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Menopausa: sintomi, quando inizia e come affrontarla

Menopause: symptoms, when it starts, and how to cope with it

Oct 13, 2026

· gpnutraceuticals

Menopause is a natural stage in every woman's life: it occurs at an average age of around 51, but the transition leading up to menopause can last for years and affect the entire body. The most common symptoms, such as hot flashes and sleep disturbances, can be managed. If they affect your quality of life, or if your periods stop before age 45, it's a good idea to talk to your doctor.

In this guide, we examine what happens during perimenopause and after the final menstrual period, the most common symptoms, changes affecting bones, the heart, and metabolism, and what current guidelines and research say about treatments, lifestyle, and nutrients.

Reading time: 13 minutes

Last updated: October 2026

Scientific review: GP Nutraceuticals Team

Main sources: Position statements from The Menopause Society, the American Heart Association, EFSA, and peer-reviewed literature

Menopause at a glance

Menopause is the permanent cessation of menstruation and occurs at an average age of around 51. The years leading up to it, known as perimenopause, are often when symptoms are most pronounced.

The drop in estrogen affects more than just the reproductive system: it influences temperature regulation, sleep, mood, bone health, metabolism, and the cardiovascular system.

Key points

  • Hot flashes affect between half and three-quarters of women and, when frequent, last a median of more than seven years.
  • They originate in the brain, in the hypothalamic centers that regulate body temperature.
  • Bone loss accelerates as early as one year before the final menstrual period.
  • The menopausal transition is a phase of increased cardiovascular risk and changes in body composition.
  • Treatment choices, both hormonal and non-hormonal, should always be personalized with a doctor.

What you'll find in this guide

  • What menopause is, when it begins, and its stages.
  • What happens in the body.
  • The most common symptoms.
  • Hot flashes and night sweats.
  • Sleep, mood, and concentration.
  • Genitourinary syndrome of menopause.
  • Health risks: bones and osteoporosis.
  • Heart, metabolism, and body composition.
  • Nutrition and lifestyle.
  • Treatment options according to the guidelines.
  • Supplements and plant extracts: evidence and claims.
  • Frequently asked questions.

This guide is for informational and educational purposes only and is not a substitute for advice from a doctor or other qualified healthcare professional.

What is menopause, and when does it begin?

Menopause is the permanent end of menstruation, caused by the ovaries ceasing to function. It is diagnosed retrospectively, after 12 consecutive months without a menstrual period, when no other cause is present.

In Western countries, the average age of menopause is about 51 years: it usually occurs between ages 45 and 55, but the age at which a woman enters menopause varies from person to person. It is not a sudden event, but the culmination of a transition that can last for years.

The stages of menopause

The international reference system, STRAW+10, distinguishes, in simplified terms:

  • Early transition: menstrual cycle length begins to vary by 7 days or more;
  • Late transition: pauses without menstruation lasting 60 days or more occur;
  • Final menstrual period: only recognized after 12 months without a period;
  • Postmenopause: the following phase, when hormone levels stabilize.

Perimenopause refers to the transition and the first 12 months after the final menstrual period: this is often the phase with the most intense symptoms.

Early, premature, and induced menopause

Early menopause occurs before age 45, and premature ovarian insufficiency, or premature ovarian failure, occurs before age 40. Unlike natural menopause, induced menopause results from surgery, chemotherapy, or radiation therapy. In these cases, specialist assessment is always needed because estrogen deficiency lasts longer and can have a greater impact on bones and the heart.

How is menopause diagnosed?

Over age 45, when typical symptoms are present, diagnosis is clinical: it is based on menstrual cycle patterns and symptoms, without routine blood tests. FSH, or follicle-stimulating hormone, testing may be useful in younger women or in specific situations.

What happens to hormones during perimenopause?

As ovarian follicles gradually decline, the pituitary gland increases production of FSH in an attempt to stimulate ovaries that are becoming less responsive. Cycles become more often anovulatory, and levels of progesterone, another hormone produced by the ovaries, decline.

Estrogen production, however, doesn’t decline in a straight line: during perimenopause, estrogen levels can fluctuate greatly before settling at low levels after the final menstrual period.

