Natural help for the menopause - herbs & nutrients

The menopause is a natural transition in every woman's life. During this phase, hormone levels - particularly oestrogen and progesterone - fall and the body switches from a reproductive to a non-reproductive state. This change is different for every woman. Many experience hot flushes, sleep disorders, mood swings, weight gain, changes in the skin, joint pain, dryness of the mucous membranes (e.g. vaginal dryness), anxiety, stress and other menopausal symptoms. The medical term "menopause" refers to the last menstrual period; the transitional period before and after this is referred to as perimenopause or postmenopause. This article is aimed at women in these stages of life and shows natural strategies that you can use to gently harmonize your hormone balance and alleviate symptoms such as hot flushes - without having to resort to medication immediately.

What happens in the body during the menopause?

The menopause occurs on average around the age of 51, but can start earlier or later depending on genetics, lifestyle and environmental factors. During this time, the body significantly reduces the production of the sex hormones oestrogen and progesterone in the ovaries. This changes many processes in the body: the metabolism slows down, the distribution of fatty tissue changes (often more in the abdomen), bone loss increases and mood swings, sleep problems and hot flushes can occur. Some women suffer more from these symptoms, while others only notice minor changes. How you experience the symptoms depends on your individual health, your lifestyle habits and also your mental attitude to this stage of life. A positive outlook on this phase and small biohacking tricks such as conscious breathing, mindfulness or moderate exercise can help you to take the transition more calmly and accept it as a natural new beginning.

Why are many women looking for natural alternatives?

Although traditional hormone replacement therapy (HRT) can effectively alleviate menopausal symptoms, it is not popular with all women due to possible side effects (e.g. a slightly increased risk of breast cancer or cardiovascular disease). In addition, some women are not allowed to use HRT for health reasons (e.g. increased risk of thrombosis or after hormone-dependent tumors). This is why many are interested in menopause herbs and natural hormone therapy. It is important to note that herbal preparations are not miracle cures. They can relieve symptoms, but are no substitute for medical advice. A gynecologist should always be consulted, especially in the case of severe symptoms. In addition, in Europe only those food supplements that have been officially approved by the European Food Safety Authority (EFSA) may be used. Many of the plants described here do not have EFSA-approved health claims; their effects are based on traditional experience and individual studies. Therefore, for most of these plants you will find a note that further research is required and that certain relationships have not been confirmed by the EFSA.

Important vital substances - building blocks for well-being

Before we look at individual herbs, it is worth taking a look at micronutrients. Vitamins and minerals make a significant contribution to health and hormone balance. A balanced menopause diet is the basis: fresh vegetables and fruit, wholegrain products, healthy fats, sufficient protein and plenty of water support the metabolism and hormone balance. Some micronutrients even have EFSA-approved statements (health claims):

• Vitamin B6: contributes to normal energy metabolism and the regulation of hormone activity. In Europe, the claim "contributes to the regulation of hormone activity" is officially approved - vitamin B6 is therefore an important helper for hormone balance. Foods such as salmon, bananas, pulses and wholegrain products provide plenty of vitamin B6.
• Vitamin D and calcium: contribute to the maintenance of normal bones. The risk of osteoporosis increases with age and falling oestrogen levels. Vitamin D is formed in the skin through sunlight; in northern countries, sunlight exposure is often insufficient, which is why many doctors recommend a supplement. Calcium is mainly found in dairy products, green vegetables and nuts. Vitamin K2 also plays a role in healthy bones, as it supports the storage of calcium in the skeleton.
• Vitamin C: supports the immune system and collagen formation - the latter is important for firm skin and strong bones. Citrus fruits, peppers, berries and broccoli are good sources of vitamin C.
• Magnesium: contributes to the normal functioning of the nervous system and muscles. Many women take additional magnesium to relieve muscle cramps or sleep problems. Good sources are nuts, seeds, green leafy vegetables and whole grains.
• Omega-3 fatty acids: are found in fatty sea fish (salmon, mackerel, herring) or algae oil. They have an anti-inflammatory effect and can support the cardiovascular system and brain function.

