Does red clover help with hot flashes during perimenopause?

Red clover is one of the more studied herbal supplements for hot flashes, and it has reasonable clinical evidence supporting a meaningful reduction in frequency for many women. It is not as effective as hormone therapy, but it is among the better-evidenced non-prescription options.

What red clover contains and how it works. Red clover (Trifolium pratense) contains four isoflavones: formononetin, biochanin A, daidzein, and genistein. These compounds are phytoestrogens, meaning they are plant-derived compounds that bind to estrogen receptors in the body, primarily estrogen receptor beta (ER-beta). By activating estrogen receptors in the hypothalamus and elsewhere, they may partially compensate for the declining estrogen levels that destabilize the body's thermoregulatory system. Hot flashes occur when the hypothalamus narrows its temperature comfort zone and triggers sweating and vasodilation in response to small temperature fluctuations that it would previously have ignored. Estrogen normally keeps this thermostat calibrated.

The clinical evidence. Several randomized controlled trials have examined red clover isoflavones for hot flashes. Hidalgo et al. (2005) found that 80 mg per day of red clover isoflavones reduced hot flash frequency by 44% compared to placebo over a 12-week period. Lipovac et al. (2012) found that 80 mg daily red clover isoflavones reduced hot flash frequency and improved overall quality of life measures including sleep, mood, and sexual function compared to placebo. Chedraui et al. (2008) found reduced Kupperman Menopausal Index scores, a composite measure of menopausal symptom burden, in women using red clover isoflavones. Tice et al. (2003) found a more modest benefit compared to HRT, noting that red clover isoflavones produced meaningful but smaller reductions in hot flash frequency than estrogen therapy. Across these trials, 80 mg per day of red clover isoflavones appears to be the dose with the most consistent evidence, and effects tend to build over 4 to 12 weeks of use.

How it compares to other options. Hormone therapy (estrogen alone or combined estrogen and progesterone) remains the most effective treatment for vasomotor symptoms and typically reduces hot flash frequency by 75% to 90%. Red clover at its most effective produces roughly 40% to 50% reduction. This difference matters when deciding whether red clover alone is sufficient for your symptom severity. For mild to moderate hot flashes, red clover may provide useful relief. For severe or very frequent hot flashes, it is unlikely to be sufficient on its own.

Important safety considerations. If you have or have had a hormone-sensitive condition such as breast cancer, endometriosis, or uterine fibroids, discuss red clover with your healthcare provider before using it. Red clover isoflavones bind estrogen receptors and are not appropriate for all women. Red clover may interact with tamoxifen through competitive estrogen receptor binding, with blood thinners due to its coumarin content, and with hormonal medications. Discuss current medications with your provider before starting.

Studies have used doses of around 40 to 80 mg of red clover isoflavones daily. Talk to your healthcare provider about the right dose for your situation.

How to assess whether it is working. Start at a consistent dose, track your hot flash frequency and severity daily (rating each episode on a 1 to 5 scale), and give it at least 8 to 12 weeks before evaluating the effect. Effects are gradual, not immediate. A reduction in frequency of 30% to 50% would be consistent with what clinical trials have found.

Tracking with PeriPlan. PeriPlan lets you log hot flash frequency and severity over time so you have objective data rather than a subjective sense of whether things have improved. Track this consistently for the full evaluation period.

When to see a doctor. If hot flashes are severe, occurring many times daily, significantly disrupting sleep, or affecting quality of life to a degree that impacts your work and relationships, discuss your full range of treatment options with your healthcare provider. Effective non-hormonal prescription options and hormone therapy exist and are safe for many women.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.