Supplements for menopause: what does the science say?

An academic leader in this space, Dr Sarah Berry, chief scientist at ZOE ​and associate professor at King’s College London, tells NutraIngredients there is opportunity for nutrition to support health at this life stage but the scientific backing is yet to stand up to much of the hype and marketing claims.

Berry highlights research at ZOE ​which reveals changes in metabolism during menopause, suggesting the importance of nutrition and lifestyle interventions, whilst spotlighting the strong potentials of phytoestrogens including isoflavones.

Discussing the demand for HRT alternatives, Berry says: “Some women may prefer more natural methods. Supplements may also be more accessible, given that they do not require a prescription. However, it is always important to avoid mega-dosing with any nutritional supplement.”

“We plan to do a lot more research on women’s health, which is really exciting,” she adds.

Menopausal symptoms​

Menopause has been a largely unaddressed and under-studied life stage, involving significant hormonal changes which can lead to an array of adverse symptoms. These can range over sleep difficulties, psychological issues, muscle and joint pains, and urogenital symptoms, and thus can have a significant impact on quality of life.

Further complications resulting from associated weight gain can increase the risk of developing metabolic disorders and ultimately conditions such as type 2 diabetes and cardiovascular diseases.

It is known that post-menopause occupies more than one third of a women’s life and as menopause is increasingly studied, the search for natural solutions to alleviate the associated symptoms has been increasing over recent years. Thus, the current menopause market is expected to expand at a CAGR of 5.33% from 2023 to 2030 (Grand Research Review 2023).

Prevalent ingredients​

Red Clover ​

Red clover extract contains isoflavones, a type of phytoestrogen, which are phenolic plant compounds with a similar molecular structure to oestrogen. This enables them to bind to oestrogen receptors and potentially mimic their actions, which studies report reduce inflammation​ and hot flush occurrence​ in menopausal women. Further evidence​ has also suggested soy isoflavones may improve various skin health outcomes.

Berry explains: “Emerging evidence around phytoestrogens is proving to be promising, and isoflavones are the most well studied of these.

“We know from observational studies that populations with high intakes of isoflavones, such as Japan and China, have a lower prevalence of menopause symptoms. However, the evidence around isoflavones is still inconsistent and research suggests that the type and the dose of isoflavones are very important.

“The gut microbiome may also have a role to play in how we all respond differently to isoflavones,” she highlighted.

Black cohosh​

Black cohosh is a herb containing various beneficial compounds such as triterpene glycosides and alkaloids, and has been proposed for menopausal symptom relief due to its ability to bind to oestrogen receptors. However, the evidence on its influence on menopausal symptoms has been inconsistent.

A previous review​ concluded that there was a lack of significant influence of black cohosh on menopausal symptoms, yet the researchers highlighted significant heterogeneity between the included study. On the other hand, a recent review​ established a greater efficiency of its use compared to a placebo for vasomotor symptoms, highlighting its potential as an alternative to HRT.

Vitamins and biotics​

Many available menopausal supplements include an array of B-vitamins to support energy, hormone regulation, and psychological function. Vitamin D is also prevalent for muscle and bone health support, whilst further research has suggested benefits to urogenital and sexual health as previously reported at NutraIngredients​.

Probiotics have also shown promise, following studies​ suggesting significant declines in microbiome diversity during menopause.

Berry adds: “Although more research is needed to fully understand the connection between diet, gut microbiome, and menopause, it's clear that maintaining a healthy diet and improving gut health can be beneficial during the menopause. Some studies suggest that the gut microbiome may influence oestrogen levels, as well as inflammation and immune function, which may impact menopause-related issues.”

Diet and menopause​

Berry draws attention to the potential importance of the diet in influencing the severity of menopausal symptoms, with research at ZOE​ investigating this.

She explained: “Recent analysis of our PREDICT 1 UK cohort found that metabolic responses after meals were more unfavourable in postmenopausal women compared to premenopausal women.”

The research, which included 1002 pre-, peri-, and postmenopausal women, reported that the postmenopausal had higher fasting blood glucose, HbA1c and inflammatory measures, as well as higher postprandial glucose and insulin responses.

Previous studies​ have also highlighted that following a Mediterranean dietary pattern rich in anti-inflammatory and antioxidant foods may contribute to preventing associated bone, metabolic and cardiovascular diseases during the postmenopausal period.

Consumer trust​

Berry warned of the dangers of “menowashing”, whereby companies place the word ‘menopause’ or ‘meno’ in front of food or supplement product to sell at an increased price despite a lack of scientific backing.

“This can be misleading for the consumer, as these products may not be backed by scientific evidence to improve symptoms of the menopause,” she emphasised.

She called for further large scale RCTs to determine stronger cause-and-effect relationships between such supplements and menopausal symptoms, to enhance consumer trust in the category.