A sensible nutritional supplement program for vital substances for women 50+ should contain a good mix of these vitamins and minerals. But be careful: "a lot helps a lot" does not apply here - too much can even be harmful. Stick to the recommended daily doses and talk to your doctor if you are unsure.

Herbs and herbal therapies

Numerous plants have made a name for themselves in folk medicine because they are said to regulate hormone levels or alleviate menopausal symptoms. Many contain so-called phytoestrogens - secondary plant substances that have a similar structure to the body's own oestrogen and can dock onto oestrogen receptors in the body. Below you will find an overview of the most important herbs, together with study results - always with the note that these are possible effects and not promises of a cure.

Red clover (Trifolium pratense)

Red clover is rich in isoflavones, a class of plant estrogens. In a 12-week, randomized, placebo-controlled study of 72 postmenopausal women, daily intake of 40 mg of dried red clover led to a significant improvement in menopausal symptoms. The Menopause Rating Scale (MRS) total score fell on average from 20.4 to 10.1 points, while the placebo group only fell from 20.8 to 17.2 points[1]. A crossover study with 109 women also showed that 80 mg of red clover isoflavones per day reduced the frequency of hot flushes and the Kupperman index by over 70%, while placebo only brought about minimal changes[2]. In a Danish study, researchers combined red clover isoflavones with probiotics: 62 women were given a preparation containing 34 mg isoflavones plus lactic acid bacteria for 12 weeks. The hot flush frequency (number of hot flushes) decreased significantly compared to the placebo, and skin conductance - an objective measure of sweating - also improved significantly[3]. These results suggest that red clover may be a helpful option for mild to moderate hot flushes. However, an EFSA health claim (approved advertising claim) is not available for this; further studies are required.

Important: Red clover can affect blood clotting and should not be taken together with blood-thinning medication. As it has a weak estrogenic effect, many experts advise caution in the case of hormone-sensitive cancers. Consult your doctor before taking it if you have a relevant pre-existing condition.

Black cohosh (Cimicifuga racemosa, also known as black cohosh)

Black cohosh is a classic women's herb. Its root contains triterpene glycosides, which are thought to act on the brain to reduce hot flushes. In a large study involving 244 Chinese women, an isopropanolic black cohosh root extract was compared with the synthetic steroid tibolone. After 12 weeks, both groups had similar improvements on the Kupperman Index (a reduction from around 24 to 7.7 and 7.5 points respectively), but the herbal treatment had significantly fewer side effects[4]. In contrast, a smaller placebo-controlled study from Thailand (54 women) found no significant differences between black cohosh and placebo in terms of hot flushes or quality of life[5]. A US study of 28 women with menopausal anxiety disorder also showed no superiority of black cohosh over placebo in terms of anxiety symptoms[6]. These mixed results suggest that black cohosh helps some women but has no effect on others.

Black cohosh is licensed in Germany as a traditional herbal medicinal product; however, there is no EFSA health claim. Caution is advised in the case of existing liver disease, as liver-damaging effects have been reported in isolated cases. Long-term use over several months without medical supervision is not recommended.

Sage (Salvia officinalis)

Sage is not only a culinary herb, but traditionally also has an antiperspirant effect. In 2016, an Iranian research team examined 100 postmenopausal women in a double-blind study: The participants took three tablets of 100 mg sage extract or a placebo every day for eight weeks. At the end of the study, the frequency and intensity of hot flushes and night sweats were significantly lower in the sage group than in the control group[7]. Another preparation - made from fresh sage leaves - was tested in a double-blind Swiss study involving 80 women. After three months, the Menopause Rating Scale total score decreased by 39% in the verum group, while the placebo group only decreased by 17%; the severity of hot flushes was also reduced by 55%[8]. These results are promising, but again there is no EFSA health claim.

