Supplement Ingredient Data

Aloe vera (oral) bladder

Aloe barbadensis miller; freeze-dried aloe vera capsules; SSAV

Evidence: none

Studied for: Marketed to soothe the bladder lining in interstitial cystitis; that use is only now entering formal testing, and the published aloe research is on skin, diabetes and bowel conditions

There is no published randomised controlled trial of oral aloe vera for interstitial cystitis. A phase 1 safety and efficacy study of freeze-dried aloe capsules at Wake Forest University Health Sciences (NCT04734106, 30 participants) began in February 2025 with estimated completion in April 2027, and no results are posted. NCCIH's aloe review covers acne, psoriasis, burns, radiation skin damage, weight loss, diabetes and inflammatory bowel disease, and does not mention bladder or urinary conditions at all. The response rates quoted in aloe marketing come from company surveys and questionnaires, not controlled trials.

Interactions: Cardiac glycosides such as digoxin (overuse of aloe latex may increase adverse effects)

Cautions: Oral aloe latex causes abdominal pain, cramps and diarrhoea, and the FDA removed it from over-the-counter laxatives in 2002 for lack of safety data; the International Agency for Research on Cancer classifies non-decolourised whole leaf extract as a possible carcinogen; oral aloe leaf extracts taken for 3 weeks to 5 years have been linked to cases of acute hepatitis

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Arbutin bladder

Beta-arbutin; hydroquinone beta-D-glucopyranoside; the marker compound of bearberry, Arctostaphylos uva-ursi

Evidence: none

Studied for: Sold as an isolated compound for urinary infections, borrowing the reputation of whole bearberry leaf. There are no human trials of isolated arbutin for any urinary outcome.

The EMA's bearberry assessment found no clinical efficacy trials even for the whole leaf, granting traditional-use registration only, and notes that marketed products contain leaf preparations rather than purified arbutin. The one large randomised trial of a standardised uva-ursi extract, ATAFUTI, randomised 382 UK women with suspected uncomplicated UTI and found no difference from placebo in symptom severity on days 2 to 4. Arbutin is converted in the body to hydroquinone, which is why the EMA caps bearberry use at one week; buying the isolated compound removes that regulatory guard rail without adding any evidence.

Cautions: Short-term use only, no more than one week; Not in kidney disorders; Not in pregnancy or breastfeeding; Not under 18 years; See a doctor if symptoms last more than 4 days; Can turn urine greenish-brown

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Berberine bladder

berberine HCl; granular berberine

Evidence: strong for metabolic outcomes; thin for bladder

Studied for: Blood sugar and cholesterol - NOT bladder symptoms

Genuine research base, almost all of it outside urinary health. Carries the longest interaction list of any ingredient in this category and is the main reason to check a bladder supplement with a pharmacist. The metabolic evidence is genuinely substantial: a systematic review and meta-analysis of 46 randomised trials in type 2 diabetes found berberine lowered HbA1c, fasting glucose and LDL cholesterol, mostly as an add-on to standard treatment. That is what the research supports, and it is not a bladder claim. Searching the medical literature for berberine and overactive bladder or urinary incontinence returns no trial of berberine itself; the single result is a 30-patient pilot of two different alkaloids, protopine and nuciferine, which was neither randomised nor placebo-controlled.

Interactions: metformin and other diabetes medications; statins; blood thinners; cyclosporine

Cautions: Not considered safe in pregnancy or breastfeeding

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Birch leaf bladder

Betula pendula; Betula pubescens; Betulae folium; silver birch leaf

Evidence: traditional

Studied for: Increasing urine output to flush the urinary tract in minor urinary complaints. Not studied for treating infection, urgency or leaks.

The EMA's public summary is explicit that the approval rests on traditional use rather than trials: the data are too limited to be used as evidence, and the only clinical study it cites is one of 15 patients with urinary tract infections. The committee judged the effect plausible on the basis of at least 30 years of documented use, 15 of them in the EU. A flushing effect is not the same as treating an infection.

Cautions: Not if you are allergic to birch leaf or birch pollen; Not if you have been told to restrict fluids, for example in severe heart or kidney disease; Not under 12 years; Use for 2 to 4 weeks only

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Buchu bladder

Agathosma betulina; Barosma betulina; round-leaf buchu; boegoe

Evidence: traditional

Studied for: Traditionally used as a urinary antiseptic and diuretic for cystitis and "water infections". Modern research is almost entirely laboratory and animal work on antioxidant, anti-inflammatory and antimicrobial activity.

A 2022 review in Frontiers in Pharmacology found no randomised, double-blind, placebo-controlled human studies of buchu at all, and stated that health claims for buchu products still need to be substantiated by such trials. Its 19th-century reputation as a urinary remedy rests on historical case reports rather than trials. The reviewers also noted that the composition of buchu extracts used in research is frequently undisclosed, so even the laboratory findings cannot be tied to any particular product.

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Calcium glycerophosphate bladder

Prelief; calcium glycerinophosphate

Evidence: very limited

Studied for: Sold as a food acid reducer to stop acidic foods and drinks triggering interstitial cystitis flares

The 2016 International Urogynecology Journal systematic review of complementary therapies for bladder pain syndrome screened 1454 citations and included 11 studies, only 4 of them randomised, and the evidence it found for calcium glycerophosphate was not among the randomised ones. What it reported instead was a finding that the supplement appears to reduce symptoms in a patient whose symptoms are exacerbated by particular foods, plus an internet survey in which respondents said they considered it helpful. That is patient perception, not controlled evidence. The review's overall verdict was that findings came from small studies and that robustly designed multicentre randomised trials are needed.

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Cleavers bladder

Galium aparine; clivers; goosegrass; sticky willy; catchweed bedstraw

Evidence: none

Studied for: Marketed for "lymphatic drainage" and urinary support. The published research is laboratory and animal work on antioxidant, antimicrobial, immunomodulatory and anticancer activity.

A review of the genus Galium in the Journal of Applied Pharmaceutical Science describes only in vitro, cell-culture and animal work for Galium aparine and records no human clinical trials of any kind. Its British Herbal Pharmacopoeia entry is a traditional-use listing, historically for skin complaints rather than the bladder. It does not appear among the EMA's herbal monographs, so no regulator has assessed even its traditional urinary use.

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Collagen peptides bladder

Hydrolysed collagen; collagen hydrolysate; marine collagen peptides

Evidence: very limited

Studied for: Marketed for pelvic floor and bladder support in midlife; the only randomised bladder trial tested collagen inside a multi-ingredient formula alongside pelvic floor exercises, never on its own

The single randomised bladder trial, published in Uro in 2025, gave 44 women aged 45 to 70 with stress, urge or mixed incontinence a six-week supplement plus pelvic floor muscle training and reported a 64% fall in QUID score against 10% on placebo. But the product also contained magnesium citrate, vitamin D3, creatine monohydrate, black cohosh, horsetail and cranberry, both arms did the same exercises, outcomes were questionnaire-based with no pad test or urodynamics, and there was no post-treatment follow-up. Nothing in that result can be attributed to the collagen. No trial has tested collagen peptides alone for any bladder symptom.

Cautions: A product labelled as collagen for bladder support may also contain black cohosh, cranberry and horsetail, each with its own cautions, so read the full ingredient list rather than assuming you are only taking collagen

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Corn silk bladder

Zea mays stigma; Maydis stigma; corn stigmata; stigma maydis

Evidence: very limited

Studied for: Traditionally used to increase urine output and ease urination. The small amount of human research that exists is on blood pressure, not on urinary symptoms.

The EMA assessment states plainly that there are no well-designed clinical trials on the diuretic activity of corn silk water extracts. The human data it could find were a 58-volunteer pilot study of blood pressure, one case report of a child with bedwetting, and a 2019 review of five hypertension trials in 567 patients showing only limited benefit alongside blood-pressure drugs. The diuretic claim rests on rat studies and long-standing use, not on trials in people with urinary symptoms.

Cautions: Not in pregnancy or breastfeeding; Not under 12 years; Keep fluid intake up while taking it

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Couch grass bladder

Elymus repens; Agropyron repens; Elytrigia repens; Graminis rhizoma; twitch grass

Evidence: traditional

Studied for: Increasing urine output to flush the urinary tract as an add-on in minor urinary complaints.

Registered by the EMA on traditional use only. Its assessment report states there are no data available from controlled clinical studies. The two human reports it found were an open trial in 99 patients and a post-marketing study of 313 patients, neither with a control group, with symptom-free rates of 32% to 53% in the second. The assessors concluded the quality of these studies could not be evaluated, so the uncontrolled improvement figures cannot be attributed to the herb.

