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Approximately 50.3% to 82.1% of women going through menopause experience hot flashes and night sweats. (21) To help manage symptoms, 40-50% of women rely on the use of complementary therapies such as plant-based supplements. (8)

Plant compounds called phytoestrogens have been found to have similar structures and functions when compared to the hormones within humans. (1) Estradiol is an estrogen steroid hormone that naturally drops throughout a woman’s life cycle. Decreases in estradiol levels create vasomotor instability, which contributes to hot flashes. Utilizing plant compounds is theorized to help compensate for the estradiol drops through a woman’s life cycle. (1)

Lower rates of postmenopausal symptoms have been observed in Asian women. This is thought to be due to the high dietary intake of soybeans, which contain isoflavones. Isoflavones are thought to work as a phytoestrogen and have a high binding affinity to estrogen beta receptors. (5) This sheds light on the mechanism behind how phytoestrogens are able to reduce hot flash frequency and vaginal dryness scores. (8)

Based on the current research findings, the ingredients in the protocol below have demonstrated efficacy in improving hot flashes associated with menopause.

Isoflavones

40-80 mg, total isoflavones per day (dosing varies based on isoflavone), minimum 12 weeks (5)(7)(14)(15)(19)

• A meta-analysis of 17 trials found reduced frequency (20.6%) and severity (26.2%) of hot flashes when compared to placebo; further analysis found isoflavones with 18.8 mg of genistein were twice as effective for reducing frequency of hot flashes (18)
• Daidzein-rich isoflavone supplementation in doses of 40 mg and 60 mg improved frequency of hot flashes by 43% and 41% after 8 weeks, and 52% and 51% after 12 weeks, respectively, when compared to 32% and 39% with placebo, without any alteration of endogenous sex hormones or thyroid hormones (14)
• For acute menopausal symptoms, 60 mg of isoflavones for six weeks decreased hot flashes by 57% and night sweats by 43%, with no other changes in serum levels of lipoproteins, estradiol, and follicular stimulating hormones when compared to that of placebo (5)
• Mean number of hot flushes decreased by 36.2% and 41.2 % in treatment group compared to 24.0% and 29.3% with placebo at week 6 and 12, respectively (7)
• Red clover isoflavones decreased Kupperman Index score at three months and number of hot flushes at one month compared to that of placebo, with no effects on cardiovascular risk markers (15)
• Hot flush frequency decreased in a pooled mean analysis when compared to that of placebo while having no statistically significant reported side effects (4)

900 mg, three times per day, minimum of 12 weeks (2)(1) or as directed (6)

• Women aged 40 to 65 with 3 or more hot flashes per day experienced better quality of life as shown by improvements in baseline questionnaire after 3 months of supplementation (2) 
• Supplementation produced a significant decrease in Kupperman Index scores as demonstrated by a decrease in the frequency and intensity of hot flashes when compared to that of placebo (6)
• Peri- and post-menopausal women receiving SJW extract experienced decreased duration, frequency, and severity of hot flashes compared to placebo, as measured by the Blatt-Kupperman index for climacteric symptoms (1)

Support hot flashes with the evidence-based ingredients in this protocol. 

Black cohosh (Actaea racemosa)

• Menopausal vasomotor symptoms reduced by 26% in pooled analysis  (17)
• All three treatment groups (black cohosh, estradiol valerate/progesterone, and estradiol valerate/medroxyprogesterone acetate) experienced decreased Kupperman menopause scores after 3 months; the black cohosh group experienced the lowest incidence of breast tenderness at 12.9% (vs. 36.7% and 14.3%, respectively) and vaginal bleeding at 6.5% (vs. 26.7% and 82.1%, respectively) (20)
• In a trial of 122 menopausal women lasting 12 weeks, women with an initial Kupperman Index equal or greater than 20 experienced a 47% reduction in scores from a dried ethanolic extract group, compared to 21% in the placebo group (9)
• In a trial of 120 menopausal women lasting 6 months, both the black cohosh and fluoxetine treatment groups experienced significantly decreased Kupperman Index and Beck’s depression scale scores; however, monthly scores for hot flushes and night sweats decreased by 85% in the black cohosh group, compared to 62% in the fluoxetine group (16)

Rhubarb extract – ERr 731

4 mg, once per day, 12 weeks (13)(12)(11)

• Menopause Rating Scale (MRS) decreased overall as shown by a decrease in number and severity of hot flushes in treatment group when compared to placebo (13)
• Total score for MRS II decreased as shown by decrease in severity of hot flushes, and increase of menopause-specific quality of life; no adverse effects were found as shown by a lack of findings through endometrial biopsies, bleeding, weight changing, blood pressure and heart rate (12)
• Number of hot flushes experienced averaged less than 1.4 per day with long-term use (48 weeks) of ERr 731 with no clinically significant adverse events (11)

Vitamin E

400-800 IU, total per day, minimum 4 weeks (21)(3)

• Severity score and frequency of hot flashes was significantly decreased when compared to placebo (21)
• Reduced frequency of hot flashes by one per day compared to placebo following crossover analysis (3)