Sage contains high doses of thujone, which can have a neurotoxic effect in high concentrations. Ready-made preparations are therefore preferable as they provide standardized (and safe) quantities.

Evening primrose oil (Oenothera biennis)

Eveningprimrose oil is extracted from the seeds of the evening primrose and is rich in gamma-linolenic acid, an omega-6 fatty acid. In an Iranian study from 2021, 56 postmenopausal women took 1,000 mg of evening primrose oil or a placebo daily for two months. The frequency and severity of night sweats decreased significantly in the evening primrose group, while the number of hot flushes was not significantly affected[9]. An older, 6-week study with 56 women showed that evening primrose oil reduced the severity of hot flushes more significantly than placebo, while the effect on the frequency was only slight[10]. These results suggest that evening primrose oil may be particularly helpful for night sweats.

As a dietary supplement, evening primrose oil should be stored in a cool, dark place so that the unsaturated fatty acids do not oxidize. People with epilepsy or a tendency to bleed should only use evening primrose oil in consultation with their doctor.

Vitex agnus-castus (monk's pepper)

Monk's pepper is traditionally used for PMS and menstrual cycle problems. A randomized, double-blind study from Iran compared 26 women who took Vitex extract for eight weeks with 26 women who received a placebo. At the end of the study, scores for total symptoms, anxiety and vasomotor symptoms (e.g. hot flushes) were significantly lower in the Vitex group[11]. However, there were no significant differences in purely physical symptoms or depressive mood. This suggests that Vitex can help with psychological symptoms and hot flushes in particular. Again, there is no EFSA health claim and monk's pepper should not be used by pregnant women.

Soy isoflavones and other phytoestrogens

Soy is oflavones are among the best-known plant-based oestrogens. In an Indian pilot study, 29 perimenopausal and 21 postmenopausal women took 100 mg of soy isoflavones daily for twelve weeks. The Menopause Rating Scale (MRS) improved by about 20% in the perimenopausal and 12% in the postmenopausal participants; the most significant improvements were in hot flushes and psychological symptoms[12]. These data suggest that soy isoflavones may provide moderate relief. Because isoflavones have a weak estrogenic effect, women with hormone-dependent tumors should consult their doctor before taking them. Other plants such as lentils, chickpeas or linseed also contain phytoestrogens - they can be regularly incorporated into the diet and also provide fiber.

Other herbs

• St. John's wort: is mainly used against depressive moods. A small study that combined St. John's wort with monk's pepper observed a reduction in hot flushes and an improvement in mood; however, the results of the study were inconclusive. Caution: St. John's wort influences the effect of many medications (e.g. the pill, blood thinners) and must not be taken without medical advice.
• Siberian rhubarb: Extracts from Rheum rhaponticum (available in Germany, for example, as Menoflavon® ) contain special hydroxystilbenes that have an oestrogen-like effect in the body. Some studies show significant relief from hot flushes and other symptoms, but no EFSA health claims are available.
• Black sage(Salvia miltiorrhiza): used in traditional Chinese medicine, but studies on menopause are limited.
• Hops: contains 8-prenylnaringenin, a potent phytoestrogen. Initial studies suggest a reduction in hot flushes as well as improvements in sleep and mood, but the data is still sparse.
• Yam root: is often used in "natural progesterone" creams.
• Maca(Lepidium meyenii): a root tuber from the Andes, traditionally used to boost female libido and vitality. Some small studies suggest that maca can alleviate mood swings and sexual problems during menopause; in one review, all four available RCTs showed positive effects[13]. However, the number of participants was small and it is not yet possible to draw any firm conclusions about the efficacy or safety of maca.
• Ashwagandha(Withania somnifera): an adaptogen from Ayurvedic medicine, known for its stress-regulating effect. A recent study of 100 perimenopausal women found that ashwagandha (2 × 300 mg/day, 8 weeks) significantly improved menopausal symptoms more than placebo - including improvements in anxiety, fatigue and sleep quality[14]. Oestrogen levels also increased significantly in the ashwagandha group, while FSH decreased. Despite these promising results, there is no EFSA health claim to date and further research is needed.