Cautions: Not in severe kidney or heart disease, because of a risk of low potassium; Not in pregnancy or breastfeeding; Keep fluid intake up while taking it; Use for 2 to 4 weeks only

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Cranberry extract bladder

Vaccinium macrocarpon; proanthocyanidins; PACs

Evidence: moderate

Studied for: Reducing repeat urinary tract infections in infection-prone women

Systematic reviews of randomised trials support a modest reduction in repeat UTIs in women prone to them. Does not treat an active infection. No evidence for stress leaks or for overactive bladder without infection.

Interactions: warfarin

Cautions: Trials that found benefit used concentrated products, not juice drinks

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D-mannose bladder

Mannose; a simple sugar related to glucose

Evidence: very limited for UTI prevention; none for leaks

Studied for: Preventing recurrent urinary tract infection in women. It is also sold under general "bladder support" and "bladder control" claims, which it has never been tested for.

The 2022 Cochrane review pooled seven randomised trials in 719 people and found the studies too small, too varied and too biased to meta-analyse, concluding there is little to no evidence either way. The largest trial since, MERIT, randomised 598 UK women in primary care to 2 g daily or placebo and found no benefit: 51.0% versus 55.7% contacted care for a suspected UTI (risk difference -5%, 95% CI -13% to 3%), and its authors said d-mannose should not be recommended for prophylaxis. NICE still lists it as something some non-pregnant women may wish to try as self-care, on the strength of a single earlier trial. No study has looked at urinary leaks.

Cautions: Not in pregnancy; Counts towards your daily sugar intake; Can cause diarrhoea or vaginal burning

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Glucosamine and chondroitin bladder

Glucosamine sulphate; glucosamine hydrochloride; chondroitin sulphate; oral GAG replacement

Evidence: very limited orally; moderate intravesically

Studied for: Sold as an oral glycosaminoglycan replacement for a damaged bladder lining in interstitial cystitis; the actual randomised evidence for these two is in osteoarthritis, and chondroitin's bladder evidence is for instillation into the bladder rather than swallowing

NCCIH's review of glucosamine and chondroitin covers osteoarthritis only, where results are mixed and the American College of Rheumatology recommends against both, and it does not mention bladder or interstitial cystitis at all. The EAU chronic pelvic pain guideline rates intravesical chondroitin sulphate as possibly effective (level 2b) and weakly recommends offering intravesical hyaluronic acid or chondroitin sulphate before more invasive measures, but that is a clinic catheter instillation, not a capsule. The oral interstitial cystitis data come from open-label studies of multi-ingredient products such as CystoProtek, which also contains hyaluronate, quercetin, rutin and olive kernel extract, so nothing can be pinned on glucosamine or chondroitin alone.

Interactions: Warfarin (both have been associated with increased bleeding risk in people taking it)

Cautions: Glucosamine may raise blood glucose in some people; safety in pregnancy and breastfeeding is poorly understood; no major safety problems were identified in the large osteoarthritis trials

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Goldenrod bladder

Solidago virgaurea; European goldenrod; Solidaginis virgaureae herba

Evidence: traditional

Studied for: Increasing urine output as an add-on in minor urinary complaints. Widely sold for cystitis and "urinary flushing" on the strength of uncontrolled studies.

The EMA granted goldenrod traditional-use registration only. Its assessment report found five human studies, some very large, reporting improvement rates as high as 79% in 1,487 patients and 96% in 512 patients, but every one was open-label and uncontrolled. The assessors concluded that the quality of the available studies cannot be evaluated, citing missing sample-size calculations, incomplete patient characteristics and no dropout data. Impressive percentages from studies with no comparison group say almost nothing about whether the herb did anything.

Cautions: Not if you are allergic to daisy family (Asteraceae) plants; Not if you have been told to restrict fluids, for example in severe heart or kidney disease; Not alongside synthetic diuretics; Not in pregnancy or breastfeeding; Not under 12 years; Use for 2 to 4 weeks only

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Gosha-jinki-gan bladder

Goshajinkigan; GJG; niu che shen qi wan; a ten-herb Japanese kampo formula

Evidence: very limited

Studied for: Overactive bladder symptoms, nocturia and urinary urgency in Japan, mostly in people who also feel the cold. Tested far more rigorously, and unsuccessfully, for chemotherapy-induced nerve pain.

The bladder evidence is small, almost entirely Japanese and largely uncontrolled: a representative example is a prospective observational study of 56 women taking gosha-jinki-gan for four weeks, in which the overactive bladder symptom score fell from 7.57 to 6.73, with the gain concentrated in the 36 women who were sensitive to cold. With no placebo group, that change cannot be attributed to the formula. When gosha-jinki-gan was tested against placebo in a large double-blind phase III trial (GENIUS, 182 patients, a different indication), it not only failed but was stopped early because neuropathy was worse in the treated group, which is a fair warning against assuming a kampo formula is inert.

Cautions: Contains processed aconite root, so treat it as a medicine rather than a food supplement and take it under professional supervision

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Hibiscus bladder

Hibiscus sabdariffa; roselle; sour tea; karkade

Evidence: moderate for blood pressure; very limited for urinary symptoms

Studied for: Studied mainly for blood pressure and other cardiometabolic markers, not for the bladder. In urinary products it has only been trialled as one component of a combination.

A 2022 review of clinical trials in Pharmaceuticals found consistent blood-pressure lowering across randomised studies, in one case comparable to captopril, plus effects on lipids and blood sugar. That review covers no urinary, bladder or menopausal outcomes. The only controlled urinary evidence is for a combination medical device of xyloglucan, hibiscus and propolis: a 2022 meta-analysis of three placebo-controlled trials in just 178 women found better clinical or microbiological resolution (odds ratio 0.13, 95% CI 0.05 to 0.33). That result belongs to the combination, not to hibiscus on its own.

Cautions: Lowers blood pressure, so take care if you already take antihypertensive medicines

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Horsetail bladder

Equisetum arvense; field horsetail; shavegrass; Equiseti herba

Evidence: traditional

Studied for: Increasing urine volume to flush the urinary tract, as an add-on in minor urinary complaints. Not studied for infection, urgency or incontinence.

The EMA's herbal committee registered horsetail on traditional use only, which means long-standing use rather than demonstrated efficacy. The strongest human study in its assessment report is a double-blind randomised trial in 36 healthy men, where 900 mg a day of dried extract for four days produced a negative fluid balance of about -322 ml, comparable to hydrochlorothiazide, but with no significant change in sodium or potassium excretion. That is a mild diuretic signal in healthy volunteers, not evidence that it treats any bladder symptom.

Cautions: Not if you have been told to restrict fluids, for example in severe heart or kidney disease; Not in pregnancy or breastfeeding; Not under 12 years; Use for 2 to 4 weeks only; Buy from a reputable source, as the toxic species Equisetum palustre is a known adulterant

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Hyaluronic acid bladder

Hyaluronan; sodium hyaluronate; HA

Evidence: moderate intravesically; none orally

Studied for: Instilled into the bladder through a catheter as glycosaminoglycan replacement for interstitial cystitis and recurrent UTI; also sold as oral capsules for the same purpose, which is a completely different thing

The two routes must not be confused. A 2016 Karger meta-analysis of 10 studies and 390 patients found intravesical hyaluronic acid, alone or with chondroitin sulphate, improved interstitial cystitis pain scores (mean difference on the visual analogue scale -3.21, 95% CI -4.16 to -2.26), while noting long-term and placebo-controlled studies were few. A 2017 International Urogynecology Journal meta-analysis of 8 studies and 800 patients with recurrent UTI found roughly 2.6 fewer UTIs per patient-year and about 130 more days to first recurrence, but only 2 of those studies were randomised (85 patients between them), only one was double-blind, reporting standards were low and publication bias was likely. Every one of those studies is a catheter instillation performed in a clinic; there is no trial of swallowed hyaluronic acid for any bladder outcome.

Cautions: Intravesical treatment requires catheterisation by a clinician and is a prescribed procedure, not something you take at home; an oral hyaluronic acid capsule should not be assumed to do what a bladder instillation does

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Java tea bladder

Orthosiphon aristatus; Orthosiphon stamineus; Orthosiphonis folium; cat's whiskers; kumis kucing

Evidence: traditional

Studied for: Increasing urine output to flush the urinary tract as an add-on in minor urinary complaints; also tested in kidney stone disease. Not studied for infection, urgency or leaks.

