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By Dr. Ellen Albertson, PhD, RDN, NBC-HWC
The dreaded hot flash. It comes out of nowhere. Suddenly you feel hot, especially around your chest, neck, and face. The heat spreads rapidly through your body, reddening your skin so it looks like you’re blushing. You start to sweat—a little or a lot! As you strip off the layers, you may experience an increased heart rate and palpitations and begin to feel anxious. Once the flash has passed, you feel cold and experience chills from the loss of body heat and reach for the layers you just removed.
Distressing, uncomfortable, and even embarrassing, the hot sensation is over fast, typically lasting only one to five minutes. However, depending on the severity and frequency, hot flashes can dampen your day, interfere with your daily activities, and decrease your quality of life.
Hot flashes can be frequent or occasional—occurring a few times a week or as much as twice an hour—and mild or moderate to severe. When hot flashes occur at night, they are known as night sweats. They can wake you up and cause sleep disturbances and even insomnia.
Also known as hot flushes or vasomotor symptoms, hot flashes are the most common symptom during the transition to menopause and often the first sign that you are entering perimenopause. According to research in the Journal of Midlife Health, approximately 85% of menopausal women experience hot flashes, and about 55% experience them when the menstrual cycle starts to become irregular. While every woman experiences the menopausal transition differently, hot flashes tend to become more frequent and intense as you move towards menopause, peaking during the late part of the menopause transition and gradually declining.
Even after you reach menopause, the point in time when you haven’t menstruated for a full year, hot flashes can continue for years. According to research from the Study of Women’s Health across the Nation (SWAN), “hot flashes and night sweats last, on average, for about seven years and may go on for 11 years or more.” Regardless of how long they last, hot flashes are annoying, distressing, and interfere with your well-being.
Hot flashes are a type of temperature dysfunction commonly caused by changes in hormone levels before, during, and after menopause. Core body temperature normally remains within a specific range that fluctuates a bit throughout the day to keep organs working well. The body has numerous mechanisms to maintain this consistency. For example, you shiver when you are cold to raise your body temperature and sweat when too hot to cool down.
Researchers don’t know exactly why changes in hormones, especially estrogen, cause hot flashes. They think that changes in estrogen affect pathways and mechanisms in the body that help keep body temperature within the normal range.
Several risk factors can increase your risk of experiencing or having more frequent hot flashes. These include smoking and having a high body mass index (BMI). Race can also be a risk factor. Black women report having more hot flashes, while Asian women say they have them less frequently.
Research suggests hot flashes may be linked to cardiovascular disease. The SWAN study found that women with more frequent hot flashes had twice the risk of heart attacks, strokes, and heart failure.
While researchers aren’t sure whether treating hot flashes will reduce your risk of heart disease, having them could indicate that you are at a higher risk of heart disease. If you aren’t taking care of your heart health, midlife is a good time to change your lifestyle and ensure your blood pressure and cholesterol levels are in a healthy range. It’s particularly important to monitor and take care of your heart health during menopause because estrogen helps protect women from heart attacks and stroke while declining levels increase risk.
There are many things you can do to improve your heart health. Start by eating a Mediterranean-style diet, managing stress, and exercising regularly. Taking certain supplements may also help.
A review of studies on supplements that reduce cardiovascular risk published in the Journal of the American College of Cardiology concluded that “Supplementation with n-3 fatty acid, n-6 fatty acid, l-arginine, l-citrulline, folic acid, vitamin D, magnesium, zinc, α-lipoic acid, coenzyme Q10, melatonin, catechin, curcumin, flavanol, genistein, and quercetin showed moderate- to high-quality evidence for reducing CVD risk factors.” Green tea, flaxseed oil, magnesium, red yeast rice, and garlic may also help improve your heart health.
While certain supplements help support your heart health as you transition through menopause, others can help you cope with hot flashes and night sweats. Below are the 10 best supplements for menopause and hot flash support.
A perennial plant native to North America, black cohosh has been used for over a century to treat many health problems, including menstrual irregularities, depression during menopause, night sweats, and hot flashes. In traditional Chinese medicine, black cohosh is used to treat fatigue, shortness of breath, and a prolapsed uterus.