With all herbs, the composition of available products can vary and the quality depends on the manufacturing process. When buying dietary supplements for the menopause, look for standardized extracts and reputable manufacturers.

Natural hormones? - Beware of misunderstandings

Many women search online for natural hormones or "progesterone natural". It is important to know that real hormones (e.g. progesterone, oestradiol) are prescription drugs. Products from the yam root only contain precursors that can be converted to progesterone in the laboratory, but do not spontaneously become active hormones in the body. Creams with so-called "bioidentical progesterone" can be prescribed as medicines, but should only be used under the supervision of a specialist. As a general rule, health claims for food supplements are not legally permitted if they have not been approved by the EFSA.

Exercise and weight control during the menopause

Even if herbal remedies can have a supportive effect, lifestyle remains the most important factor for a pleasant menopause. Exercise in particular helps to cushion typical changes. Due to the drop in hormone levels, muscle mass decreases, while fat mass - especially around the abdomen - increases. Strength training is highly recommended to counteract weight gain during the menopause. Muscles burn more calories than fat tissue, strengthen the bones and improve insulin sensitivity. A combination of strength and endurance training is ideal, about three to four times a week for 30-60 minutes. Regular everyday exercise (e.g. brisk walks, cycling or climbing stairs) also goes a long way towards keeping the metabolism active. Yoga or Pilates can also improve posture and help to reduce stress.

Stress management and sleep

Stress and inner restlessness exacerbate many menopausal symptoms. Relaxation techniques such as meditation, breathing exercises, mindfulness training or autogenic training can help to calm the nervous system. Caffeine, alcohol and heavy meals should also be avoided before going to bed. A dark, cool bedroom promotes restful sleep. If sleep problems occur during the menopause, a tea made from lemon balm or lavender in the evening can have a calming effect. It also helps to put away screens (cell phone, TV, tablet) at least one hour before going to bed - this allows the body to better produce the sleep hormone melatonin.

Nutrition during the menopause

Fiber-rich foods such as vegetables, fruit and wholegrain products support digestion and help to keep blood sugar levels stable. Phytoestrogens from soybeans, linseed and red clover can have a positive effect on hormone levels in a gentle way. Fermented foods such as yogurt, sauerkraut or kefir provide beneficial probiotics that strengthen the intestinal flora - in the red clover study with probiotics, this was probably an additional factor in the positive effects[3]. Many experts also recommend reducing the consumption of sugar and refined carbohydrates, as these can promote weight gain and insulin resistance.

Make sure you consume enough protein (approx. 1 g protein per kilogram of body weight) to maintain your muscles. High-quality fats from avocado, nuts, seeds and olive oil provide essential fatty acids and support the heart and brain. Drink at least 1.5-2 liters of water a day. However, alcohol and nicotine should be limited as they can increase hot flushes.

Biohacking for women - modern approaches

The term biohacking for women describes methods with which you can consciously optimize your own body. This includes, for example, tracking symptoms, sleep and mood using apps or fitness wearables. This allows you to identify what triggers your hot flushes - for example stress, alcohol or spicy food. Some women also rely on alternating hot and cold showers or sauna sessions to train the autonomic nervous system. Others swear by intermittent fasting, which can be good for the metabolism and hormone balance. It is important to approach such self-experiments cautiously and to listen to the body's signals.

Menopause supplement & product recommendation

Food supplements can be useful if they provide specific important vitamins and minerals and are based on high-quality herbal extracts. A good menopause supplement should, for example, contain isoflavones from red clover or soybeans, vitamin B6 (to support hormone activity), vitamin D and calcium (for the bones) and magnesium (for nerves and muscles). Black cohosh, sage or monk's pepper can also be added, provided this is well tolerated by the individual.