Estrogen receptors are found in the brain, bones, blood vessels, genital and urinary mucous membranes, skin, and muscles. That’s why menopause affects more than just the reproductive system: it also affects temperature regulation, sleep, mood, bones, metabolism, and the heart.

Did you know? Why one blood test isn’t enough

During perimenopause, estradiol levels can vary greatly from month to month. That’s why, in women over 45 with typical symptoms, a single hormone test doesn’t tell us much.

What are the most common symptoms of menopause?

Menopause symptoms vary widely: some women have few and mild symptoms, while others experience a range of symptoms that affect their daily lives. The symptoms most commonly reported are:

  • hot flashes and night sweats, known as vasomotor symptoms;
  • irregular periods during perimenopause, with periods that are closer together, farther apart, or heavier;
  • insomnia and waking during the night;
  • irritability, mood swings, and anxiety;
  • memory and concentration difficulties;
  • vaginal dryness, discomfort during sex, and urinary symptoms;
  • joint and muscle pain;
  • decreased sexual desire and fatigue.

Muscle and joint pain is often overlooked: a 2026 meta-analysis of more than 93,000 women found it in about 57-59% of perimenopausal and postmenopausal women, compared with 40% before the transition. Not all changes during this phase are related to menopause: age, stress, sleep, and general health also matter. The following sections explore the main symptoms and ways to manage them.

Hot flashes and night sweats: why do they occur?

Hot flashes and night sweats, known as vasomotor symptoms, are the most typical symptoms of menopause. According to a review published in JAMA in 2023, they affect about 50-75% of women during the menopausal transition; a 2026 meta-analysis estimates a prevalence of around 74% in Europe and the Americas.

A hot flash is a sudden feeling of heat that starts in the chest, neck, and face, often accompanied by redness, sweating, and palpitations. At night, it can interrupt sleep.

How long do hot flashes last?

Longer than previously thought. In the U.S. SWAN study, women with frequent symptoms had a median duration of 7.4 years, including about 4.5 years after their last menstrual period. Those who start having them early, before menopause, tend to experience them for longer.

Where do hot flashes come from?

Hot flashes originate in the brain. Some neurons in the hypothalamus, called KNDy neurons, are normally regulated by estrogen. When estrogen levels drop, they become overactive and, through neurokinin B, disrupt the center that controls body temperature.

As a result, even small increases in temperature are perceived as excessive and trigger vasodilation and sweating. This discovery has led to a new class of non-hormonal medications.

Sleep, mood, and concentration: what other symptoms can occur?

Sleep disturbances, mood swings, and difficulty concentrating are among the symptoms most commonly reported during perimenopause, although they are often attributed to stress or age.

Sleep. During menopause, night sweats, anxiety, and hormonal fluctuations can make sleep fragmented and nonrestorative, affecting mood and energy during the day.

Mood. The North American Menopause Society guidelines (now The Menopause Society) describe perimenopause as a window of vulnerability for depressive symptoms, even in women with no history of depression. Irritability and mood swings are common and often temporary; persistent sadness or loss of interest in daily activities, however, warrant talking to a doctor.

Memory and concentration. Many women describe "brain fog." In the SWAN study, cognitive performance was slightly lower during perimenopause, but returned to previous levels after menopause: in most cases, the difficulties are mild and temporary.

Vaginal dryness and urinary symptoms: what changes during menopause?

Genitourinary syndrome of menopause (GSM) encompasses the changes caused by estrogen deficiency in the vulva, vagina, urethra, and bladder: dryness, burning, pain during intercourse, urinary urgency, and recurrent urinary tract infections.

According to the North American Menopause Society, it affects between 27% and 84% of postmenopausal women and is often underdiagnosed. Unlike hot flashes, it tends to persist or worsen over the years.

For mild symptoms, the first step is vaginal lubricants and moisturizers. For moderate or severe symptoms, guidelines consider low-dose vaginal estrogen and other prescription local therapies effective: with low-dose vaginal estrogen, blood levels remain within the postmenopausal range.

What are the health risks of menopause?

In addition to more obvious symptoms, declining estrogen levels can increase the risk of two problems that cause no symptoms for years: bone loss, which can lead to osteoporosis, and heart and blood vessel disease. That's why the transition is also the right time to focus on prevention.

