Supplements, plant remedies and myths

Part 11 of 12 · All topics on the menopause

Why simple solutions are so attractive

When medical information seems contradictory, promises such as “natural hormone balance in three weeks” become especially attractive. Many products present a complicated physical process as an easily corrected deficiency. A powder, a capsule or an online test is then supposed to provide the solution. But a plausible-sounding mechanism is not yet proof that a product works in controlled studies.

At least three questions are helpful for judging this: was the remedy tested in a suitable study with a comparison group? Was an improvement achieved that matters to women, such as less distressing hot flushes or better sleep? And were side effects and interactions studied sufficiently? Without this information, a personal account is not reliable proof of benefit.

Soy, isoflavones and other plant substances

Soy products can be part of a healthy diet. This is different from highly concentrated extracts sold as a treatment for hot flushes. Taken together, the studies on soy, isoflavones and related products do not provide a consistently convincing basis for a reliable clinical effect against vasomotor symptoms. In its 2023 position statement, the Menopause Society did not recommend herbal remedies and food supplements as an established treatment for this. [1]

Black cohosh is also often mentioned. However, research is hard to compare because of differences in extracts, dose, study quality and the symptoms studied. Some studies report benefits, others do not; for individual products, safety questions and interactions may also be relevant. Being sold in a pharmacy or labelled “herbal” does not allow you to infer general effectiveness or harmlessness. [1] [2]

A sensible principle is this: plant substances can be pharmacologically active. This is exactly why they deserve the same attention as other active ingredients. If you take medicines for a chronic illness or have had cancer, you should discuss products and possible interactions with a healthcare professional.

“Bioidentical” – a word that hides a lot

Bioidentical basically describes a hormone that is chemically the same as the body’s own hormone. The term, however, says nothing yet about whether the product is approved, controlled for quality and purity, or used in a clinically tested dose. Approved medicines can contain bioidentical hormones. This is different from individually compounded preparations, for which there may be less reliable data on quality and safety.

Good information should therefore not play “bioidentical” off against “synthetic”, as if these were automatically the categories safe and unsafe. What counts is the active ingredient, dose, manufacture, approval, indication and independent evidence. Mentioning a saliva test also does not guarantee an individually optimal dose.

The myth of the perfect hormone test

During the perimenopause, hormone levels can fluctuate considerably. A single measured value is therefore often not a reliable picture of the whole transition. In women over 45 with typical changes, the diagnosis is in many cases made clinically, from the symptoms and the cycle history, not by a general hormone test. In younger age groups or with particular questions, tests can on the other hand make sense. [3] [4]

Caution is appropriate when a company first sells a large hormone profile and then recommends its own expensive package of products that matches exactly the “imbalances” it claims to have found. This can be a conflict of interest. Which medical decision is the test supposed to change? Are there limit values that have been tested for this purpose? Would the treatment be different without the test? Such questions help to tell benefit from marketing.

What good studies do differently

A randomised trial assigns participants by chance to different treatments. If one group benefits clearly more, this can point to a specific effect. Even so, the number of participants, the length of the study, blinding, dropouts and conflicts of interest have to be checked. For symptoms that fluctuate over time, comparison with a control group is especially important, because changes can also happen with placebo or without targeted treatment.

Also look at whether a study measured symptoms directly or only laboratory values. An “improvement in hormonal balance” is not by itself a clear clinical endpoint. What counts is whether women feel better, stay healthier or whether relevant health risks fall – and at what price.

The appeal of a simple solution

If you sleep badly, sweat at night and are exhausted during the day, it is understandable to wish for a quick solution that is as gentle as possible. Advertising picks up exactly this need. A powder is meant to “bring your hormones into balance”, a tea to detoxify the liver, a capsule to remove all the symptoms of midlife. Such promises often sound scientific because they use terms like neurotransmitters, cortisol or bioavailability. But being scientific does not come from technical words. It comes from checkable studies in people with a comprehensible comparison group.

In product advertising, three things are often mixed together: a substance has a biological effect in the laboratory; in a small study one measured value improves; and finally it is claimed that it helps in daily life against a whole bundle of symptoms. There are large uncertainties between these steps. An active laboratory substance is not automatically an effective or safe medicine. Equally, a trial without a control group cannot reliably tell the placebo effect, the natural course and a real effect apart.

