The truth behind your menopause supplements: How the health industry is preying on

Dr Xand van Tulleken previously exposed the truth about celebrity-endorsed supplements that claim to promote longevity. Now, he delves into the booming menopause industry and reveals the damaging role social media plays in the promotion of wellness.

Are you a woman worried about the menopause? There’s a supplement for that. Dozens, in fact – as well as menopause shampoo, menopause face cream, menopause clothes… and even menopause chocolate.

How did the menopause create such a booming industry? The answer goes back almost a quarter of a century to 2002, when part of a major HRT trial was stopped early.

The headline finding was a 26 per cent increase in invasive breast cancer in the women taking combined oestrogen and progestin  –  the standard HRT – compared with those on placebo.

The trial had also found increases in heart attack, stroke and blood clots, partly offset by fewer hip fractures and cases of colon cancer. The study was later found to be flawed – the actual increased risk was a tiny 0.5 per cent – but it kick-started a major panic among women with the result that many either stopped taking HRT or decided to avoid it altogether.

One of the main beneficiaries of this was the wellness industry, as women turned away from HRT and towards the supplement aisle.

Sales of black cohosh (a plant from the North American prairies long used as an indigenous medicine) surged, calls to medicines helplines about herbal alternatives more than doubled and the menopause supplement market grew from a niche category into a global industry worth around £13billion in 2024, projected to approach £18.5billion by 2030.

To analyse the industry, Jayne Harper, a professor of reproductive science and co-founder of the International Reproductive Health Education Collaboration, sent one of her University College London medical students, Poppy Sullivan, to examine 201 menopause supplements.

Among them all, there was not a single ingredient that appeared in every product.

The fact that so many supplements didn’t converge on a common ingredient suggests that no one − not even the people making supplements − knows which ingredients will help with symptoms of menopause.

The most common vitamin in the supplements was B6, appearing in almost 70 per cent. The highest dose of B6 was 50mg  – which is 4,167 per cent of the recommended daily allowance of 1.2mg in the UK. High doses of vitamin B6 have been associated with nerve damage. At the other end of the scale was a supplement that contained only 0.21mg of B6.

Poppy also pointed out a study showing that high vitamin B12 and B6 intake could increase the risk of hip fracture in postmenopausal women; another linked high zinc doses to genitourinary complications that increased the risk of urinary tract infections and potential hospitalisation.

The dosing range of vitamin D also varied, from 50 per cent to 40,000 per cent of the recommended daily allowance, while for vitamin B12, the dose ranged from 15 per cent to 20,000 per cent of the recommendation.

The most common botanical ingredient was red clover, a phytoestrogen, but it was present in only 39 per cent of the tested supplements.

There is no evidence to support the use of any of these ingredients in menopause other than vitamin D and calcium, and even these are only recommended by some menopause societies.

Poppy found black cohosh in 8 per cent of the supplements – a substance implicated in many instances of acute liver injury. Two supplements also contained levels of zinc above the generally recommended upper daily limit.

Added together, the various risks posed by the different menopause supplement ingredients seem like an appalling possibility for someone just trying to manage their menopause safely.

‘I think most people take supplements because they think that, even if they don’t work, it’s not going to do them any harm,’ Poppy said. ‘But some of these supplements might be harmful. They feel quite under-researched.’

The most frustrating thing is that the menopause supplements industry would probably be far smaller if the findings from the Women’s Health Initiative (WHI) suggesting that HRT increases the risk of breast cancer had been more carefully publicised.

Headlines like ‘Study Is Halted Over Rise Seen in Cancer Risk’ appeared in papers around the world. The articles quoted the line from the press conference: ‘A 26 per cent increase in breast cancer risk is too high a price to pay.’  This sounds absolutely terrible: 26 per cent is a big number.

But the findings are harder to interpret than they seemed. What the study actually found was that, over one year, among 10,000 women taking combined HRT (oestrogen plus progestin) 38 cases of invasive breast cancer were expected, compared with about 30 cases among 10,000 women taking placebo.

That’s an excess of eight cases per 10,000 women per year  –  that’s the 26 per cent figure quoted. But the study showed that HRT increased a woman’s individual risk of getting breast cancer by less than half a per cent over five years.

These are statistics that doctors struggle to get their head around, so it’s not surprising the public was confused.