Like many of the supplements covered here, black cohosh is a phytoestrogenic herb, which means it contains plant compounds that act like estrogen in the body. Although it’s unclear exactly how black cohosh works, it may modulate estrogen, influence the neurotransmitter serotonin, impact inflammation, or work as an antioxidant.
One study of 80 postmenopausal women with hot flashes who were given black cohosh for eight weeks experienced a reduction in the number and severity of hot flashes and improved quality of life.
Black cohosh can be taken as a tincture, tablet, or capsule.
A shrub native to the Mediterranean, Europe, and Central Asia, Vitex has been widely used to treat female health problems, including PMS, fibroid cysts, irregular periods, and menopausal symptoms. Hippocrates used Vitex for injuries and inflammation as far back as 450 BC and Pliny the Elder used the plant to support menstruation and lactation.
Scientists believe Vitex influences hormone levels through the hypothalamic-pituitary-ovarian axis, a system that regulates female reproduction. A small randomized controlled trial of 52 Korean women found that, compared to controls, participants who took Vitex for eight weeks experienced fewer hot flashes along with less anxiety and overall menopausal symptoms.
Both the seeds and fruit of the plant are used to make supplements, which are available as a liquid extract or capsule.
Native to the Americas and named because its yellow flowers open at sunset, the oil made from evening primrose seeds are used for menopausal symptoms, PMS, high cholesterol, and inflammatory skin problems like eczema and acne. Like the other herbs mentioned, evening primrose oil has phytoestrogenic properties that may work by affecting estrogen receptors and increasing estrogen levels.
While more research is needed to show its effectiveness, a randomized controlled trial published in the Journal of Menopausal Medicine found that, compared to controls, women who took 1,000 milligrams of evening primrose oil twice a day experienced fewer and less-severe night sweats and shorter and less frequent and severe hot flashes.
Another randomized clinical trial of 56 menopausal women between 45 and 59 years of age found that, compared to controls, women who took 500 milligrams of evening primrose oil for six weeks experienced improvements in frequency, severity, and duration of hot flashes. However, only the severity of hot flashes was significantly better compared to controls.
The study of 80 postmenopausal women that found black cohosh to be an effective treatment for hot flashes also concluded that evening primrose oil reduced the severity of hot flashes, but not the total number.
Evening primrose oil is generally available as a soft gel.
A perennial found in Europe, Western Asia, Africa, North America, and South America, red clover is an important medicinal and pollinator plant. Used to treat menopausal symptoms, including hot flashes, depression, anxiety, and vaginal dryness, it’s also used to lower cholesterol levels, promote weight loss, and improve skin, hair, and bone health.
While more research is needed, a review and meta-analysis looking at red clover as a treatment for hot flashes and menopausal symptoms found a reduction in hot flash frequency compared to controls. A randomized controlled trial of 50 pre- and postmenopausal women who took a female complex containing red clover along with black cohosh, dong quai, milk thistle, American ginseng, and chaste tree berry for three months found a 73% reduction in the number of hot flashes and a 69% reduction in night sweats in women taking the supplement.
Red clover can be taken as a capsule or tablet or enjoyed as a tea.
A cruciferous adaptogenic root vegetable native to Peru, maca offers numerous potential health benefits. Along with reducing menopausal symptoms (including hot flashes, vaginal dryness, and low libido), maca is used to improve memory and mood, reduce blood pressure, and increase energy levels.
Considered a superfood, maca is highly nutritious and easy to add to baked goods, smoothies, and desserts. 50 grams (about 2/3 of a cup) contains 7 grams of protein, 3 grams of fiber, 41% of your daily value (DV) for iron, 12% of the DV for calcium, and over 200% of your DV for vitamin C. Maca can also be consumed as a capsule or tea.
Maca may help balance and regulate hormone levels. A small randomized controlled trial of postmenopausal women aged 49 to 58 concluded that, compared to controls, subjects who took maca experienced a significant reduction in hot flashes and profuse sweating as well as other menopausal symptoms such as mood swings, fatigue, stress, and decreased libido.
A root and herb used in traditional Chinese medicine, ginseng is credited with numerous health benefits. Along with treating menopausal symptoms, it may reduce inflammation, regulate blood sugar, increase energy, boost the immune system, and improve mood and memory.
A systematic review of 15 randomized controlled trials concluded that “ginseng can significantly reduce hot flashes, menopausal symptoms, and quality of life in menopausal women.”