What studies on herbal remedies really say

Soy and isoflavones have been studied for a long time. Black cohosh and various mixed products also appear in many guides. The scientific results, however, are not consistent. Products differ in extract, dose, manufacturing process and quality. So a positive result for one particular product cannot simply be transferred to any capsule of the same plant species. Some studies are small, short or methodologically not informative enough.

The 2023 position statement of the Menopause Society does not recommend food supplements and herbal remedies as an evidence-based treatment of vasomotor symptoms. This is a statement about proven benefit for a defined purpose. It does not mean that all foods with the relevant ingredients are problematic, or that no user could subjectively experience an improvement. But it does mean that a general promise of effectiveness is not sufficiently backed up. [1]

With herbal products too, possible side effects and interactions must be watched. If you have existing liver disease, take several medicines or have had a hormone-dependent cancer, you should not experiment without professional advice. “Natural” describes the origin of a substance, not its safety profile. Many highly effective medicines have plant models; and many naturally occurring substances can be toxic.

“Bioidentical” sounds more precise than the advertising often is

The term bioidentical describes the molecular structure of a hormone that matches a hormone made by the body. On its own it says nothing about the quality of manufacture, the clinical evidence for a product or the safety of a particular way of using it. Approved products with bioidentical active ingredients must be told apart from individually made preparations that have not been tested in the same way. Public discussion often lumps the two together.

A cream marketed as natural can also have systemic effects. Another preparation may deliver unreliable amounts. If you are considering a hormone product, you should therefore ask about approval, proven effect, assured dosing and protection of the womb lining – not only about the advertising name. Saliva and laboratory tests that supposedly tune individual hormone doses perfectly are also, without a clear clinical indication, no reliable replacement for a well-conducted history. [3] [5]

A guide to reading product pages critically

You do not need scientific training to ask the most important questions. Is a specific study named? Was it carried out in people? How many women took part? Was it compared with placebo or with a suitable treatment? How long was it studied? What was the actual improvement? And does the manufacturer fund the study, or did the authors declare conflicts of interest?

A common warning sign is the combination of a very broad promise and weak evidence. If a single product is meant to help at the same time with hot flushes, excess weight, skin ageing, anxiety, dementia and “hormone chaos”, extraordinarily good evidence would be needed. Usually, instead, individual studies, personal accounts and unclear biological explanations are simply strung together. Another warning sign is artificial deadlines after which a discount supposedly expires at once.

It is not necessary to call every product a fraud. Many sellers are convinced they are selling something useful. For a sound decision, though, what counts is the quality of the evidence, not the intention behind the advertising. Questions are legitimate, especially when money, hope and health come together.

Myths that are especially persistent

“Every woman needs a complete hormone test from 40.” No. With typical symptoms from about 45, clinical assessment is often more informative; exceptions apply in special situations. “All symptoms from 40 come from oestrogen deficiency.” Also no. Different illnesses can cause similar symptoms. “Hormone therapy is dangerous in principle.” Wrong as a blanket statement. The decision depends on the product, the route of use, personal risk and the aim of treatment. “Non-hormonal means free of side effects.” This is not true either. [3]

“A special diet replaces any treatment.” A healthy diet can contribute a lot to health, but it is not a proven full replacement for severe vasomotor symptoms. “If a friend recommends a remedy, it will help me too.” Personal experience can give hints, but symptoms and expectations differ. “After the menopause it is all over.” Some symptoms recede, others – such as urogenital ones – can last longer or appear later. Good information should not only correct such statements, but explain in an understandable way why they sound plausible.

Scepticism is a form of self-care

Nobody needs to feel ashamed of wanting a treatment that is as simple as possible. But especially with chronic, fluctuating symptoms, it is important not to become dependent on every new product idea. Before you buy, decide which specific problem the remedy is meant to solve. Check the evidence. If there is no good evidence, weigh costs and risks carefully. And never skip medical investigation just because an advertisement claims a “hormonal cause”.

A health system that gave women too little information for a long time creates room for the market in quick answers. The better alternative is not to judge women who try such products. It is to offer information that is accessible, understandable and checkable. This is exactly what these pages are meant to contribute.

