The evidence
What works, and what does not
Twelve things sold to women in perimenopause and menopause, graded against what the trials actually measured.
How to read the grades
- Works
- Good evidence behind them, for the thing named.
- Might help
- The trials point one way, and they are small or mixed.
- Not proven
- Sold with confidence. The research does not carry it.
- Avoid
- Reasons to leave these alone, or to ask first.
A grade is always tied to one use. The same thing can hold up for one job and fall over for another, which is why every card names the job.
Good evidence
Good evidence behind them, for the thing named.
Creatine
The gym supplement that turned out to have decent evidence in postmenopausal women, as long as you lift.
For muscle and strength, with resistance training: worksFor bone density: not provenFor brain fog: not provenOmega 3
Good evidence for blood fats. Much weaker evidence for the things it gets sold for in menopause.
For high triglycerides: worksFor hot flashes: not provenFor mood: not provenVitamin D
Worth taking through a British winter for your bones. Not the energy fix it is sold as.
For bones and muscle when your level is low: worksFor energy and mood: not provenFor weight: not provenProtein
The least glamorous thing on this page, and the one with the strongest case behind it.
For holding on to muscle as you age: worksFor feeling full: might helpFiber
Boring, cheap, and backed by better evidence than anything sold in a jar.
For bowels and gut comfort: worksFor long term heart and bowel health: worksFor weight: might help
Might help
The trials point one way, and they are small or mixed.
Magnesium
Sold for sleep and calm. The sleep evidence is thinner than the ads suggest.
For sleep: not provenFor mood and anxiety: not provenFor constipation: might helpCollagen
Skin trials mostly point the same way. Most of them are small, short and rated at high risk of bias.
For skin hydration and elasticity: might helpFor wrinkles: might helpFor joints, hair and nails: not provenSage
Four small trials, all pointing the same way, and none of them big enough to settle it.
For hot flashes: might helpFor night sweats and sleep: not proven
Not proven
Sold with confidence. The research does not carry it.
Black cohosh
The most bought herb for menopause. Cochrane found the evidence insufficient, and there are liver injury reports.
For hot flashes and night sweats: not provenFor use if you have liver problems: avoidRed clover isoflavones
A plant estrogen sold for hot flashes. Cochrane found no clear benefit outside high genistein soy extracts.
For hot flashes and night sweats: not provenFor cholesterol and bone density: not provenAshwagandha
Sold hard for stress and sleep. Many trials, mostly small, and a short list of people who should leave it alone.
For stress and sleep: not provenFor use in pregnancy, or with a thyroid or autoimmune condition: avoidCBD
Sold everywhere for sleep and anxiety. The UK food regulator caps it at 10mg a day and tells anyone on medication to stay away.
For hot flashes: not provenFor sleep and anxiety: not provenFor use if you take any medication, or are pregnant or trying to conceive: avoid
How these pages are written
- Every source listed was opened and read. Nothing is cited second hand.
- No number, study or quote is invented. Where a source did not give a dose, the page carries no dose.
- Where the evidence is thin or mixed, the page says so in the first two lines rather than the last.
- Each page says what the trials measured. None of this treats or relieves menopause.
- We plan to make our own products one day. When we do, we will only sell things this guide supports, and the label will only say what the rules allow. If we grade something not proven, we will not sell it for that.
This is general information, not medical advice. Check with your doctor or pharmacist, especially if you take medication.
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