The truth about menopause supplements

It’s no wonder that a huge selection of supplements claim to relieve menopause’s unpleasant effects. 

More than half of women who go through menopause find its symptoms distressing. In fact, 10% leave their jobs because of the burden.

But do menopause supplements actually work? Which products are backed by clinical evidence, and which are just “menowashing”?

In today’s short episode of ZOE Science & Nutrition, Jonathan and Dr. Sarah Berry ask: What’s the evidence behind menopause supplements?

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Episode transcripts are available here.

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[00:00:00] Jonathan: Hello and welcome to ZOE Shorts, the bite-sized podcast where we discuss one topic around science and nutrition. I'm Jonathan Wolf, and today I'm joined by Dr. Sarah Berry, and today's subject is menopause supplements.

[00:00:17] Sarah: So, almost every woman goes through menopause. It's a natural part of aging, but it can come with really serious symptoms that severely impact our day-to-day life. So, it's no surprise that people are turning to all sorts of supplements for relief. 

[00:00:32] Jonathan: So that makes sense Sarah. I guess the question is, do any of these menopause supplements actually work?

[00:00:37] Sarah: Well, menopause has been hugely understudied in the past and women are still really underrepresented in health research, so there's a lot we don't know, but there is a picture emerging, 

[00:00:52] Jonathan: So let's hear more.

[00:00:58] Sarah: So, Jonathan, the menopause is a point in time when a woman's periods have stopped for 12 months, which on average occurs when they're 51 years old. But actually, there can be many years leading up to this point, which we can call the perimenopause phase. Now, imagine a woman in perimenopause where she is in a stage of this hormonal chaos, as I like to call it, where she may be experiencing a whole host of symptoms like hot flushes, night sweats, poor sleep, and poor mood.

[00:01:18] Jonathan: And Sarah, every time I hear about this, I'm just amazed at how this was never discussed as I was growing up. So what's going on in someone's body that brings about menopause? 

[00:01:27] Sarah: So during the perimenopause phase, estrogen and progesterone fluctuate and their levels go up and down in a quite unpredictable way causing this hormonal chaos.

[00:01:40] Jonathan: And so Sarah, is it that change in these hormone levels sort of going up and down that's causing a lot of these symptoms? 

[00:01:47] Sarah: It is, but also women do experience many of these symptoms after the menopause where these hormone levels have reduced but have stabilized. 

[00:01:57] Jonathan: Got it. So it's not just they're going up and down. It's also when you’ve just lost the level of estrogen that you used to have had before. So let's talk some more about these symptoms then. What are, what are people dealing with? 

[00:02:06] Sarah: Well, Jonathan, we actually have some of our own data from the ZOE Health Study, which is the biggest study of menopause and nutrition in the world. Now, hot flushes may be the most talked about symptoms, but when we looked at over 8,000 women in perimenopause, we found that sleep disturbances were the most common symptoms reported by 82% of women. 

[00:02:26] Jonathan: 82% Sarah, that's enormous. 

[00:02:29] Sarah: Jonathan, that is absolutely huge, especially considering how many women at any point of time are in this perimenopausal phase. Now, Jonathan, we also found that more than half of women experience brain fog, anxiety, weight gain, low libido, joint pain, and memory loss. 

[00:02:48] Jonathan: I mean, as always, Sarah, I'm just stunned by how many women report really serious symptoms. I mean, every single one of those symptoms was more than half the people. Am I right that from this study, we also discovered for the first time that women who have a worse diet quality are more likely to experience these symptoms.

[00:03:06] Sarah: Yeah, so what we found was that those who had a healthy dietary pattern had about 30% less likelihood of experiencing hot flushes and sleep disturbances, and about 20% less likelihood of experiencing brain fog, joint pain, anxiety, or low mood. Interestingly, Jonathan, we also found that people that were living with obesity were also much more likely to have these symptoms. So for example, those people living with obesity had nearly two times greater likelihood of experiencing brain fog or headaches compared to those who were normal weight. 

[00:03:40] Jonathan: And these symptoms sound really difficult to cope with just how many people are being affected.

[00:03:45] Sarah: Yeah, unfortunately, they're really widespread and we've just seen this from our own data. This is really relevant if we consider the fact that 30% of the female population are peri or post-menopause at any point in time. So we're talking about a lot of people. What's really alarming is almost half of those women find their symptoms distressing, and even 10% of women leave their jobs due to the burden of their menopause symptoms.

[00:04:12] Jonathan: So you can see why people would be desperate for a quick fix right?