Registered by the EMA on traditional use only. Its assessment report identified just two human studies: an open study in 67 patients showing a 15% rise in urine output, which the report notes was weaker than horsetail, and a placebo-controlled trial in 76 people with kidney stones that found no statistically significant difference from placebo. So the single controlled trial was negative. The committee accepted the indication on safety and long use rather than on proven effect.

Cautions: Not if you have been told to restrict fluids, for example in severe heart or kidney disease; Not in pregnancy or breastfeeding; Not under 18 years; See a doctor if symptoms persist beyond 2 weeks

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L-arginine bladder

Arginine; L-arginine hydrochloride

Evidence: limited

Studied for: Tested as an oral treatment for interstitial cystitis and bladder pain syndrome on the theory that it boosts nitric oxide production in the bladder

This is one of the few bladder supplements that has actually been put through randomised placebo-controlled trials, and it failed them. The EAU chronic pelvic pain guideline states that after oral L-arginine no symptomatic relief or change in nitric oxide production could be shown. A 2016 International Urogynecology Journal systematic review of complementary therapies for bladder pain syndrome reports that the Korting randomised trial found no differences between groups on intention-to-treat analysis. The honest reading is not that the evidence is missing but that it is negative.

Interactions: Antihypertensive drugs (arginine is a vasodilator and can add to their blood-pressure-lowering effect)

Cautions: May increase mortality risk in people who have had an acute myocardial infarction; long-term use may worsen peripheral artery disease; commonly causes abdominal pain, bloating, nausea and diarrhoea; case reports of oesophagitis and of acute pancreatitis

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Lactobacillus crispatus CTV-05 bladder

CTV-05; Lactin-V

Evidence: limited intravaginally; none orally

Studied for: Preventing recurrent urinary tract infection after treated cystitis; tested as an intravaginal suppository, never as an oral capsule

Route is the whole story here. Stapleton's phase 2 double-blind trial gave 100 premenopausal women with recurrent UTI an intravaginal Lactin-V suppository daily for 5 days then weekly for 10 weeks after treatment for cystitis: recurrent UTI occurred in 15% (7 of 48) on Lactin-V versus 27% (13 of 48) on placebo, a relative risk of 0.5 (95% CI 0.2 to 1.2). That confidence interval crosses 1, so the result did not reach statistical significance and it was a phase 2 study, not a confirmatory one. No trial has tested swallowing this strain for bladder outcomes, and it is not sold as a licensed medicine.

Cautions: Avoid if you are severely ill or immunocompromised: NCCIH reports infections and other serious harms are more likely in those groups; the tested product is an investigational vaginal suppository, not an oral supplement on sale

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Lactobacillus probiotic strains (general) bladder

L. crispatus; L. acidophilus; L. plantarum; L. gasseri; L. casei

Evidence: early

Studied for: Supporting the urogenital microbiome; urgency and infection-prone bladders

The urinary microbiome is a real and active research area, and L. crispatus dominates a healthy urogenital microbiome. Which strains, at what dose, by which route, for which women is not settled. The pooled Cochrane result against placebo was not significant (RR 0.82, 95% CI 0.60 to 1.12). Association is not causation.

Cautions: Caution with live cultures if immunocompromised - ask a clinician

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Lactobacillus reuteri RC-14 bladder

L. reuteri RC-14; RC-14; usually sold paired with L. rhamnosus GR-1

Evidence: limited

Studied for: Preventing recurrent urinary tract infections; almost always tested in combination with L. rhamnosus GR-1 rather than on its own, and orally rather than vaginally

RC-14 has no meaningful trial evidence of its own for bladder outcomes: it is studied as half of the GR-1/RC-14 oral capsule. In the 2015 Cochrane review that pairing was compared with trimethoprim-sulfamethoxazole in postmenopausal women over 12 months with no significant difference (RR 1.12, 95% CI 0.95 to 1.33), while the review's overall probiotic-versus-placebo result was RR 0.82 (95% CI 0.60 to 1.12) across 9 studies and 735 participants, all low quality. NCCIH summarises the same review as finding no evidence of a beneficial effect. Marketing that treats RC-14 as a proven bladder ingredient is running well ahead of the data.

Cautions: Avoid if you are severely ill or immunocompromised: NCCIH reports infections and other serious harms are more likely in those groups; some probiotic products have been found to contain organisms other than those on the label

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Lactobacillus rhamnosus GR-1 bladder

L. rhamnosus GR-1; GR-1; usually sold paired with L. reuteri RC-14

Evidence: limited

Studied for: Preventing recurrent urinary tract infections and restoring vaginal lactobacilli; the key trial in postmenopausal women used oral capsules, not a vaginal product

The 2015 Cochrane review of probiotics for preventing UTI pooled 9 studies and 735 participants and found no clear benefit over placebo (RR 0.82, 95% CI 0.60 to 1.12), rating all outcomes low quality because of small samples and poor reporting. The GR-1/RC-14 study it included gave postmenopausal women oral capsules of at least 10 to the 9 CFU twice daily for 12 months against trimethoprim-sulfamethoxazole, and the review's probiotic-versus-antibiotic comparison found no significant difference (RR 1.12, 95% CI 0.95 to 1.33, one study, 223 women). With no placebo arm in that comparison you cannot tell whether both worked or neither did. NCCIH's own summary of the same review states it did not find evidence of a beneficial effect.

Cautions: Avoid if you are severely ill or immunocompromised: NCCIH reports infections and other serious harms are more likely in those groups; some probiotic products have been found to contain organisms other than those on the label

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Magnesium bladder

magnesium hydroxide; magnesium oxide

Evidence: background

Studied for: Bladder muscle relaxation

Rests on older, small studies. Not a reason on its own to choose a bladder supplement. The evidence is essentially one 1998 double-blind trial of magnesium hydroxide in 40 women with sensory urgency or detrusor instability: 55 per cent reported improvement against 20 per cent on placebo, but the urodynamic measurements showed no difference, the authors called the results preliminary, and we have found no replication in the decades since.

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Methenamine hippurate bladder

Hiprex; hexamine hippurate; methenamine

Evidence: moderate

Studied for: Preventing recurrent urinary tract infection, including as an alternative to daily low-dose antibiotic prophylaxis

This is a prescription-only medicine, not a supplement, and it should never be grouped with over-the-counter bladder products. The ALTAR non-inferiority randomised trial in UK NHS clinics randomised 240 women to methenamine hippurate or daily antibiotic prophylaxis for 12 months: UTI incidence was 1.38 episodes per person-year on methenamine against 0.89 on antibiotics, and that 0.49 difference stayed inside the pre-specified non-inferiority limit of one episode per year, with low and comparable adverse event rates in both arms. NICE's evidence review rated the underlying evidence very low quality because of small samples, missing data and inconsistency, and the AUA/CUA/SUFU recurrent UTI guideline says clinicians may offer it (conditional recommendation, evidence grade C). It works by releasing formaldehyde in acidic urine, so anything that alkalinises your urine undermines it.

Interactions: Sulphonamides (must not be given concurrently because of the risk of crystalluria); urinary alkalinising agents such as potassium citrate mixtures; acetazolamide

Cautions: Prescription-only medicine in the UK, not a food supplement; contraindicated in severe renal failure (creatinine clearance or GFR under 10 ml/min), severe dehydration, metabolic acidosis, gout and hepatic dysfunction; preferably avoided in pregnancy; can cause gastric and bladder irritation, nausea, vomiting, rash and itching

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Mimosa pudica bladder

sensitive plant

Evidence: very limited

Studied for: Marketed for gut cleansing; no established urinary role

The thinnest evidence base of the ingredients commonly found in bladder formulas.

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Pumpkin seed extract bladder

Cucurbita pepo

Evidence: limited

Studied for: Overactive bladder symptoms and night-time urination

Small clinical studies report improvements in urgency and night trips. The studies are small, often short and frequently industry-connected - a promising direction rather than settled science. The trial most often cited for this ingredient tested a pumpkin seed plus soy germ combination in 120 women over 12 weeks (2014); it was funded by the ingredient supplier, tested the combination rather than pumpkin seed alone, and is not indexed in PubMed. The PubMed-indexed study of pumpkin seed oil is weaker still: 45 subjects, no placebo group, 10 g of oil a day, with a co-author employed by the company that produced the oil.

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Quercetin bladder

Quercetin dihydrate; quercetin glycosides

Evidence: early

Studied for: Marketed for bladder inflammation and interstitial cystitis; the human trial evidence is in men with chronic prostatitis or in multi-ingredient capsules, not in women with bladder pain

A 2025 Frontiers in Pharmacology review of phytochemicals for interstitial cystitis found the quercetin evidence is entirely preclinical, from rodent and cell models of cyclophosphamide-induced cystitis, and cited no human trials. Neither the 2022 AUA interstitial cystitis and bladder pain syndrome guideline nor the EAU chronic pelvic pain guideline makes any statement about quercetin. Where it does appear in human bladder studies it is one of six ingredients in products such as CystoProtek, so nothing can be attributed to quercetin itself. Its poor water solubility and heavy first-pass metabolism mean oral bioavailability is low.

