The Effectiveness of Non-Soy Oral Herbal Supplements for Menopausal Symptoms: A Systematic Review

Background: Menopause is a biological process characterised by the cessation of menstruation and substantial changes in ovarian hormone production. As many women seek non-hormonal alternatives to hormone replacement therapy, interest in herbal supplements has increased. However, the evidence for their effectiveness remains inconsistent due to the diversity of available supplements. This systematic review aimed to evaluate whether oral herbal supplements improve menopausal symptoms in women. Methods: A systematic search of PubMed, Scopus, Embase and PsycINFO was conducted in October 2025 to identify randomised controlled trials (RCTs) assessing non-soy oral herbal supplements for menopausal symptoms. The primary outcomes examined included neurological symptoms, sleep quality, and vasomotor symptoms. The secondary outcomes were overall quality of life and reported adverse effects. Results: Thirty RCTs met the inclusion criteria. Of these, 28 reported improvements in menopausal symptoms, particularly reductions in the severity and frequency of vasomotor symptoms. Nineteen distinct herbal interventions were identified. The two RCTs using black cohosh and dong quai found no measurable effects. Two studies demonstrated significant improvements in specific cognitive domains, although evidence for broader cognitive benefits was limited. Overall quality of life was generally improved, and no major adverse effects were reported. Conclusions: The substantial heterogeneity in the studies identified from this review across multiple factors, including different herbal interventions, doses, duration, and assessment methods, makes it difficult to come to an overall conclusion on whether or not herbal supplementation is effective for treating menopausal symptoms. Further well-designed trials are needed to clarify the efficacy and optimal dosing of herbal treatments.