[00:04:15] Sarah: And it's a $5 billion industry at the moment, and it's growing rapidly. People are trying all sorts to combat their symptoms. And there's even this term called menowashing. And basically, this means stick the word meno in front of the product, whether it be a food supplement, or a skin cream, and you can double the price and sell more. So people are trying anything. And the recent survey showed that 30% of people are trying herbal remedies, 30% are trying vitamins, and 51% are trying any kind of dietary therapy as an alternative to HRT, and then Jonathan, of course, there is HRT as well. 

[00:04:51] Jonathan: So you and I discussed hormone replacement therapy, HRT in a previous episode with Professor Joanne Manson, who led some of the huge clinical trials that looked at HRT. So if you're listening to this and you haven't heard that podcast, I think you might find that really interesting. My very brief summary would be that Joanne said HRT replaces the missing hormones and can be an effective treatment for menopause symptoms for many women, but it's not necessarily the right choice for everyone. Would that be about right Sarah? 

[00:05:20] Sarah: Yeah, that's right Jonathan, and a key focus of my research here at ZOE is to look at how diet may impact menopause symptoms and also health in post-menopausal women. So outside of changing your diet and HRT, there are loads of supplements out there. Black cohosh, flaxseed, red clover, ginseng St John's wort. I'm just listing a few of the supplements that are sold for menopause here. 

[00:05:46] Jonathan: That's a lot of supplements. Do they help people get any relief and you know, what's the actual clinical evidence? 

[00:05:50] Sarah: So interestingly, if you search up the evidence around menopause supplements and symptoms, what you see is there's about 500 clinical trials that have looked at a whole array of different supplements in menopause symptoms, but despite this, there's actually not a lot of good evidence showing that dietary supplements can relieve menopause symptoms and there's no consensus of the evidence. So studies on black cohosh, which is derived from a herb, have very inconsistent results. There's uncertainty around the effects of vitamin E, and again, there's really limited and very inconclusive research into evening primrose oil, ginseng, melatonin, wild jam, and many of these other supplements.

[00:06:30] Jonathan: So none of this sounds very promising for the many people who are listening to this show who might be suffering with these symptoms or know someone who is. 

[00:06:39] Sarah: I agree. But I do think where things start to get interesting is the science and evidence around phytoestrogens. 

[00:06:46] Jonathan: Phyto what exactly is Sarah? 

[00:06:49] Sarah: So phytoestrogens are natural substances that come from plants, but their chemical structures are really similar to estrogen, so they bind to the many different estrogen receptors that we have spread throughout our body. They are a family of compounds of which the most studied is a compound called isoflavone. Isoflavones are found in many plants, but they're found in particularly high concentrations in soy, as well as being found in flaxseed and red clover. 

[00:07:16] Jonathan: And how might these isoflavones affect menopause symptoms?

[00:07:21] Sarah: Well, firstly, we know that isoflavones can mimic the effects of estrogen by binding to the many estrogen receptors that we have in our body. Secondly, we know that populations that have a high intake of soy isoflavones, such as women in China and Japan have much lower incidents of menopausal symptoms. So for example, as the intake of soy goes up in a country, the rates of symptoms go down. To put this into context, the average intake of soy isoflavones in the UK and the US is less than half a milligram a day, whilst in China and Japan is anywhere between 20 to 70 milligrams a day. 

[00:08:00] Jonathan: Wow. So that's 50 to a hundred times higher in China and Japan compared to the UK or US.

[00:08:10] Sarah: Yeah, absolutely. 

[00:08:11] Jonathan: Well that's great news then Sarah. So should we just be giving everyone these isoflavone supplements? 

[00:08:16] Sarah: Well, Jonathan, as you know with me, there's always a but, and this but is that the clinical trials of supplementation are actually quite inconsistent,

[00:08:25] Jonathan: and do we know why they're inconsistent?

[00:08:27] Sarah: Yeah, so there's been more than 60 clinical trials investigating the effects of isoflavones on symptoms and hot flushes in particular. Now, some show benefit, but some don't, and if we try and work out what's going on by looking at all of these trials together, what we see is at the type and also the dose of isoflavone is important.

[00:08:46] Jonathan: Okay, so what type of isoflavone and how much should be people taking if they want to get this benefit? 

[00:08:54] Sarah: Okay, so firstly, let's look at the types of isoflavones. So there are two main forms. There's genistein and daidzein. Some of the evidence shows that a dose of more than 15 milligrams of genistein a day is the most effective at reducing symptoms. But where it gets even more interesting, Jonathan, is that we also find that some individuals respond more than others to isoflavones, and this is because the gut microbiome is involved in metabolizing isoflavones into their very active form, which is called Equol, and it's this really active form that binds really strongly to the estrogen receptors.