Interactions: CYP3A4 and CYP2C19 substrates (quercetin inhibits both enzymes in vitro; clinical relevance unclear); warfarin (a case report of raised INR that normalised on stopping); tamoxifen and losartan (increased exposure in preclinical models)

Cautions: Most of the interaction signal is in vitro, animal or single case reports rather than human trials, so treat it cautiously if you take a drug with a narrow therapeutic index; no adverse effects on kidney or liver function were seen in the trials reviewed, and up to 2000 mg a day was tolerated in a COPD safety study

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Saw palmetto bladder

Serenoa repens; Sabal serrulata; American dwarf palm

Evidence: strong for male prostate symptoms; none for women's bladder symptoms

Studied for: Lower urinary tract symptoms caused by an enlarged prostate, in men. It appears in women's bladder supplements, but has essentially not been tested for women's bladder symptoms.

The Cochrane review pooled 27 trials in 4,656 men and concluded that saw palmetto alone provides little to no benefit for lower urinary tract symptoms due to benign prostatic enlargement, with the evidence graded high to moderate certainty. That is strong evidence of no effect, not simply an absence of evidence, and NCCIH reports the same, including at three times the usual dose. No comparable trials exist in women, so its inclusion in women's bladder formulas is a marketing decision rather than an evidence-based one.

Cautions: Avoid in pregnancy and breastfeeding; Rare reports of liver injury (LiverTox likelihood score D), so stop and seek advice if jaundice or dark urine develop

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Soy germ isoflavones (bladder formulas) bladder

soy isoflavone extract

Evidence: limited

Studied for: Urinary symptoms after menopause; usually combined with pumpkin seed

Plausible mechanism via oestrogen-sensitive bladder and urethral tissue, tested mostly in small combination studies rather than alone. See the separate soy isoflavones row for the menopause evidence. The bladder evidence rests on a single 2014 trial of a pumpkin seed plus soy germ combination product, funded by the ingredient supplier and not indexed in PubMed. We have found no trial of soy germ on its own for urinary symptoms, which is why no primary source is linked here.

Cautions: Discuss with a clinician if there is a history of hormone-sensitive cancer

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Stinging nettle root bladder

Urtica dioica radix; Urticae radix; nettle root

Evidence: limited for male prostate symptoms; none for women's bladder symptoms

Studied for: Lower urinary tract symptoms related to an enlarged prostate, in men. Every trial participant has been male; it has not been studied for women's bladder symptoms.

The EMA's 2024 monograph registers nettle root on traditional use only, for prostate-related urinary symptoms in men once a doctor has excluded serious causes, and lists no known interactions. A systematic review and meta-analysis of five double-blind trials in 1,128 patients reported better symptom scores, peak urine flow and prostate volume, but it appeared in a minor journal and reported an implausibly large effect size (standardised mean difference -10.47) without a visible risk-of-bias assessment, so it should not be read as confirmation. Nothing at all tests nettle root in women.

Cautions: See a doctor first so that serious causes of urinary symptoms are ruled out; Can cause nausea, heartburn, bloating or diarrhoea

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Uva ursi bladder

bearberry; Arctostaphylos uva-ursi

Evidence: traditional

Studied for: Traditional urinary antiseptic use

Long traditional use with limited modern trial support. The EMA found no clinical efficacy trials and granted traditional-use registration only, and the ATAFUTI randomised trial in 382 UK women found no difference from placebo. Herbal references consistently describe it as a SHORT-TERM herb, which sits oddly inside products designed for daily indefinite use.

Cautions: Short-term use only; Not in pregnancy; Not in kidney disease

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Vitamin C (ascorbic acid) bladder

Ascorbic acid; L-ascorbic acid

Evidence: very limited

Studied for: Marketed to acidify urine and so prevent UTI; actually studied as UTI prophylaxis in pregnancy, and separately as a urinary acidifier in catheterised and spinal-cord-injured patients

A 2018 BMC Pregnancy and Childbirth systematic review of non-antibiotic UTI prevention in pregnancy found a single relevant trial, Ochoa-Brust 2007, in which 110 pregnant women took 100 mg ascorbic acid daily and 12.7% developed infection versus 29.1% of controls. The reviewers flagged unclear intention-to-treat analysis and selection bias, because non-adherent women and those with serious side effects were excluded from the analysis. The acidification premise that most bladder supplements sell also does not hold up: 500 mg six-hourly failed to produce a significant fall in urine pH in spinal cord injury patients, and 4 g daily alongside methenamine had no significant effect on mean urine pH in catheterised patients. There is no trial in midlife or postmenopausal women.

Interactions: Chemotherapy and radiotherapy (discuss with your oncologist before supplementing); niacin plus simvastatin (antioxidants may blunt the rise in HDL)

Cautions: Upper intake level is 2000 mg a day for adults; higher doses cause diarrhoea, nausea and abdominal cramps; high intakes raise urinary oxalate and uric acid excretion, so avoid them if you have had calcium oxalate stones, pre-existing hyperoxaluria or renal disease; theoretical risk of excess iron absorption in haemochromatosis

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Vitamin D bladder

cholecalciferol

Evidence: background

Studied for: Pelvic floor and bladder symptoms, observationally

Low vitamin D status has been associated with pelvic floor and bladder symptoms in observational research, but supplementing has not been convincingly shown to fix leaking. A blood-test conversation, not a reason to buy a bladder product. The trial usually cited for vitamin D is a pilot of 56 postmenopausal women with urgency incontinence and low vitamin D: episodes fell 43 per cent on vitamin D against 27.6 per cent on placebo, but that difference was not statistically significant (p=0.22), and frequency, nocturia, urgency and severity did not differ between the groups. It reached significance only in the 33 black women in the study. Marketing that cites this trial rarely mentions that the headline result was negative.

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Zinc bladder

Zinc gluconate; zinc citrate; zinc picolinate

Evidence: very limited

Studied for: Marketed for immune support in bladder formulas; there is essentially no bladder or urinary research in adult women, and what exists is in children

The NIH Office of Dietary Supplements professional fact sheet on zinc does not mention urinary tract infection or bladder health anywhere, which tells you how thin this evidence base is. The one systematic review and meta-analysis of micronutrients and UTI concluded that it was not possible to determine the impact of zinc supplements, and its population was paediatric, not midlife women. Nothing supports adding zinc to a bladder supplement for a woman going through menopause.

Interactions: Quinolone antibiotics; tetracycline antibiotics (zinc and the antibiotic each block the other's absorption, so separate doses by 2 to 6 hours); penicillamine; thiazide diuretics (increase urinary zinc loss)

Cautions: Upper intake level is 40 mg a day for adults; 50 mg or more a day interferes with copper absorption, can reduce immune function and lowers HDL cholesterol; high doses cause nausea, dizziness, headache, gastric distress and vomiting

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DHEA both

Dehydroepiandrosterone; prasterone (the vaginal prescription form); Intrarosa

Evidence: moderate vaginally; very limited orally

Studied for: Vaginal prasterone is a prescription pessary studied and licensed for moderate to severe dyspareunia and vulvovaginal atrophy of menopause; oral DHEA is a food supplement studied for menopausal quality of life, menopausal symptoms and sexual function

The 2025 AUA/SUFU/AUGS genitourinary syndrome of menopause guideline says clinicians should offer vaginal DHEA to improve vulvovaginal dryness and/or dyspareunia (moderate recommendation, evidence grade C), on the strength of two 12-week phase III placebo-controlled trials; it rates certainty of evidence as low and makes no recommendation about urinary symptoms, urgency, incontinence or recurrent UTI. Oral DHEA is a different picture: a Cochrane review of 28 RCTs in 1,273 women found no improvement in quality of life, unclear effects on menopausal symptoms, and acne in 15% of DHEA users versus under 3% of controls. The pivotal vaginal trials ran only 12 weeks, so longer-term benefits and harms remain uncertain. DHEA does not appear anywhere in the Menopause Society's 2023 nonhormone therapy position statement, so it was not assessed there.