Bone health

Estrogen slows bone resorption: when levels fall, bone is removed faster than it is rebuilt.

In the SWAN study, bone loss accelerates about a year before the final menstrual period and slows about two years afterward. Over the ten years spanning menopause, lumbar spine bone mineral density declined by an average of 10.6%, with more than two-thirds of this loss (7.4%) occurring during those three years.

For this reason, the menopausal transition is the time when osteoporosis prevention matters most. Helpful measures include:

  • adequate calcium intake, preferably from foods (dairy products, calcium-rich water, leafy green vegetables, legumes, nuts);
  • adequate vitamin D levels, to be assessed with your doctor;
  • enough protein and weight-bearing and resistance exercise, which can also help prevent falls;
  • no smoking and little alcohol.

For most postmenopausal women, the North American Menopause Society recommends a calcium intake of about 1200 mg per day from food and any supplements, while avoiding excess. Discuss with your doctor whether a bone density scan (MOC/DXA), the test used to diagnose osteoporosis, is appropriate.

Heart, metabolism, and body composition

Cardiovascular disease is the leading cause of death among women, and the risk rises markedly after menopause. In 2020, the American Heart Association identified the menopausal transition as a phase when risk accelerates, due to changes in body fat, LDL cholesterol, and blood vessel health.

Weight or body composition? SWAN data show that body weight increases gradually with age, without a specific jump related to menopause. Body composition changes, however: during the transition, fat accumulation doubles in speed and muscle mass declines, continuing until around two years after the final menstrual period.

Abdominal fat can increase the risk of insulin resistance and cardiovascular problems. For this reason, menopause can be a good time to check blood pressure, cholesterol, and blood sugar with your doctor.

How can you manage menopause through diet and lifestyle?

Lifestyle does not eliminate menopause symptoms, but it has the greatest influence on health in the years that follow.

  • Diet: a Mediterranean-style diet rich in vegetables, fruit, legumes, whole grains, fish, nuts, and extra-virgin olive oil; enough protein to preserve muscle; fewer ultra-processed foods, added sugars, and alcohol.
  • Physical activity: it has not been shown to reduce hot flashes, but aerobic activity protects the heart and metabolism, resistance exercises strengthen muscles and bones, and balance exercises reduce the risk of falls.
  • Weight and smoking: in women with overweight, weight loss is considered one of the helpful non-drug approaches to hot flashes; smoking is associated with more frequent hot flashes and greater bone loss.
  • Psychological well-being: cognitive behavioral therapy (CBT) and clinical hypnosis are the non-drug approaches with the strongest evidence for reducing distress related to hot flashes.

Did you know? Practical tips for hot flashes

Wearing layers, keeping the bedroom cool, or limiting alcohol, hot drinks, and spicy foods can offer practical relief. However, clinical studies have not shown a significant reduction in hot flash frequency.

Hormone replacement therapy and alternatives: what do the guidelines say?

Many women go through this phase with manageable symptoms; for some, however, the symptoms affect their quality of life. In these cases, international guidelines outline several options for relieving symptoms, to be chosen with a doctor.

Hormone therapy

According to The Menopause Society’s 2022 position statement (formerly the North American Menopause Society), hormone therapy (formerly called hormone replacement therapy) is the most effective treatment for hot flashes and genitourinary syndrome, and prevents bone loss and fractures.

  • For women under 60 or within 10 years of the start of menopause, and without contraindications, the balance of benefits and risks is considered favorable for treating bothersome hot flashes and preventing bone loss.
  • If started after age 60 or more than 10 years after menopause, the balance appears less favorable, due to a greater absolute risk of coronary heart disease, stroke, venous thrombosis, and dementia.
  • For women with a uterus, estrogen should be combined with a progestogen; the type, dose, and route of administration should be tailored to the individual.
  • It is contraindicated, among other things, in cases of breast cancer, previous thrombosis or cardiovascular events, liver disease, or unexplained bleeding.

In the United States, in November 2025, the FDA asked manufacturers of hormone therapy medications to remove references to cardiovascular disease, breast cancer, and probable dementia from the boxed warning. The warning about endometrial cancer remains for systemic estrogen taken alone. The first updated labels, covering six products, were approved in February 2026. The decision, which reignited scientific debate, applies only to U.S. labels: in Europe, drug information is determined by the EMA and AIFA.

