, quitting smoking, eating a healthy diet, and exercising regularly have been shown to reduce the risks of heart disease and osteoporosis.

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Selected References

• Borud E, White A. A review of acupuncture for menopausal problems. Maturitas. 2010;66(2):131–134.
• Chervenak J. Bioidentical hormones for maturing women. Maturitas. 2009;64(2):86–89.
• Coon JT, Pittler MH, Ernst E. Trifolium pratense isoflavones in the treatment of menopausal hot flushes: a systematic review and meta-analysis. Phytomedicine. 2007;14(2-3):153–159.
• Geller SE, Shulman LP, van Breemen RB, et al. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause. 2009;16(6):1156–1166.
• Geller SE, Studee L. Botanical and dietary supplements for mood and anxiety in menopausal women. Menopause. 2007;14(3 Pt 1):541–549.
• Innes KE, Selfe TK, Taylor AG. Menopause, the metabolic syndrome, and mind-body therapies. Menopause. 2008;15(5):1005–1013.
• Innes KE, Selfe TK, Vishnu A. Mind-body therapies for menopausal symptoms: a systematic review. Maturitas. 2010;66(2):135–149.
• Lethaby A, Marjoribanks J, Kronenberg F, et al. Phytoestrogens for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews. 2007 [edited 2010];(4):CD001395. Accessed at www.thecochranelibrary.com on January 25, 2012.
• Mahady GB, Low Dog T, Barrett ML, et al. United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause. 2008;15(4 Pt 1):628–638.
• Maki PM, Freeman EW, Greendale GA, et al. Summary of the National Institute on Aging―sponsored conference on depressive symptoms and cognitive complaints in the menopausal transition. Menopause. 2010;17(4):815–822.
• National Institutes of Health. NIH State-of-the-Science Conference Statement on Management of Menopause-Related Symptoms. National Institutes of Health Web site. Accessed at consensus.nih.gov/2005/menopausestatement.pdf (250KB PDF) on January 25, 2012.
• Nelson HD, Vesco KK, Haney E, et al. Nonhormonal therapies for menopausal hot flashes: systematic review and meta-analysis. JAMA. 2006;295(17):2057–2071.
• Newton KM, Reed SD, LaCroix AZ, et al. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo. Annals of Internal Medicine. 2006;145(12):869–879.
• Palacio C, Masri G, Mooradian AD. Black cohosh for the management of menopausal symptoms: a systematic review of clinical trials. Drugs and Aging. 2009;26(1):23–36.
• Reed SD, Newton KM, LaCroix AZ, et al. Vaginal, endometrial, and reproductive hormone findings: randomized, placebo-controlled trial of black cohosh, multibotanical herbs, and dietary soy for vasomotor symptoms: the Herbal Alternatives for Menopause (HALT) Study. Menopause. 2008;15(1):51–58.
• Shams T, Setia MS, Hemmings R, et al. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Alternative Therapies in Health and Medicine. 2010;16(1):36–44.

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