The 2 a.m. wardrobe change
You wake up damp. Not dewy, damp. The pillowcase needs flipping, the T-shirt needs replacing, and the duvet has been kicked onto the floor like it owes you money. Then, twenty minutes later, you're freezing.
Night sweats are simply hot flashes that happen while you sleep, and for many women they're the symptom that does the most damage, because they take your sleep with them. So it makes complete sense to walk into a pharmacy, see a shelf of menopause blends, and hope one of them is the answer.
We went through the research on the best supplements for night sweats so you don't have to read a few hundred studies at 2 a.m. The honest summary is not exciting: the evidence is weak across the board. But some options are weaker than others, a couple have real safety notes, and there are better-studied paths worth knowing about.
First, a reality check on supplements
In the U.S., the FDA does not approve dietary supplements for safety or effectiveness before they're sold. A label saying a product supports cooling comfort or hormonal balance isn't a claim anyone checked.
Quality is a real issue too. Some black cohosh products have been found to contain the wrong plant or unlisted herbs, and some wild yam creams tested have contained undisclosed steroids. So even when a study looks promising, the bottle on your shelf may not match what was studied.
One more quirk: most research lumps night sweats and daytime hot flashes together (the medical term for both is vasomotor symptoms). Very few studies look at night sweats alone, so most of what follows is about the whole package.
The best supplements for night sweats (low bar): soy and red clover
If anything on the shelf deserves the label of best supplement for night sweats, it's probably one of these two, and that's a low bar.
Soy isoflavones are plant compounds with weak estrogen-like effects. A 2016 analysis of 62 studies and 6,653 women, summarized by the National Center for Complementary and Integrative Health (NCCIH), found soy produced modest drops in how often hot flashes happened, but no significant reduction in night sweats specifically. Many of the studies were low quality. The Menopause Society's 2023 guidance does not recommend soy, noting the trials were small and short. Part of the problem may be biology: only about 35% of North American women can convert a soy compound called daidzein into equol, the form thought to do the work, and there's no commercial test to tell you which group you're in.
Safety-wise, short-term use appears generally safe, but long-term use of soy extracts has been associated with thickening of the uterine lining. Eating soy foods appears safe for women with or at risk of breast cancer; the safety of concentrated supplements in that group is less clear.
Red clover also contains isoflavones. A 2016 meta-analysis found it may reduce how often hot flashes happen, mainly in women having five or more a day. One small 2017 trial in 62 perimenopausal women found a red clover extract combined with probiotics beat placebo. Studies have used it for up to three years without obvious harm, but questions remain about its effect on hormone-sensitive tissue like the breast and uterus.
Black cohosh: popular, mixed, and with a liver footnote
Black cohosh is probably the best-known menopause herb, and the research is a genuine tangle. A 2012 Cochrane review of 16 trials with 2,027 women found no significant difference from placebo in how often hot flashes happened. A large 2006 trial of 351 women found no difference from placebo in hot flashes or night sweats at 3, 6 or 12 months. A 2017 meta-analysis did find it beat placebo, but it still fell short of hormone therapy. The Menopause Society's 2023 statement does not recommend it.
A smaller 2009 trial of 88 women found the same pattern: symptoms improved in every group, including placebo, and black cohosh showed no real advantage. Back in 2015, the American College of Obstetricians and Gynecologists (ACOG) also concluded that the data don't show herbal supplements like black cohosh work for hot flashes. That's a lot of large, careful studies landing in the same place.
The safety footnote is about the liver. At least 83 cases of liver injury have been reported worldwide in people taking black cohosh. A direct cause hasn't been proven, and contaminated or mislabeled products may explain some of them. The U.S. Pharmacopeia recommends this label warning: stop using it and talk to a healthcare practitioner if you have a liver disorder or develop symptoms of liver trouble. Early lab research also hints at a possible interaction with statins.
The 'save your money' tier
These are common in menopause blends and online lists. Their track records in controlled trials are not great.
- Magnesium: a 2015 trial of 289 postmenopausal women with a history of breast cancer compared two doses of magnesium oxide with placebo. Hot flashes were similar in every group. The magnesium groups did get more diarrhea.
- Evening primrose oil: in a six-month trial of 56 women, it did no better than placebo. Hot flashes dropped by about one a day on the oil and by 2.6 a day on placebo.
- Flaxseed: a 2012 trial of 188 women found no difference from placebo in hot flashes after six weeks.
- Ginseng: a 16-week trial of 384 women showed no more improvement than placebo.
- Vitamin E: two small trials showed limited effect, and The Menopause Society says there's very little evidence of real benefit.
- Dong quai: a 24-week trial found no difference from placebo. It also comes with concerns about sun sensitivity and blood thinning.
- Omega-3s: one small trial looked promising, but a larger 12-week trial of 355 women found no difference from placebo.
- Wild yam cream: one trial found no benefit, and your body can't turn the yam compound diosgenin into progesterone, whatever the label implies.
Pollen extract is the odd one out. A single trial of 53 women reported a 65% drop in symptoms compared with 38% on placebo. One small study isn't enough to build on, and The Menopause Society doesn't recommend it yet.
What has better evidence for night sweats
This is where the news gets better. The Menopause Society says hormone therapy remains the most effective treatment for hot flashes and night sweats. For most healthy women under 60 and within 10 years of menopause, it says the benefits outweigh the risks, and the decision should be individualized with a clinician.
If hormones aren't right for you, or you'd rather not, the Society's 2023 guidance recommends several nonhormonal options:
- Cognitive behavioral therapy (CBT), which in two trials led 65% to 78% of women to report meaningfully less bother from their hot flashes.
- Clinical hypnosis, which cut hot flash frequency by 74% compared with 17% in a comparison group in one 12-week trial. It can be done with a trained provider or an app.
- Prescription medications, including certain antidepressants (SSRIs and SNRIs), gabapentin, oxybutynin and fezolinetant, a newer, first-of-its-kind FDA-approved drug for hot flashes.
- Weight loss, for women who have weight to lose; behavioral weight-loss programs have been linked to fewer hot flashes, though the studies are small.
A licensed clinician helps decide whether any of these prescription options are appropriate for you. Asking about them is not the same as agreeing to take them.
And the bedroom stuff? Cooling pillows, fans and moisture-wicking pajamas didn't reduce measured night sweats in the small studies the Society reviewed, although some women reported sleeping better. If a fan by the bed helps you get back to sleep faster, that's a win, even if it's not a treatment.
If you want to try a supplement anyway
That's your call, and plenty of women do. A few ways to do it sensibly:
- Pick one at a time and give it 8 to 12 weeks, keeping a simple log of night sweats so you can tell if it's actually doing anything. Many trials show placebo groups improving too, so your own before-and-after record matters.
- Tell your clinician and pharmacist what you're taking, especially if you take prescription medications or have liver problems.
- Skip black cohosh if you have liver disease, and stop it if you notice signs of liver trouble.
- Talk to your clinician before soy or red clover extracts if you've had breast cancer or another hormone-sensitive condition.
- Be wary of blends with long ingredient lists. More herbs means more unknowns, not more relief.
Night sweats are miserable, but they're also one of the most treatable parts of menopause. If the supplement aisle has let you down, that's not a sign you're out of options. It usually just means the better ones are on the other side of a conversation.