When choosing products, the focus should be on quality and transparency. Many cheap preparations contain fillers or insufficient doses of the active ingredients. The combination of different herbs can also be useful - as the Danish study with red clover and probiotics showed[3]. Nevertheless, consumers should not haphazardly take everything at the same time, but should patiently try out what works for them. Remember: If no EFSA health claims are available, providers are not allowed to make any claims of efficacy (there is often a reference to the lack of confirmation by the authority).

Here you can find our product: XTRA FUEL Meno Balance. It contains a carefully balanced mixture of red clover isoflavones, sage extract, vitamins and minerals. Please note that the positive effects described are based on studies and are not yet approved as health claims in Europe - further research is required.

Menopause alternative treatment: what really works?

There are numerous alternative approaches - from acupuncture and homeopathy to Schuessler salts. However, only a few methods have been scientifically well researched. Acupuncture can relieve hot flushes in the short term, but the effects are often similar to those of sham acupuncture. Homeopathy is based on different principles and is scientifically controversial. If you want to try alternative methods, you should consult an experienced therapist and ensure that you receive conventional medical care at the same time.

Regular checks of bone density, blood values and cardiovascular risk are important during the menopause. Targeted menopause prevention - i.e. sufficient exercise, a balanced diet and stress management - can have a positive effect on many symptoms. Medical treatments are also available for severe symptoms: from classic HRT and low-dose antidepressants (to relieve hot flushes) to local estrogen for vaginal dryness. Natural methods can supplement these therapies, but cannot replace them in all cases.

Conclusion: herbal balance and mindfulness

The menopause is not a clinical picture, but a natural stage in life. A conscious herbal balance means using plants and nutrients as gentle companions to support inner balance. Studies have shown that red clover, black cohosh, sage, evening primrose oil and monk's pepper can alleviate hot flushes or psychological complaints. Studies from Iran, China, Denmark and India report positive effects[11][4][3][12]. However, these are mostly small to medium sized studies and not all results are consistent. It is therefore important to have realistic expectations and be aware of possible side effects.

A mindful lifestyle remains the foundation: sufficient sleep, exercise, a nutritious diet, little alcohol, stress reduction and a supportive environment all contribute significantly to experiencing the menopause as a positive new beginning. After all, the end of the fertile years also marks the beginning of a new phase full of personal freedom and opportunities. If you decide to take dietary supplements, you should make sure they are of high quality and agree their intake with your doctor. There are clear EFSA statements for some vital substances such as vitamin B6 or vitamin D; further studies are required for herbs. With patience, knowledge and self-care, the path through the menopause can be made much smoother.

Note: All preparations mentioned in this article (herbs, oils, etc.) are foods or traditional herbal medicines. They are not intended to treat, cure or prevent diseases. The effects described have not been confirmed by the European Food Safety Authority (EFSA); further research is required.