Cautions: Vaginal prasterone labelling contraindicates it in known or suspected oestrogen-dependent cancer and in women with known, suspected or past breast cancer; women with a cancer history were excluded from the pivotal trials; oral DHEA causes androgenic side effects, most commonly acne; vaginal prasterone is a prescription medicine, not an over-the-counter supplement

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5-HTP menopause

5-hydroxytryptophan; oxitriptan

Evidence: very limited

Studied for: Depression, and specifically tested for menopausal hot flushes; also promoted for sleep, anxiety and appetite

A Cochrane review found only 2 of 111 identified trials were of adequate quality, together covering 64 people; they favoured tryptophan or 5-HTP over placebo but the authors judged the evidence insufficient to be conclusive and preferred established antidepressants, which are proven effective and safe. Memorial Sloan Kettering's monograph states 5-HTP showed no benefit for hot flushes. Cochrane also flags that a possible association between these substances and the potentially fatal eosinophilia-myalgia syndrome has not been resolved. 5-HTP is absent from the Menopause Society's 2023 nonhormone therapy position statement.

Interactions: SSRIs; tricyclic antidepressants; MAOIs; linezolid; St John's wort; SAM-e; carbidopa

Cautions: Do not combine with serotonergic medicines because of serotonin syndrome risk; contaminated products have been linked to eosinophilia-myalgia syndrome and a scleroderma-like illness; it can interfere with 5-HIAA urine testing for carcinoid tumours

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Ashwagandha menopause

Withania somnifera; Indian ginseng; winter cherry; KSM-66; Sensoril

Evidence: early

Studied for: Stress, anxiety and sleep in general adult populations; three small trials in peri- and postmenopausal women using menopause symptom scales

The menopause evidence is three small randomised trials totalling roughly 280 women, all conducted in India, all using extract supplied or funded by the ingredient manufacturer, the longest running 24 weeks and none independently replicated. NCCIH states there is not enough evidence to determine whether ashwagandha helps menopause. The cortisol story used to sell it does not close: a 2025 meta-analysis found ashwagandha significantly lowered measured cortisol (-1.16 ug/dL, P<0.001) while producing no significant change in perceived stress (P=0.40), and no trial has shown that lowering cortisol improves menopausal symptoms. Ashwagandha is not named anywhere in the Menopause Society's 2023 nonhormone therapy position statement, so it was not assessed.

Interactions: Sedatives; diabetes medicines; blood pressure medicines; immunosuppressants; thyroid medication including levothyroxine

Cautions: NIH LiverTox records around 23 published cases of clinically apparent liver injury since 2017, typically 2 to 12 weeks after starting, mostly cholestatic, with rare fatal cases or emergency transplant, and assigns a likelihood score of B; Denmark banned it in 2023 and the UK Food Standards Agency has an open safety assessment; measurably alters thyroid hormones, so avoid if you have a thyroid or autoimmune disorder or are about to have surgery; avoid in pregnancy and breastfeeding; no long-term safety data beyond about three months

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Black cohosh menopause

Actaea racemosa; Cimicifuga racemosa; black snakeroot

Evidence: limited for hot flushes; none for stress incontinence

Studied for: hot flushes and night sweats; overall menopausal symptom scores

The 2012 Cochrane review pooled 16 randomised trials in 2,027 women and found no difference from placebo in daily hot flush frequency (mean difference 0.07 flushes per day, 95% CI -0.43 to 0.56, P=0.79; three trials, 393 women), concluding there is insufficient evidence to support its use. Trials were mostly short and used varied preparations, so the question is unsettled rather than closed. The Menopause Society's 2023 nonhormone therapy position statement names black cohosh on its not-recommended list (Level I). NIH LiverTox assigns black cohosh a likelihood score of A, its highest category, meaning products sold as black cohosh are a well-established cause of clinically apparent liver injury.

Interactions: tamoxifen; doxorubicin; docetaxel; simvastatin; drugs metabolised by CYP3A4

Cautions: Established cause of clinically apparent liver injury (LiverTox likelihood score A), with onset typically 2 to 12 weeks; stop and seek medical advice for jaundice, dark urine or right upper abdominal pain; avoid if you have liver disease; avoid in pregnancy as it may act as an abortifacient; products have been found to contain the wrong Actaea species

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Calcium menopause

Calcium carbonate; calcium citrate

Evidence: moderate for bone health with vitamin D; none for hot flushes

Studied for: Bone loss and fracture prevention after menopause (usually alongside vitamin D); it is not a hot flush treatment and has not been trialled as one

The NIH Office of Dietary Supplements says fracture findings are mixed: one meta-analysis of 500-1,200 mg calcium with 400-800 IU vitamin D found 15% fewer fractures overall and 30% fewer hip fractures, while other systematic reviews found no benefit. The recommended intake rises to 1,200 mg a day for women over 50 specifically to lessen bone loss after menopause, and food counts towards that total. Calcium is absent from the Menopause Society's 2023 nonhormone therapy position statement, which deals with vasomotor symptoms only.

Interactions: Levothyroxine (separate doses by at least 4 hours); quinolone antibiotics (separate by 2 hours); bisphosphonates; dolutegravir; lithium

Cautions: Do not exceed 2,000 mg/day in total from food plus supplements if you are over 50; supplemental calcium at about 1,000 mg/day was linked to more kidney stones in the Women's Health Initiative; calcium carbonate causes more constipation and bloating than calcium citrate in older adults

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Chasteberry menopause

Vitex agnus-castus; chaste tree; agnus castus; monk's pepper

Evidence: moderate for premenstrual syndrome; very limited for hot flushes; none for stress incontinence

Studied for: premenstrual syndrome and cyclical breast pain; hot flushes

The European Medicines Agency accepted a well-established use indication of premenstrual syndrome for one specific dry extract at 20 mg a day, but examined menopausal symptoms separately and did not accept them, concluding that efficacy cannot be substantiated. The largest and most rigorous menopause trial cited by the Menopause Society (n=100) tested a mixed supplement rather than Vitex alone and found no difference from placebo in daily hot flush frequency or intensity after 16 weeks, so Vitex on its own has barely been tested for hot flushes. The Menopause Society's 2023 nonhormone therapy position statement names chasteberry on its not-recommended list (Level II).

Interactions: dopamine agonists such as bromocriptine and cabergoline; dopamine antagonists including antipsychotics and metoclopramide; oral contraceptives; oestrogens and anti-oestrogens; drugs metabolised by CYP2C19 or CYP3A4

Cautions: Avoid in pregnancy and while breastfeeding — reproductive studies suggest extracts of the fruit may influence lactation; discuss with your doctor if you have a hormone-sensitive cancer, as chasteberry has phytoestrogenic properties; reported effects include nausea, headache, gastrointestinal upset, menstrual disturbance, acne and rash

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Curcumin menopause

Turmeric extract; Curcuma longa; diferuloylmethane

Evidence: limited

Studied for: Hot flushes, mood, bone density and metabolic markers in postmenopausal women; separately studied for osteoarthritis and non-alcoholic fatty liver disease

A systematic review of 12 RCTs in postmenopausal women, using 80-1,000 mg daily for 8 weeks to 12 months, found conflicting results on hot flushes: one trial reported significantly fewer than placebo and another found no association, with no significant effect on psychological or sexual outcomes and no change in serum oestradiol. Most trials were small, ten of the twelve came from a single country, and several combined curcumin with other agents, so the reviewers concluded the RCT results are conflicting and limited and called for well-designed placebo-controlled trials. Curcumin is not assessed in its own right in the Menopause Society's 2023 nonhormone therapy position statement; it appears once, inside the vitamin E discussion, as part of a trial of curcumin and vitamin E.

Cautions: NIH LiverTox scores turmeric and curcumin A, a well documented cause of clinically apparent liver injury, usually 1 to 4 months after starting; high-bioavailability formulations using piperine (black pepper) or lipid nanoparticles are the ones most often implicated; the HLA-B*35:01 allele was found in over 70% of cases versus 10-15% of controls; stop and seek medical advice for jaundice, dark urine or unexplained fatigue; NCCIH says supplement doses may be unsafe in pregnancy

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Dong quai menopause

Angelica sinensis; dang gui; danggui; female ginseng

Evidence: very limited for hot flushes; none for stress incontinence

Studied for: hot flushes and night sweats

The single randomised trial cited by the Menopause Society gave 71 women 4.5 g of dong quai daily or placebo and found no difference in hot flush frequency after 24 weeks. Dong quai is traditionally used within multi-herb formulas rather than alone, so a single-herb trial may not reflect traditional practice, but no larger trial has changed the picture. The Menopause Society's 2023 nonhormone therapy position statement names dong quai on its not-recommended list (Level II) and flags possible photosensitisation, anticoagulation and carcinogenicity.