There are two main varieties: American ginseng and Korean red ginseng (aka Panax Ginseng). While both types contain active plant compounds called ginsenosides, Korean ginseng tends to be more potent. Ginseng can be taken as a capsule, tea, or tonic and is also found in supplement complexes designed to increase energy.
Valerian, an herb native to Europe and Asia, offers a double wellness whammy for women going through menopause. First, it can reduce hot flashes. Second, it calms the nervous system, which can improve common menopausal sleep disorders like insomnia.
One study of 68 menopausal women found that, compared to controls, subjects who took 255 milligrams of valerian capsules three times a day for eight weeks experienced a statistically significant reduction in the severity and frequency of hot flashes.
Valerian can be taken as a capsule, tincture, or tea and is found in combination with other relaxing, sleep-promoting herbs like hops and lemon balm.
One of the few plants that’s a vegetable, herb, and spice, fennel is a wonderful licorice-flavored food that is rich in phytoestrogens. You can eat the plant from stems to root raw or cooked and use the seeds as a spice. You can also sip fennel tea or consume fennel seed capsules as a supplement.
Research suggests supplementing with fennel in capsule form may not only help with hot flashes, it may also reduce anxiety, insomnia, and vaginal dryness associated with the menopausal transition. A placebo-controlled trial of 90 postmenopausal women found that individuals taking two 100 milligrams of fennel capsules for eight weeks experienced a reduction in menopausal symptoms.
A systematic review and meta-analysis of the effect of fennel on menopausal women found a statistically significant improvement in not only hot flashes but also vaginal dryness and sexual satisfaction.
Another randomized trial of 68 postmenopausal women published in the Journal of Menopausal Medicine found that, compared to a placebo, an extract made from fennel and valerian relieved sleep disorders and the severity and frequency of hot flashes.
Whether consumed as tofu, tempeh, edamame, or a protein powder, eating more soy products may help cool down hot flashes. After age 50, women need to eat about 50% more protein to maintain muscle mass—so eating more soy can help you meet your body’s needs.
Like several of the other supplements mentioned, soy contains phytoestrogens, plant compounds that may have a similar effect to estrogen made by the body. These plant chemicals may be responsible for soy’s ability to reduce menopausal symptoms.
An analysis and systematic review of the efficacy of phytoestrogens for menopausal symptoms concluded that “phytoestrogens appear to reduce the frequency of hot flushes in menopausal women, without serious side effects.”
In addition, a 2018 randomized clinical trial of 204 women complaining of hot flashes found that, compared to controls, women who consumed 50 milligrams of soy isoflavone for 12 weeks experienced fewer and less severe hot flashes.
The WAVS (Women’s Study for the Alleviation of Vasomotor Symptoms), a study of postmenopausal women who had at least two hot flashes a day, found that women who ate a low-fat, vegan diet plus half a cup of cooked whole soybeans for 12 weeks experienced a reduction in frequency and severity of hot flashes compared to controls. An impressive 59% of women in the intervention group completely stopped experiencing moderate-to-severe hot flashes.
An herb related to soy, fenugreek has been used in both traditional Chinese and Indian medicines to treat everything from obesity (it helps curb appetite) and high blood pressure to digestive issues and migraines. Extracts from the plant, which smell like maple syrup, are used in teas, soaps, spices, and cosmetics.
One study found that women between 40 and 65 who took 600 milligrams of fenugreek seed extract for 12 weeks reported a significant reduction in hot flashes and night sweats and improved quality of life compared with controls who took a placebo.
Fenugreek seed can be taken as a capsule or liquid standardized extract. It’s also available as a tea or a powder, which can be added to liquids like milk or juice.
If you are one of the many women experiencing menopausal symptoms like hot flashes and night sweats, take comfort in knowing you’re not alone and that many effective, natural supplements can help manage your symptoms.
Before taking any supplements, it’s always smart to consult your physician, especially if you are taking prescription medications and/or are pregnant. (Yes, you can get pregnant during the menopausal transition.)
If you are experiencing hot flashes, along with trying supplements, consider increasing your intake of fruits and vegetables, exercising regularly, reducing caffeine and alcohol, limiting spicy foods and foods high in added sugars, quitting smoking if you’re a smoker, managing stress, and, of course, dressing in layers.
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