[00:09:31] Jonathan: Just to make sure I've got it, Sarah. So I eat this food, like let's say I'm eating lots of soy. It's got this isoflavone in it, then actually my gut microbes are breaking that down and actually turning it into like the active chemical. A bit like a medicine that's going into my body and really affecting me. Is that right? 

[00:09:46] Sarah: Yeah. So the isoflavones are active as you consume them, but they become even more active if they're converted into equol, and some people have the bacteria to convert them into this kind of super active form, and some people don't. So we know this varies from person to person. So we know, for example, that people In Asia produce equol, so about 40 to 60% of people have the gut microbiome that enables them to produce equol from Isoflavones. This compares to the UK and the US where only about 20 to 30% of people have the gut bacteria that converts the isoflavones into this really active equol form.

[00:10:28] Jonathan: Just thinking about everything you've just described, I'm suddenly thinking about a very recent podcast that we did on ultra processed food with Tim and Chris. They were saying that almost every time that scientists try and extract a single active ingredient from a food to make a supplement, it tends to fail in clinical trials, whereas the whole food works. And usually, this is because the idea that there's one single chemical in this food that is responsible for all the health properties turns out to be wrong. So when you just remove the whole food and you just go to this one supplement, suddenly you do this, study and you don't get the results. Is it possible that we're in the same direction here, so we're thinking about supplements of this one chemical, instead of saying, let's eat the soybean and these other whole foods that are creating these benefits that we see in Asia.

[00:11:19] Sarah: Well, I think it's clear that in some populations such as Japan and China, people can get enough of these isoflavone compounds from foods that are naturally in their diet. But in the UK and the US it's actually quite hard to get a decent amount of these at that effective dose that I mentioned earlier. So I do think that for UK, US and other populations that aren't getting enough from their foods, they may want to try supplements. I do think that the evidence that I mentioned, That has used isoflavone supplements. It's reasonably consistent at that dose of 15 milligrams of genistein a day. 

[00:12:00] Jonathan: And final question, since this area is still being researched, what do we know about the long-term safety of phytoestrogens?

[00:12:08] Sarah: So I think it's still something we are learning a lot more about. We need to study more. There have been questions regarding the safety of phytoestrogens estrogens in women that may have had certain cancers that are impacted by estrogen. I think so far the data would show that as long as we are not megadosing, just like we shouldn't be megadosing, in my opinion, on any supplement, vitamin or mineral, they seem to be safe. But as always, I would caution people on Megadosing and watch the space for further research.

[00:12:44] Jonathan: So Sarah, what can we take away from all of this? 

[00:12:46] Sarah: So I think, Jonathan, it's very clear that menopause symptoms are really prevalent, that a huge proportion of women who are perimenopausal but also postmenopausal, suffer from very burdensome symptoms across a whole range of different symptoms that are really distressing for many women.
I think that it's very clear from the evidence that improving your overall dietary pattern, so having a Mediterranean style diet with plenty of fruits, vegetables, unprocessed plants, and a variety of different plants is going to improve your symptoms, and maintaining a healthy weight. I think that the evidence for most of the supplements that are marketed is incredibly weak and I think that the only evidence that's good enough to suggest that there might be an improvement is from Isoflavones. My personal opinion is that if there's a supplement that's got Meno in front of it, a skincare product that's got Meno in front of it, a hair shampoo that's got Meno in front of it, it's simply meno washing and it's washing money down the drain that could be better spent elsewhere. 

[00:13:57] Jonathan: I guess maybe to wrap up, why are you personally so excited about your research around nutrition and menopause?

[00:14:02] Sarah: It's something all my friends are talking about. Everyone's talking about HRT, the pros and cons. Everyone's talking about, ‘Oh have you heard there's this latest supplement out there?’ These friends are incredibly well-educated, but unfortunately, all of the marketing out there around these menopause supplements is so powerful, and so I'm really committed through our ZOE research to really try and unravel what it is about. Different diets, different foods and different food chemicals that may be able to reduce some of the burden of these symptoms.

[00:14:39] Jonathan: If you'd like to see whether ZOE's personalized nutrition program can help with your menopause symptoms, you can get 10% off by going to I'm Jonathan Wolf. 

[00:14:46] Sarah: And I'm Sarah Berry.

[00:14:48] Jonathan: Join us next week for another ZOE Podcast.