Sources

1. [1] Shakeri, F., Taavoni, S., Goushegir, A., & Haghani, H. (2015). Effectiveness of red clover in alleviating menopausal symptoms: a 12-week randomized, controlled trial. Climacteric, 18(4), 568-573. DOI: 10.3109/13697137.2014.999660.
2. [2] Lipovac, M., Chedraui, P., Gruenhut, C., Gocan, A., Kurz, C., Neuber, B., & Imhof, M. (2012). The effect of red clover isoflavone supplementation over vasomotor and menopausal symptoms in postmenopausal women. Gynecological Endocrinology, 28(3), 203-207. DOI: 10.3109/09513590.2011.593671.
3. [3] Lambert, M. N. T., Thorup, A. C., Hansen, E. S. S., & Jeppesen, P. B. (2017). Combined red clover isoflavones and probiotics potently reduce menopausal vasomotor symptoms. PLOS ONE, 12(6), e0176590. DOI: 10.1371/journal.pone.0176590.
4. [4] Bai, W., Henneicke-von Zepelin, H. H., Wang, S., Zheng, S., Liu, J., Zhang, Z., et al. (2007). Efficacy and tolerability of a medicinal product containing an isopropanolic black cohosh extract in Chinese women with menopausal symptoms: a randomized, double-blind, parallel-controlled study versus tibolone. Maturitas, 58(1), 31-41. DOI: 10.1016/j.maturitas.2007.04.009.
5. [5] Tanmahasamut, P., Vichinsartvichai, P., Rattanachaiyanont, M., Techatraisak, K., Dangrat, C., & Sardod, P. (2015). Cimicifuga racemosa extract for relieving menopausal symptoms: a randomized controlled trial. Climacteric, 18(1), 79-85. DOI: 10.3109/13697137.2014.933410.
6. [6] Amsterdam, J. D., Yao, Y., Mao, J. J., Soeller, I., Rockwell, K., & Shults, J. (2009). Randomized, double-blind, placebo-controlled trial of Cimicifuga racemosa (black cohosh) in women with anxiety disorder due to menopause. Journal of Clinical Psychopharmacology, 29(5), 478-483. DOI: 10.1097/JCP.0b013e3181b2abf2.
7. [7] Kiani Rad, S., Forouhari, S., Samsami Dehaghani, A., Vafaei, H., Sayadi, M., & Asadi, M. (2016). The effect of Salvia officinalis tablet on hot flashes, night sweating, and estradiol levels in postmenopausal women. International Journal of Medical Research & Health Sciences, 5(8), 257-263.
8. [8] Dimpfel, W., Chiegoua Dipah, G. N., Bommer, S., Suter, A., & Schoop, R. (2021). Effectiveness of Menosan® Salvia officinalis in the treatment of a wide spectrum of menopausal complaints: a double-blind, randomized, placebo-controlled trial. Heliyon, 7(2), e05910. DOI: 10.1016/j.heliyon.2021.e05910.
9. [9] Kazemi, F., Masoumi, S. Z., Shayan, A., & Oshvandi, K. (2021). The effect of evening primrose oil capsules on hot flashes and night sweats in postmenopausal women: a single-blind randomized controlled trial. Journal of Menopausal Medicine, 27(1), 8-14. DOI: 10.6118/jmm.20033.
10. [10] Farzaneh, F., Fatehi, S., Sohrabi, M. R., & Alizadeh, K. (2013). The effect of oral evening primrose oil on menopausal hot flashes: a randomized clinical trial. Archives of Gynecology and Obstetrics, 288(5), 1075-1079. DOI: 10.1007/s00404-013-2852-6.
11. [11] Naseri, R., Farnia, V., Yazdchi, K., Alikhani, M., Basanj, B., & Salemi, S. (2019). Comparison of Vitex agnus-castus extract with placebo in reducing menopausal symptoms: a randomized, double-blind study. Korean Journal of Family Medicine, 40(6), 362-367. DOI: 10.4082/kjfm.18.0067.
12. [12] Ahsan, M., & Mallick, A. K. (2017). The effect of soy isoflavones on the Menopause Rating Scale score in perimenopausal and postmenopausal women: a pilot study. Journal of Clinical and Diagnostic Research, 11(9), FC13-FC16. DOI: 10.7860/JCDR/2017/26034.10654.
13. [13] Lee, M. S., Shin, B. C., Yang, E. J., Lim, H. J., & Ernst, E. (2011). Maca(Lepidium meyenii) for treatment of menopausal symptoms: a systematic review. Maturitas, 70(3), 227-233. DOI: 10.1016/j.maturitas.2011.07.017.
14. [14] Gopal, S., Ajgaonkar, A., Kanchi, P., Kaundinya, A., Thakare, V., Chauhan, S., et al. (2021). Effect of an ashwagandha(Withania somnifera) root extract on climacteric symptoms in women during perimenopause: a randomized, double-blind, placebo-controlled study. Journal of Obstetrics and Gynaecology Research, 47(12), 4414-4425. DOI: 10.1111/jog.15030.