FRIDAY, Feb. 18, 2022 (HealthDay News) — Women struggling with life change often head to the supplements section of their pharmacy to deal with menopausal symptoms like hot flashes and insomnia.

But experts say they’d be better off going to their doctor and seeking clinically proven treatments rather than relying on an herbal remedy.

There is little clinical evidence that supplements like black cohosh, soy isoflavones, Swedish pollen, magnolia bark and melatonin effectively relieve menopausal symptoms, said obstetrician Dr. Jennifer Howell and gynecologist at Duke Health in Durham, North Carolina.

“The ingredients in most supplements have been studied and not shown to be better than placebo over time,” Howell said. “Most of them are reasonably safe. You can try them. But it’s hard for me to endorse them.”

The supplement most widely touted as a remedy for menopause – black cohosh – has been shown in two high quality clinical trials is no better than a placebo, according to the US National Institutes of Health (NIH) Office of Dietary Supplements.

Worse still, in rare cases, black cohosh can damage the liver.

“Some experts actively discourage it because there’s no evidence that black cohosh works, and some patients will experience liver inflammation from it,” Howell said.

Soy isoflavones — essentially plant-based estrogens — have had mixed results in treating menopausal symptoms, according to the NIH. Howell warns women who have an increased risk of cancer to speak with their doctor before trying soy isoflavonesbecause estrogen can fuel some tumors.

An extract derived from the roots of rhapontic, or false rhubarb, is used in some proprietary herbal supplements for menopause. A small scale clinical trial in Germany showed some benefit for the extract over placebo, but no follow-up research has taken place.

One of the problems with these and other supplements is that they’re not regulated by the U.S. Food and Drug Administration, Howell said.

“They can make claims and they don’t need to be backed up with rigorous scientific data like a drug would,” she said.

Experts also warn that there is little to no evidence for another “herbal” product increasingly used by postmenopausal women – marijuana.

Cannabis and wine are two remedies that women have turned to for decades when coping with menopause, said Dr. Suzanne Fenske, assistant clinical professor of obstetrics, gynecology and reproductive sciences at the Icahn School of Medicine at Mount Sinai, New York.

The legalization of marijuana has led to more women trying pot for menopause relief. A study presented at the 2020 meeting of the North American Menopause Society found that more than a quarter of American female veterans had used marijuana to treat their menopause, and another 10% were planning to try it.

“People are still going to wine and cannabis, and now we’re finally pricing it out,” Fenske said.

But most research on marijuana and women’s health has so far focused on pot use during pregnancy and breastfeeding, according to a 2021 evidence review in the journal. Cannabis and cannabinoid research.

“Although some users may find cannabis beneficial for improving signs and symptoms commonly associated with menopause… (e.g., insomnia, irritability, joint pain, depression), there is little data on the effectiveness and the safety of cannabis use in this setting,” the review concluded.

Howell said her concerns about using marijuana to relieve menopausal symptoms stem in part from her knowledge of treatment history during the life change. For decades, women were diagnosed as neurotic and loaded with tranquilizers if they had trouble making the transition.

“We’ve been there before and we’ve done it with addictive drugs given to women during menopause,” Howell said. “I personally don’t care much. Women were prescribed highly addictive barbiturates, sedatives and sleeping pills for menopause in the past, which is really hard and dangerous to stop.”

Women trying supplements are probably better off talking to their doctors about hormone replacement therapy, Fenske and Howell said.

Hormone replacement therapy offers greater relief from menopausal symptoms than is seen with supplements, Fenske said.

In addition to that, “if hormone replacement therapy is initiated within 10 years of menopause, there are actually some benefits” for overall health, Fenske said. She noted that women who receive hormone therapy have a reduced risk of heart disease, colon cancer and osteoporosis.

Hormone therapy was widely used from the 1960s, and even touted as “like being female forever”, until the 2002 Women’s Health Initiative study raised concerns that the treatment might increase the breast cancer risk, Fenske said.

More recent studies and a new analysis of older studies have also shown that healthy women who take hormone replacement therapy for a short time around their transition actually have a lower risk of premature death from all causes. Howell said. JTherapy is generally limited to three to five years.

“I think this should be the first line for patients who have symptoms around the time of menopause,” Howell said. “It shouldn’t be, ‘Try everything else and then we’ll let you use that.'”

A host of other medications have been shown to relieve specific symptoms like hot flashes or insomnia, including antidepressants and antiepileptics, Howell said.

Another way women can help ease their symptoms is to change their eating habits, Fenske said.

“We know that nutrition is actually really important,” she said. “You can get an exacerbation of hot flashes and night sweats from what we put into our bodies.”

For example, lots of carbs in your diet can make hot flashes worse, as can drinking alcohol too close to bedtime, Fenske said.

The Office of Women’s Health has more information on menopause symptoms and relief.

SOURCES: Jennifer Howell, MD, obstetrician and gynecologist, Duke Health, Durham, NC; Suzanne Fenske, MD, assistant clinical professor, obstetrics, gynecology, and reproductive sciences, Icahn School of Medicine at Mount Sinai, New York City