Nonhormonal therapies

For those who cannot or do not wish to use hormones, The Menopause Society’s 2023 position statement recommends cognitive behavioral therapy, clinical hypnosis, certain antidepressants (SSRIs and SNRIs), gabapentin, and fezolinetant as the options supported by the highest level of evidence.

Fezolinetant and elinzanetant, authorized in the European Union in November 2025, act directly on the brain mechanism behind hot flashes by blocking the receptors on which neurokinin B acts. They are prescription medicines: for fezolinetant, the EMA requires liver function tests before starting treatment and every month during the first three months.

Discuss every treatment choice with your doctor or gynecologist, who can assess your symptoms, medical history, and risk factors.

Can a supplement help? Evidence and claims about plant extracts

In Western countries, 40% to 50% of women use complementary therapies for menopausal symptoms. To make informed choices, two separate questions need to be asked: what the studies suggest, and what regulations allow you to claim on the label.

Scientific evidence and regulatory claims are two different things. A claim permitted on a label describes a physiological function recognized by an authority and does not prove that a product reduces hot flashes. Likewise, a positive study alone does not authorize a claim.

What the studies suggest

The 2023 position statement by The Menopause Society does not recommend plant-based supplements and extracts to treat hot flashes because the evidence is inconsistent. The largest meta-analyses show an overall modest benefit compared with placebo, but the studies are often small and heterogeneous.

Ingredient

What studies suggest about hot flashes

Safety

Soy isoflavones

Isoflavone extracts reduced hot flash frequency by about 20% more than placebo (2012 meta-analysis). However, studies of soy-based foods and some recent meta-analyses have found no benefit.

Well tolerated in studies of up to 2 years. If you have a hormone-sensitive cancer, discuss it with your doctor.

Red clover

The most recent meta-analyses (2021 and 2026) indicate a small to moderate effect, more pronounced with at least 80 mg of isoflavones per day. Earlier reviews had found no significant benefits.

Well tolerated in the short term; long-term data are limited.

Kudzu

Few studies: a combination of kudzu flowers and mandarin peel reduced hot flashes compared with placebo (84 women, 12 weeks); a combination with turmeric showed no differences; the only study of the root alone had no placebo group.

Well tolerated in the available short-term studies. Not to be confused with Pueraria mirifica, a different species associated with adverse effects.

Black cohosh

Conflicting results: a 2023 meta-analysis indicates a modest benefit, while the Cochrane review and analyses based on higher-quality studies do not confirm it.

Controlled studies have not found liver abnormalities, but rare cases of liver damage have been reported.

Sage

Preliminary evidence: a meta-analysis of 4 small studies (310 women) suggests a reduction in frequency, with statistical significance just out of reach.

Well tolerated in the available studies.

Three factors help put these findings into context:

  • In available comparisons, the effects of plant extracts are less than those of hormone therapy;
  • In studies, placebos also reduce hot flashes, in some cases by more than 50%: this is why only controlled comparisons count;
  • The effect of isoflavones depends in part on the gut microbiota, which converts daidzein into equol: only some people produce it, which explains some of the variability.

Calcium, vitamin D, and magnesium, meanwhile, have not shown effects on hot flashes in controlled studies.

What a supplement can claim

Vitamins and minerals. Claims are assessed by EFSA and authorized by Regulation (EU) 432/2012. They relate to physiological functions, not the treatment of menopausal symptoms:

  • Vitamin D contributes to the maintenance of normal bones and normal muscle function;
  • Calcium is needed for the maintenance of normal bones;
  • Vitamin K contributes to the maintenance of normal bones;
  • Magnesium contributes to the reduction of tiredness and fatigue, normal psychological function, and the maintenance of normal bones;
  • Vitamin B6 contributes to the regulation of hormonal activity and to the reduction of tiredness and fatigue.

Plant extracts. At the European level, the assessment of claims for botanicals is suspended. In Italy, the Ministry of Health guidelines allow physiological effects associated with traditional use: for black cohosh, for example, "relief of menopausal symptoms," with the warning not to use it in cases of liver dysfunction or disease. These claims have not been assessed by EFSA and do not amount to evidence of clinical efficacy.