Interactions: warfarin and other anticoagulants; antiplatelet drugs; ACE inhibitors; clozapine; drugs metabolised by cytochrome P450

Cautions: Can cause photosensitivity and photodermatitis, so avoid strong sun and sunbeds; avoid in pregnancy and while breastfeeding; discuss with your doctor if you have a hormone-sensitive cancer, as dong quai has shown oestrogenic activity and stimulated oestrogen receptor positive breast tumour cells in the laboratory

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Evening primrose oil menopause

Oenothera biennis; EPO; gamolenic acid; gamma-linolenic acid

Evidence: very limited for hot flushes; none for stress incontinence

Studied for: hot flushes and night sweats; breast pain; premenstrual syndrome

The one menopause trial cited by the Menopause Society randomised 56 women to 500 mg of evening primrose oil daily or placebo for six months; hot flushes fell by 1.0 per day on evening primrose oil and by 2.6 per day on placebo, so it did not beat placebo. That is a single small trial, and the handful of later trials are also small and conflicting. The Menopause Society's 2023 nonhormone therapy position statement names evening primrose oil on its not-recommended list (Level II). NCCIH separately states there is insufficient evidence to show whether evening primrose oil helps menopause symptoms.

Interactions: warfarin and other anticoagulants; antiplatelet drugs; lopinavir and other antiretrovirals; blood pressure medicines

Cautions: Avoid in pregnancy — use has been associated with prolonged rupture of membranes and arrest of descent in labour; commonly causes abdominal pain, nausea, indigestion and loose stools

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Flaxseed lignans menopause

Linum usitatissimum; linseed; secoisolariciresinol diglucoside; SDG lignans

Evidence: limited for hot flushes; none for stress incontinence

Studied for: hot flushes and night sweats; mild menopausal symptoms

The largest trial is a phase III randomised double-blind placebo-controlled study (NCCTG N08C7) of 188 postmenopausal women given a bar containing 410 mg of flaxseed lignans or placebo for six weeks; a little over a third of women in both groups had a 50% fall in hot flush score, and the investigators concluded flaxseed is not effective for hot flushes. NCCIH describes the wider picture as conflicting, with one study suggesting effectiveness while placebo-controlled comparison showed no significant differences. Flaxseed is not mentioned anywhere in the Menopause Society's 2023 nonhormone therapy position statement, so it was not assessed.

Interactions: anticoagulant and antiplatelet drugs (NCCIH describes this as a theoretical concern rather than a confirmed interaction)

Cautions: Do not eat raw or unripe flaxseed, which may contain toxic compounds; take with plenty of water and expect bloating, wind or loose stools at higher doses; may affect the result of a double contrast barium enema, so tell your radiology team; discuss with your doctor if you have oestrogen receptor positive breast cancer

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Gamma-aminobutyric acid (GABA) menopause

GABA; gamma-aminobutyrate

Evidence: very limited

Studied for: Stress markers and sleep onset in small short studies; sold for menopausal anxiety, tension and sleep, which has not been tested

A systematic review of 14 studies of oral GABA found limited evidence of effects on stress markers and only very limited evidence of objective sleep improvement, mostly a modest shortening of time to fall asleep. The central problem is whether swallowed GABA reaches the brain at all: those reviewers state there are no data showing GABA blood-brain barrier permeability in humans, and an earlier review concluded no definite conclusion is possible and noted that most of the positive human studies were authored by people affiliated with the company making the supplement. GABA does not appear in the Menopause Society's 2023 nonhormone therapy position statement.

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Green tea extract (EGCG) menopause

EGCG; epigallocatechin-3-gallate; Camellia sinensis catechin extract

Evidence: limited for weight and cholesterol; none for menopausal symptoms

Studied for: Weight, blood cholesterol and cancer prevention; trialled in postmenopausal women for breast density, body fat and bone density rather than for menopausal symptoms

NCCIH says green tea catechins plus caffeine may have a modest effect on body weight and modestly lower total and LDL cholesterol, with inconsistent results for cancer and heart disease. The safety arm of the Minnesota Green Tea Trial, which gave 1,315 mg catechins (843 mg EGCG) daily for 12 months to 1,075 postmenopausal women, found raised ALT in 6.7% on extract versus 0.7% on placebo (P < 0.001), seven of them classed as serious adverse events. NIH LiverTox scores green tea extract A, a well established cause of clinically apparent liver injury, with more than 100 published cases, including fatal acute liver failure and cases requiring urgent transplant, typically appearing 1 to 6 months after starting. Green tea does not appear in the Menopause Society's 2023 nonhormone therapy position statement.

Interactions: Nadolol; atorvastatin; raloxifene

Cautions: The liver risk attaches to concentrated tablet and capsule extracts, not to brewed tea; stop at once and seek medical advice for jaundice, dark urine, nausea or unusual fatigue; anyone who has had green tea related liver injury should avoid re-exposure and any supplement containing green tea; extracts contain caffeine and can raise blood pressure

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Hops and 8-prenylnaringenin menopause

Humulus lupulus; hop extract; 8-PN; 8-prenylnaringenin

Evidence: early for hot flushes; none for stress incontinence

Studied for: hot flushes and night sweats; menopausal symptom scores; sleep

Three small human trials exist: 67 women for 12 weeks on 100 or 250 micrograms a day of standardised hop extract, a 36-woman crossover study on 10 micrograms a day of 8-prenylnaringenin, and 120 women for 90 days on hop tablets, all reporting reductions in menopausal symptom scores. All three were small and short, and in the first trial the higher dose performed less well than the lower one, which is not the pattern a genuine dose-response produces. 8-Prenylnaringenin is described as the most potent phytoestrogen identified so far, binding oestrogen receptor alpha with roughly 100 times the affinity of genistein — that is a safety question as much as a selling point. Hops is not mentioned anywhere in the Menopause Society's 2023 nonhormone therapy position statement, so it was not assessed.

Cautions: Discuss with your doctor before use if you have a hormone-sensitive cancer; because 8-prenylnaringenin is strongly oestrogenic, reviewers flag unresolved questions about uterine and breast tissue proliferation and about interference with aromatase inhibitors

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Maca menopause

Lepidium meyenii; Peruvian ginseng; maca root

Evidence: limited for hot flushes; none for stress incontinence

Studied for: menopausal symptom scores; sexual function and libido

A systematic review found four randomised trials, all of which reported favourable effects on the Kupperman Index or Greene Climacteric Scale. The reviewers judged the number of trials, sample sizes and methodological quality too limited to draw firm conclusions and stated that maca's safety has not been proved. The Menopause Society's 2023 nonhormone therapy position statement names maca on its not-recommended list (Level II), citing exactly those quality and sample-size problems rather than a clear negative result — so this is an unanswered question, not a settled failure.

Cautions: Can interfere with testosterone blood tests, so tell your doctor before testing; reported effects include altered menstrual cycles, intermenstrual bleeding, moodiness, cramps, gastritis and insomnia; discuss with your doctor if you have a hormone-sensitive cancer such as breast or uterine cancer

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Melatonin menopause

N-acetyl-5-methoxytryptamine

Evidence: limited for sleep; very limited in menopause

Studied for: Studied mainly for jet lag, delayed sleep-wake phase disorder, shift work and sleep disorders in children; sold as a menopause product for night-time waking and night sweats, which is not what those trials tested

NCCIH rates the jet lag evidence as medium quality and says there is not enough strong evidence to recommend melatonin for chronic insomnia. A systematic review and meta-analysis of seven RCTs in 497 menopausal women found no significant improvement in sleep quality (PSQI standardised mean difference -0.87, 95% CI -1.94 to 0.19) and no significant effect on menopausal symptoms, with very high heterogeneity between trials. A possible bone density signal came only from trials where melatonin was combined with calcium, vitamin D or strontium, so it cannot be attributed to melatonin. Melatonin is absent from the Menopause Society's 2023 nonhormone therapy position statement.

Interactions: Anticoagulants (blood thinners)

Cautions: Long-term safety is not established; people with epilepsy and anyone on anticoagulants should use it only under medical supervision; product content is unreliable, with 22 of 25 melatonin gummies in a 2023 analysis mislabelled at 74-347% of the stated dose

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Omega-3 fatty acids (EPA and DHA) menopause

Fish oil; eicosapentaenoic acid; docosahexaenoic acid; n-3 fatty acids

Evidence: limited

Studied for: Hot flushes and night sweats; separately studied for cardiovascular disease, depression and triglycerides

The largest trial gave 355 peri- and postmenopausal women 1.8 g/day of omega-3 or placebo for 12 weeks and found no improvement in hot flush frequency or bother (2.5 versus 2.7 fewer flushes per day; P = 0.28). An earlier, smaller trial of 91 women did report a benefit, so the trial results conflict and the negative trial is much the larger. The Menopause Society's 2023 statement calls the evidence mixed and inconclusive and names omega-3s on its not-recommended list.