Why anecdotal successes seem so convincing

A personal success story is vivid. If someone tells you she slept through the night again after a week with a plant extract, that sounds more tangible than a meta-analysis with a cautious conclusion. This does not make the story untrue. It only means that its cause remains unclear. Perhaps her sleep would have improved anyway, perhaps her workload or expectations changed, perhaps the product really helped. Without a comparison, this cannot be decided with certainty.

Studies with placebo groups help to reduce this uncertainty. Several methodologically good studies with comparable results can be even more convincing. But even a systematic review is not automatically strong if the underlying studies are very small or prone to bias. This is why these pages distinguish between a plausible idea, first indications and a sufficiently proven treatment option.

Three claims and the matching counter-question

If a product “balances hormones”, ask: which hormones were measured, in whom, and which clinically relevant problem got better as a result? If a remedy is “scientifically tested”, ask: was the study randomised, was there a suitable comparison group, and were side effects recorded? If an advertisement claims that conventional medicine is hiding a natural solution, ask: where are the independently checkable data?

Such questions protect you not only from unnecessary spending. They also reduce the risk of missing treatable illnesses. If, because of heavy bleeding, lasting exhaustion or painful intimate symptoms, you only order products, you may not get suitable diagnosis. Good information should open the way to suitable care, not replace it.

Study compass: five steps from the title to the finding

Step one – the research question. Which problem was meant to be studied? Some studies ask how often hot flushes occur. Others test whether a medicine reduces hot flushes, and others deal with long-term risks. A source about frequency cannot directly prove that a treatment works. So first check whether the study answers your question at all.

Step two – the group studied. How old were the participants? Were they in the perimenopause, the early postmenopause or many years after the last bleeding? Were particular illnesses excluded? Which countries and healthcare systems were represented? The more your situation differs from the study population, the more carefully the result should be applied.

Step three – the study design. A randomised controlled trial is especially well suited to many questions about effectiveness, because participants are assigned by chance to treatment or comparison. A cohort study can follow over years which symptoms occur and how risks develop. A systematic review evaluates several studies using comprehensible criteria. None of these forms answers every medical question equally well.

Step four – the actual result. Was the number of hot flushes reduced, or the subjective burden, sleep or quality of life? A result can be statistically significant but change little in daily life. Conversely, a smaller average change can matter for individual women. Look at whether the authors give absolute differences and how wide the uncertainty around the estimate is.

Step five – safety and limits. For how long were side effects recorded? Were there enough participants to detect rare serious risks? Were conflicts of interest disclosed? Are data independent of other study groups, or are the same participants analysed repeatedly? Especially for a treatment that could be used for many years, a short study of effectiveness is not automatically sufficient research on long-term safety.

Why language and origin must be kept apart in studies

Many important studies from Spain, France and Germany have been published in English. Conversely, English-language reviews can summarise work from several countries. For the international literature search behind these pages, three things are therefore marked separately: the language of publication, the origin of the data and the type of scientific work. Only in this way can we avoid, for example, a French cohort disappearing as purely “English research”, or a guideline from a professional society counting as a new participant study of its own.

The Spanish Mi Menopausia studies use app-based data and can make important everyday burdens visible. Their participants, however, selected themselves; from this, a representative frequency for all women in Spain cannot simply be derived. The French ELISA survey describes care and experiences but does not replace a randomised treatment trial. The SWAN cohort provides especially valuable long-term data on the course of symptoms, while WHI has contributed central randomised findings on hormone therapy. [6] [7] [8] [9]

What a DOI and a PMID are

Many sources in the reference list have a DOI or a PubMed entry. The Digital Object Identifier is a permanent identifier for digital publications. The PubMed Identifier Number – PMID for short – points to an entry in the biomedical literature database PubMed. Both make things easier to find. But they do not by themselves say that a study is of high quality or that the full text can be read free of charge.

If you click a link, you will usually find the title, the authors, the journal and a summary. Sometimes an additional link leads to the full text, for example via PubMed Central. For journal articles behind a paywall, only the summary may be freely accessible. For checking a text, the permanent original entry is still helpful.