Soy isoflavones. In 2012, EFSA concluded that the evidence was insufficient to authorize a claim about reducing vasomotor symptoms.

Frequently asked questions about menopause

At what age does menopause begin?

In Western countries, the average age is around 51, usually between 45 and 55. If menstrual periods stop before age 45, a specialist evaluation is recommended.

How long does perimenopause last?

It varies greatly: from a few months to several years. Menopause is reached 12 months after the last menstrual period.

How long do hot flashes last?

In the SWAN study, women with frequent hot flashes had a median duration of 7.4 years. Those who start having them early tend to have them for longer.

Are blood tests needed for diagnosis?

Over age 45, with typical symptoms, usually not: diagnosis is clinical. FSH may be useful in younger women or in specific situations.

Can you still get pregnant during perimenopause?

Yes. UK guidelines generally recommend continuing contraception for 2 years after the last period if it occurs before age 50, and for 1 year if it occurs after. After age 55, it can be stopped in almost all cases.

Is it true that you gain weight during menopause?

Not necessarily. Weight gradually increases with age, but menopause mainly changes body composition: more abdominal fat and less muscle mass.

Is hormone therapy safe?

It depends on the person. According to The Menopause Society, for women under 60 or within 10 years of menopause and with no contraindications, the benefits outweigh the risks for treating hot flashes. The decision should always be made with a doctor.

Do supplements work for hot flashes?

The main guidelines do not recommend them as a treatment. Some meta-analyses report modest benefits from soy and red clover isoflavone extracts; results for black cohosh and sage are mixed or preliminary.

When should you consult a doctor?

  • When symptoms affect your quality of life, sleep, or work.
  • In the event of vaginal bleeding after menopause, which should always be evaluated.
  • If your periods stop before age 45.
  • If you experience persistent sadness, marked anxiety, or recurring negative thoughts.
  • Before starting supplements, if you take medication or have any medical conditions.

In summary

Menopause is a natural stage in a woman's life, but the transition leading up to it can last for years and affect the whole body: thermoregulation, sleep, mood, bones, heart, and metabolism.

Today, we have a better understanding of the mechanisms behind the symptoms and more treatment options, which should be chosen individually with a doctor.

Nutrition, physical activity, and attention to cardiovascular and bone health also make this phase a window for prevention in the years ahead.

Evidence for supplements and plant extracts is still limited and should be assessed separately from the claims permitted on labels.

The GP Nutraceuticals approach

GP Nutraceuticals develops formulations inspired by the latest scientific knowledge, selecting quality ingredients and paying particular attention to composition, dosages, and the quality of raw materials.

Among the formulations dedicated to women's well-being during menopause:

Geras Gold® – dietary supplement combining plant extracts (kudzu, dioscorea, sage, black cohosh, red clover, chaste tree, damiana), resveratrol, vitamins, and minerals. According to the permitted claims for supplements, black cohosh is traditionally used to relieve menopausal symptoms, and sage promotes regular sweating; vitamin B6 contributes to the regulation of hormonal activity; vitamin D, vitamin K, magnesium, and zinc contribute to the maintenance of normal bones.

Supplements should not be considered substitutes for a varied, balanced diet and a healthy lifestyle. For advice on use and duration of intake, consult your doctor or gynecologist, especially if you are receiving treatment or have specific health conditions. Do not use in cases of liver dysfunction or disease.

To learn more about the characteristics of the formulations, you can consult the respective product information sheets and the Hormonal Balance collection.

Scientific sources and references

This guide was prepared based on the main international guidelines and the peer-reviewed scientific literature available at the time of publication.

Guidelines and consensus documents

  1. The North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. PMID: 35797481
  2. The North American Menopause Society. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590. PMID: 37252752
  3. The North American Menopause Society. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976-992. PMID: 32852449
  4. Maki PM, Kornstein SG, Joffe H, et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause. 2018;25(10):1069-1085. PMID: 30179986
  5. Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97(4):1159-1168. PMID: 22344196
  6. El Khoudary SR, Aggarwal B, Beckie TM, et al. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention. A Scientific Statement From the American Heart Association. Circulation. 2020;142(25):e506-e532. PMID: 33251828
  7. The North American Menopause Society. The role of calcium in peri- and postmenopausal women: 2006 position statement. Menopause. 2006;13(6):862-877.
  8. Faculty of Sexual and Reproductive Healthcare (FSRH). Contraception for Women Aged over 40 Years. 2017, updated in 2023.