Interactions: Warfarin and other anticoagulants or antiplatelets

Cautions: Doses of 2-15 g/day of EPA and/or DHA may increase bleeding time; common side effects are nausea, heartburn and diarrhoea; tell your surgeon or anticoagulation clinic that you take it

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Panax ginseng menopause

Panax ginseng; Asian ginseng; Korean red ginseng; G115

Evidence: limited for hot flushes; none for stress incontinence

Studied for: hot flushes; menopausal symptom scores; sexual arousal; fatigue and well-being

A systematic review of four randomised trials found that the one trial measuring hot flush frequency failed to show a significant effect of Korean red ginseng over placebo, with some benefit reported for sexual arousal and well-being. Most of the included studies were at high risk of bias and the reviewers concluded firm conclusions cannot be drawn. The Menopause Society's 2023 nonhormone therapy position statement names ginseng on its not-recommended list (Level I), citing a trial in which 384 postmenopausal women took the G115 extract or placebo for 16 weeks with no greater reduction in hot flushes than placebo.

Interactions: insulin and sulfonylureas; monoamine oxidase inhibitors; imatinib; warfarin; drugs metabolised by CYP3A4

Cautions: May lower blood sugar, so monitor closely if you take diabetes medicines; reported effects include insomnia, nervousness, fast heart rate, nausea and diarrhoea; cases of bleeding around surgery have been reported

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Pine bark extract menopause

Pycnogenol; French maritime pine bark extract; Pinus pinaster bark extract

Evidence: early for menopausal symptoms; none for stress incontinence

Studied for: menopausal symptom questionnaires including hot flushes and sleep; cardiovascular and antioxidant measures

Three randomised trials in menopausal women have been reported — 155 women on 200 mg a day for six months, 70 women on 100 mg a day for eight weeks, and 156 women on 60 mg a day for 12 weeks — each describing improvements in menopausal symptom questionnaires. The review collecting them was written by an author affiliated with the branded product, the trials used different doses, durations and questionnaires, and Memorial Sloan Kettering notes that systematic reviews have concluded the evidence for Pycnogenol is insufficient and that large-scale studies are needed. Pine bark extract is not mentioned anywhere in the Menopause Society's 2023 nonhormone therapy position statement, so it was not assessed.

Interactions: warfarin and other anticoagulants; antiplatelet drugs

Cautions: Can inhibit platelet clumping and may raise bleeding risk alongside blood-thinning medicines; may cause irritability and lower energy

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Red clover menopause

Trifolium pratense; red clover isoflavones; Promensil

Evidence: limited for hot flushes; none for stress incontinence

Studied for: hot flushes and night sweats; menopausal symptom scores; vaginal dryness

The Cochrane review of phytoestrogens (43 trials, 4,084 women) pooled five Promensil trials and found no significant difference from placebo in daily hot flush frequency (mean difference -0.93, 95% CI -1.95 to 0.10). A separate 2021 meta-analysis of eight trials did report a reduction of 1.73 hot flushes per day (95% CI -3.28 to -0.18, P=0.0292), so the answer depends heavily on which trials are pooled. Treat one widely cited review with care: Ghazanfarpour and colleagues (Avicenna Journal of Phytomedicine, 2015) concluded red clover had a positive effect on hot flushes although their pooled result was not significant (MD -1.99, P=0.067), and called an oestradiol effect significant when the reported interval crossed zero (SMD 0.240, 95% CI -0.001 to 0.482, P=0.051). Red clover is not mentioned anywhere in the Menopause Society's 2023 nonhormone therapy position statement, so it was not assessed rather than assessed and rejected.

Interactions: warfarin and other anticoagulants; antiplatelet drugs; methotrexate; tamoxifen and other drugs metabolised by CYP1A2, CYP2C8, CYP2C9, CYP2C19, CYP2D6 or CYP3A4

Cautions: Avoid if you have a hormone-sensitive cancer such as oestrogen receptor positive breast cancer, because red clover has oestrogenic activity; case reports describe subdural haematoma and subarachnoid haemorrhage in women taking red clover supplements

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Rhodiola menopause

Rhodiola rosea; golden root; arctic root; roseroot

Evidence: early for menopausal symptoms in combination with black cohosh; none alone; none for stress incontinence

Studied for: stress, fatigue and low mood; menopausal symptom scores when combined with black cohosh

The only menopause trial of any size is a 12-week randomised double-blind placebo-controlled study in 220 women, in which Rhodiola combined with black cohosh cut Kupperman Menopausal Index scores by 71.2% from baseline against 26.3% on placebo, beating black cohosh alone. Because Rhodiola was only ever given alongside black cohosh, that trial cannot show what Rhodiola does on its own, and no trial has tested Rhodiola alone for hot flushes. Memorial Sloan Kettering lists its studied uses as stress, fatigue, endurance and depression — menopause is not among them. Rhodiola is not mentioned anywhere in the Menopause Society's 2023 nonhormone therapy position statement, so it was not assessed.

Interactions: warfarin; phenytoin; drugs metabolised by CYP3A4; drugs transported by P-glycoprotein; antidepressants

Cautions: Reported side effects include dizziness and dry mouth; a case of fast heart rhythm was reported in a patient taking Rhodiola together with antidepressants

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S-equol menopause

S-equol; equol; daidzein metabolite

Evidence: limited for hot flushes; none for stress incontinence

Studied for: hot flushes in women whose gut bacteria cannot make equol from dietary soy

A 2019 systematic review and meta-analysis pooled five randomised trials in 728 women and reported that supplementing equol significantly lowered hot flush scores, with the authors arguing that whether a woman can make equol herself is the main reason soy isoflavone trials disagree. Three of the five trials found a significant benefit and two did not, the trials were small, and the target group is narrow — the benefit is claimed specifically for equol non-producers. The Menopause Society's 2023 nonhormone therapy position statement names the soy metabolite equol on its not-recommended list (Level II), judging the evidence mixed and the studies limited. It has not been studied for bladder leakage.

Cautions: A trial reported abdominal distension and thickening of the womb lining at 10 to 20 mg daily; discuss with your doctor before use if you have a hormone-sensitive cancer, as equol binds oestrogen receptors

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Saffron menopause

Crocus sativus stigma; crocin; safranal; affron

Evidence: early

Studied for: Low mood, anxiety and hot flushes around menopause; also studied for major depressive disorder

A 6-week double-blind trial in 60 postmenopausal women with major depressive disorder found 30 mg a day of saffron improved both depression scores and a hot flush measure compared with placebo. A larger 12-week trial of 28 mg a day of a standardised saffron extract in 86 perimenopausal women found significantly greater improvement in psychological symptoms but no greater improvement than placebo on the vasomotor subscale (P = 0.401), and that trial was funded by the extract manufacturer with the lead author receiving company funding. The trials are few, small and short, and the mood signal is more consistent than the hot flush signal. Saffron does not appear in the Menopause Society's 2023 nonhormone therapy position statement.

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Sage menopause

Salvia officinalis; common sage; garden sage

Evidence: early for hot flushes; none for stress incontinence

Studied for: hot flushes and night sweats; excessive sweating; menopausal symptom scores and sleep quality

The strongest study is a four-week double-blind randomised placebo-controlled trial in 80 women aged 48 to 65 taking a fresh sage leaf extract, reporting a 39.2% fall in the Menopause Rating Scale (P=0.002) and a 55.3% fall in hot flush severity by week three (P=0.028). That is one short trial of one proprietary extract, and the other commonly quoted sage study was an open-label trial in 69 women with no placebo group, which cannot separate a real effect from the large placebo response typical of hot flush trials. Sage's European regulatory standing is traditional use for the relief of excessive sweating, which rests on long-standing use rather than clinical trials. Sage is not mentioned anywhere in the Menopause Society's 2023 nonhormone therapy position statement, so it was not assessed.