Epidemiology, cohort studies, and mechanisms

  1. Crandall CJ, Mehta JM, Manson JE. Management of menopausal symptoms: a review. JAMA. 2023. PMID: 36749328
  2. Ellahi SA, Spector A, Talaulikar V, et al. Global prevalence of vasomotor symptoms in the menopause transition: systematic review and meta-analysis. Climacteric. 2026. PMID: 42747278
  3. Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-539. PMID: 25686030
  4. Rance NE, Dacks PA, Mittelman-Smith MA, et al. Modulation of body temperature and LH secretion by hypothalamic KNDy (kisspeptin, neurokinin B and dynorphin) neurons: a novel hypothesis on the mechanism of hot flushes. Front Neuroendocrinol. 2013;34(3):211-227. PMID: 23872331
  5. Greendale GA, Huang MH, Wight RG, et al. Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology. 2009;72(21):1850-1857.
  6. Greendale GA, Sowers M, Han W, et al. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women's Health Across the Nation (SWAN). J Bone Miner Res. 2012;27(1):111-118. PMID: 21976317
  7. Greendale GA, Sternfeld B, Huang MH, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5):e124865. PMID: 30843880
  8. Fang Y, Liu F, Zhang XY, et al. Mapping global prevalence of menopausal symptoms among middle-aged women: a systematic review and meta-analysis. BMC Public Health. 2024. PMID: 38956480
  9. Kruse C, McKechnie T, Dworsky-Fried J, et al. Musculoskeletal manifestations of perimenopause: a systematic review and meta-analysis of 93,021 women. JB JS Open Access. 2026. PMID: 41523660

Plant extracts and nutrients

  1. Franco OH, Chowdhury R, Troup J, et al. Use of plant-based therapies and menopausal symptoms: a systematic review and meta-analysis. JAMA. 2016;315(23):2554-2563. PMID: 27327802
  2. Oh M, Park JH, Park S, Park S. Efficacy of plant-derived dietary supplements in improving overall menopausal symptoms in women: an updated systematic review and meta-analysis. Phytother Res. 2024. PMID: 38189863
  3. Taku K, Melby MK, Kronenberg F, et al. Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: systematic review and meta-analysis of randomized controlled trials. Menopause. 2012. PMID: 22433977
  4. Kang I, Rim C, Yang HS, et al. Effect of isoflavone supplementation on menopausal symptoms: a systematic review and meta-analysis of randomized controlled trials. Nutr Res Pract. 2022;16(Suppl 1):S147. PMID: 35651836
  5. Luan H, Liu Q, Guo Y, et al. Effects of soy isoflavones on menopausal symptoms in perimenopausal women: a systematic review and meta-analysis. PeerJ. 2025. PMID: 40718787
  6. Lethaby A, Marjoribanks J, Kronenberg F, et al. Phytoestrogens for vasomotor menopausal symptoms. Cochrane Database Syst Rev. 2007;(4):CD001395. PMID: 17943751
  7. Kanadys W, Barańska A, Błaszczuk A, et al. Evaluation of the clinical meaningfulness of red clover (Trifolium pratense L.) extract for relieving hot flashes and menopausal symptoms in peri- and postmenopausal women: a systematic review and meta-analysis of randomized controlled trials. Nutrients. 2021;13(4):1258. PMID: 33920485
  8. Jiang WL, Wu K. The effectiveness of red clover on hot flashes in menopausal women: a GRADE-assessed systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2026. PMID: 42269521
  9. Tice JA, Ettinger B, Ensrud K, et al. Phytoestrogen supplements for the treatment of hot flashes: the Isoflavone Clover Extract (ICE) Study. A randomized controlled trial. JAMA. 2003;290(2):207-214. PMID: 12851275
  10. Kim JE, Jeong H, Hur S, et al. Efficacy and safety of kudzu flower–mandarin peel on hot flashes and bone markers in women during the menopausal transition: a randomized controlled trial. Nutrients. 2020;12(11):3237. PMID: 33105861
  11. Ahn HY, Hur DH, Kim YJ, et al. Efficacy and safety of extract obtained from Pueraria thunbergiana Bentham and Curcuma longa L. on the improvement of the menopausal symptoms. J Korean Obstet Gynecol. 2020;33(4):75. doi:10.15204/JKOBGY.2020.33.4.075
  12. Bihlet A, Byrjalsen I, Andersen JR, et al. The efficacy and safety of multiple dose regimens of kudzu (Pueraria lobata) root extract on bone and cartilage turnover and menopausal symptoms. Front Pharmacol. 2021;12:760629. PMID: 34744740
  13. Chiba T, Tousen Y, Nishijima C, Umegaki K. The prevalence of dietary supplements that claim estrogen-like effects in Japanese women. Nutrients. 2022;14(21):4509. PMID: 36364772
  14. Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012;(9):CD007244. PMID: 22972105
  15. Sadahiro R, Matsuoka LN, Zeng BS, et al. Black cohosh extracts in women with menopausal symptoms: an updated pairwise meta-analysis. Menopause. 2023. PMID: 37192826
  16. Laakmann E, Grajecki D, Doege K, et al. Efficacy of Cimicifuga racemosa, Hypericum perforatum and Agnus castus in the treatment of climacteric complaints: a systematic review. Gynecol Endocrinol. 2012. PMID: 22385322
  17. Naser B, Schnitker J, Minkin MJ, et al. Suspected black cohosh hepatotoxicity: no evidence by meta-analysis of randomized controlled clinical trials for isopropanolic black cohosh extract. Menopause. 2011. PMID: 21228727
  18. Moradi M, Ghavami V, Niazi A, et al. The effect of Salvia officinalis on hot flashes in postmenopausal women: a systematic review and meta-analysis. Int J Community Based Nurs Midwifery. 2023. PMID: 37489230
  19. LeBlanc ES, Hedlin H, Qin F, et al. Calcium and vitamin D supplementation do not influence menopause-related symptoms: results of the Women's Health Initiative Trial. Maturitas. 2015. PMID: 26044075
  20. Park H, Qin R, Smith TJ, et al. North Central Cancer Treatment Group N10C2 (Alliance): a double-blind placebo-controlled study of magnesium supplements to reduce menopausal hot flashes. Menopause. 2015. PMID: 25423327
  21. EFSA Panel on Dietetic Products, Nutrition and Allergies. Scientific Opinion on the substantiation of health claims related to soy isoflavones and maintenance of bone mineral density and reduction of vasomotor symptoms associated with menopause. EFSA Journal. 2012;10(8):2847. doi:10.2903/j.efsa.2012.2847

Medicines and regulatory framework

  1. European Medicines Agency. Lynkuet (elinzanetant): EPAR. EU marketing authorization on November 17, 2025. ema.europa.eu
  2. European Medicines Agency. Veoza (fezolinetant): communication to healthcare professionals on the risk of liver injury and new recommendations for monitoring liver function. 2025. ema.europa.eu
  3. Elimination of the Black Box Warning on Menopausal Hormone Therapy. Obstet Gynecol. 2026;147(5):642-646. PMID: 41687116
  4. U.S. Food and Drug Administration. HHS advances women's health, removes misleading FDA warnings on hormone replacement therapy. Press release, November 10, 2025. fda.gov
  5. U.S. Food and Drug Administration. FDA approves labeling changes for menopausal hormone therapy products. Press release, February 12, 2026. fda.gov
  6. Commission Regulation (EU) No 432/2012 establishing a list of permitted health claims made on foods.
  7. Ministry of Health. Decree of August 10, 2018, and decree of January 9, 2019: list of substances and herbal preparations permitted in food supplements and Ministry guidelines on physiological effects.

Update history

Version 1.0 – October 2026

First publication of the guide.

This page will be updated periodically to incorporate new scientific evidence, revisions to international guidelines, and research developments on menopause and nutraceuticals.

 

Gabriele Poli

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