Cautions: Sage leaf contains thujone; EU herbal guidance caps intake at 5 mg of thujone a day and limits traditional use for sweating to two weeks; thujone acts on GABA-A receptors and high exposure has been linked to seizures, so avoid high-dose or prolonged sage preparations and do not take sage essential oil internally

Helps stress leaks: noHelps hot flushes: unclearPrimary sourceOur page on thisFull entry →

Soy isoflavones menopause

Glycine max isoflavones; genistein; daidzein; soy extract

Evidence: limited for hot flushes; none for stress incontinence

Studied for: hot flushes and night sweats; menopausal symptom scores; vaginal dryness

The Cochrane review of phytoestrogens covered 43 trials in 4,084 women and found no conclusive evidence that phytoestrogen supplements reduce the frequency or severity of hot flushes and night sweats, although four trials of extracts providing more than 30 mg a day of genistein did consistently reduce hot flush frequency. Many of the included trials were small, short and at high risk of bias, and the preparations varied widely, so a genuine effect of concentrated genistein cannot be ruled out or confirmed. The Menopause Society's 2023 nonhormone therapy position statement names soy foods and soy extracts on its not-recommended list (Level II), calling the findings mixed. NCCIH notes soy foods appear safe for breast cancer survivors but that the safety of concentrated supplements is uncertain.

Interactions: tamoxifen; aromatase inhibitors; levothyroxine

Cautions: Talk to your oncologist before using concentrated isoflavone supplements if you have or have had a hormone-sensitive cancer; long-term supplement use has been linked to thickening of the womb lining; avoid if you are allergic to soy

Helps stress leaks: noHelps hot flushes: unclearPrimary sourceOur page on thisFull entry →

St John's wort menopause

Hypericum perforatum; hypericin; hyperforin

Evidence: limited

Studied for: Depression, and vasomotor symptoms of menopause; frequently sold in menopause blends combined with black cohosh

NICE NG23 tells clinicians to advise people with a personal history of, or at high risk of, breast cancer that although there is some evidence St John's wort may help relieve vasomotor symptoms, there is uncertainty about appropriate dosage, persistence of effect, variation in the nature and potency of preparations, and potential serious interactions with other medicines including tamoxifen, anticoagulants and anticonvulsants. NCCIH says it is not consistently effective even for depression and should not replace conventional care. The interaction profile, not the efficacy, is the clinically decisive fact about this herb. The Menopause Society's 2023 statement does not assess it in its own right - it appears only as something sometimes combined with black cohosh - while the statement's blanket position is that over-the-counter supplements and herbal therapies are not recommended for hot flushes.

Interactions: Tamoxifen; warfarin and other anticoagulants; anticonvulsants; combined oral contraceptives; ciclosporin; tacrolimus; digoxin; oxycodone; HIV antiretrovirals including indinavir; irinotecan and other cancer chemotherapy; SSRIs and other antidepressants (serotonin syndrome risk)

Cautions: It induces CYP3A4, CYP1A and CYP2C9 and P-glycoprotein, so it lowers blood levels of many prescription medicines - have a pharmacist check every medicine you take before you start it; contraceptive failure and transplant rejection have been reported; never start or stop it without telling your prescriber, as levels of other drugs change both ways; LiverTox rates its own liver injury risk as unlikely but notes it can increase the hepatotoxicity of other drugs through these interactions

Helps stress leaks: noHelps hot flushes: unclearPrimary sourceOur page on thisFull entry →

Valerian menopause

Valeriana officinalis; valerian root

Evidence: limited

Studied for: Insomnia, anxiety and stress; heavily marketed for menopausal sleep problems and night sweats, which is not where the main body of research sits

NCCIH says the evidence on whether valerian helps sleep problems is inconsistent, and that the American Academy of Sleep Medicine recommended against using it for chronic insomnia in adults. On menopause specifically, NCCIH notes that three small studies suggest valerian might be helpful for menopause symptoms but there is not enough evidence to know for certain. Valerian does not appear in the Menopause Society's 2023 nonhormone therapy position statement, whose general position is that supplements and herbal remedies are not recommended for hot flushes.

Interactions: Alcohol; sedatives

Cautions: Do not take it with alcohol or sedatives; long-term safety is unknown and the evidence covers only about 300-600 mg daily for up to 6 weeks; stopping abruptly after long use may cause anxiety and insomnia; avoid in pregnancy and breastfeeding; side effects include headache, stomach upset, mental dullness, excitability and vivid dreams

Helps stress leaks: noHelps hot flushes: unclearPrimary sourceOur page on thisFull entry →

Vitamin E menopause

Alpha-tocopherol; tocopherol

Evidence: limited

Studied for: Hot flushes and night sweats in menopausal women and in breast cancer survivors; also taken generally as an antioxidant

The Menopause Society's 2023 nonhormone therapy position statement reviewed two crossover trials (120 and 50 women) and found only a limited reduction in hot flush frequency compared with placebo. Those trials were small, short and crossover in design, so the small difference is hard to separate from placebo response. Vitamin E is named explicitly on that statement's not-recommended list, at Level I.

Interactions: Warfarin and other anticoagulants or antiplatelets; niacin plus statin combinations; chemotherapy and radiotherapy

Cautions: High doses increase bleeding risk; do not exceed the tolerable upper intake level of 1,000 mg/day of supplemental alpha-tocopherol; ask an oncologist before using antioxidant supplements during chemotherapy or radiotherapy

Helps stress leaks: noHelps hot flushes: noPrimary sourceOur page on thisFull entry →

Vitamin K2 (menaquinone) menopause

Menaquinone; MK-4; MK-7; menatetrenone

Evidence: limited

Studied for: Post-menopausal bone loss and fracture risk; not studied for hot flushes or bladder symptoms

The strongest single trial gave 180 micrograms a day of MK-7 to 244 healthy postmenopausal women for three years and found it slowed the age-related decline in bone mineral content and density at the lumbar spine and femoral neck, with no change at the total hip. The NIH Office of Dietary Supplements notes an older systematic review found MK-4 reduced hip, vertebral and non-vertebral fractures, but later work found vitamin K did not alter bone turnover, density or geometry in healthy North American postmenopausal women, and co-supplementation with calcium and vitamin D confounds many trials. Vitamin K does not appear in the Menopause Society's 2023 nonhormone therapy position statement.

Interactions: Warfarin and other vitamin K antagonist anticoagulants

Cautions: If you take warfarin, keep vitamin K intake steady and speak to your anticoagulation clinic before starting or stopping a K2 supplement, because sudden changes alter the anticoagulant effect; no upper intake level has been set as toxicity is low

Helps stress leaks: noHelps hot flushes: noPrimary sourceOur page on thisFull entry →

Wild yam menopause

Dioscorea villosa; colic root; rheumatism root; diosgenin

Evidence: very limited for hot flushes; none for stress incontinence

Studied for: hot flushes and menopausal symptoms, usually as a topical cream

Wild yam is sold on the claim that its plant steroid diosgenin turns into progesterone in the body; Memorial Sloan Kettering states plainly that there is no evidence the human body can make that conversion, which happens only in a laboratory. One clinical trial of a yam cream for hot flushes reported no significant benefit, and human data overall come from a few small studies with mixed results. The Menopause Society's 2023 nonhormone therapy position statement names wild yam on its not-recommended list (Level II) and warns that tested yam creams often contain no yam extract at all and have been adulterated with undisclosed steroids.

Cautions: Yam creams have been found adulterated with undisclosed steroid hormones, so the product may not contain what the label claims; discuss with your doctor if you have a hormone-sensitive cancer; Dioscorea villosa has caused chronic kidney injury in animal models

Helps stress leaks: noHelps hot flushes: noPrimary sourceOur page on thisFull entry →

Urox (Crataeva nurvala + Equisetum arvense + Lindera aggregata) bladder

Cratevox; Crataeva nurvala stem bark; horsetail stem; Lindera aggregata root; sold as Urox or Bedtime Buddy

Evidence: limited

Studied for: Overactive bladder symptoms: daytime frequency, night-time trips, urgency and incontinence, studied as a fixed three-herb blend rather than as separate ingredients

The only branded blend in this category with a properly designed trial behind it. A phase 2 randomised, double-blind, placebo-controlled trial in 150 adults (59 per cent women, average age 63) reported significantly lower daytime frequency, fewer night-time trips, less urgency and less incontinence after 8 weeks, with no side effects causing withdrawal. Three things temper it: one of the authors is from Seipel Group, the company that makes Urox; it is a single phase 2 trial at two primary care centres, not an independent replication; and the participants were a mixed group of men and women with overactive bladder, so it says nothing about stress leaks specifically. Graded limited rather than moderate for that reason. A separate trial of the same blend in children with bedwetting is registered but is a protocol, not a result.

Interactions: No documented interactions found in the sources we checked

Cautions: Horsetail is a diuretic and the European Medicines Agency registered it on traditional use only; see the separate horsetail row. Not studied in pregnancy or breastfeeding

Helps stress leaks: noHelps hot flushes: noPrimary sourceOur page on thisFull entry →