Every time I encounter risk data like these, I think of the lottery: I can double my chances of winning the lottery simply by buying an extra ticket, but my absolute chance of winning would change only from one in 45million to one in 22.5million. I’m still extremely unlikely to win.

The 26 per cent figure is the relative increase. Without the context of how small the starting number is, it sounds like your chances of getting cancer have gone up by a quarter, but in absolute terms, your risk over a year has gone up by less than half a per cent over five years, an increase of the kind we accept every day.

Currently, being on the combined contraceptive pill carries a similar increase in breast cancer risk, and so does having a couple of glasses of wine a night.  Neither of those causes panic, or governments to halt trials.

There were other problems with the Women’s Health Initiative study. The women in the study were not representative of the typical population who starts taking HRT. The average participant was 63, and only about 12 per cent were in their early fifties, the age at which women typically start treatment.

Results from this population of older women, who were already at higher risk of heart disease and breast cancer because of their age, were presented as though they applied to all women, including the younger women who make up the majority of HRT users.

For women in their fifties, the age when people typically start HRT, the absolute risk increase is smaller than the headline figures suggested. When the results were reanalysed by age, it became clear that women who started HRT within ten years of menopause had a reduced risk of heart disease and death.

The timing mattered enormously: if a woman decides to start HRT aged 52 at the start of her menopause, it seems there is a good chance the benefits will outweigh the risks; start it at 65 and the harms and benefits may change places.

The Women’s Health Initiative study had two parts: one part assessed oestrogen and progestin HRT in women with a uterus (the part that was stopped early), and another testing oestrogen HRT alone in women who had had hysterectomies.

In women without uteruses, oestrogen HRT turned out to be associated with a decreased risk of breast cancer compared with placebo  –  oestrogen on its own seemed to protect against the very disease the headlines said it caused.

This result wasn’t reported until 2004, but by then the idea that hormones cause cancer had taken hold. Researchers at Yale estimated that between 2002 and 2012, around 50,000 American women who had had hysterectomies may have died prematurely because they stopped taking or never started oestrogen therapy that could have protected them from cancer.

The British Menopause Society concluded that the decline in prescribing meant that ‘almost a generation of women have mostly been denied the opportunity of improved quality of life during their menopausal years’.

It is almost impossible to separate the supplement industry from the influencer industry. The supplement market is worth over $200billion globally. In one survey, around half of consumers said that their purchasing decisions were influenced by social media, and the proportion was higher among younger buyers.

Influencer marketing in the supplement industry alone generated an estimated $6.8billion in revenue in 2022, a figure that has grown since.

If you are selling supplements now, you are almost by definition an influencer, because you’re certainly not acting as a doctor or a scientist, and the product is almost indistinguishable from the personality selling it.

The evidence for most of these products is thin, and the ingredients are mostly not patented or trademarked, so they’re all pretty similar.

How is the industry selling billions of pounds’ worth of them every year? How does an individual brand stand out? And once you’ve clicked ‘buy’, can you even trust that what arrives is what it says on the label?

I wanted to understand the machinery – how supplements are marketed, and what’s actually in them.

When you click on a link to a supplement company, you are often asked questions about your personal details and goals, after which the ‘perfect’ product for you is suggested, sometimes ‘by AI’: ‘The quiz is just a way of gathering information about you in a way that makes it feel personal and valuable to you! It doesn’t change what we’re trying to sell you!’

It’s a kind of choose your own adventure, but there’s only one ending: ‘You have to understand that whatever choice you make, you’re always taken to the same supplement.’ I am interviewing Mo, who asked that I heavily anonymise her.

She is a former marketer for one of the largest and fastest-growing supplement companies in the US. I have called her to ask about performance marketing, a digital advertising strategy whereby, rather than a company paying upfront for ad space, they pay only if there’s a result  –  a click or a sale  –  that goes through to their product.

Mo left Europe to join one of the most successful consumer beauty supplement companies in the world as a performance marketer. You won’t have heard of the place she worked at, as it was really a holding company for many different supplements.

But if you’re on social media, you’ll almost certainly know some of the supplements it sells. Mo shares her screen with me and starts showing me the company’s main products  –  things like liquid collagen, for hair, skin and wellness.

‘It’s all produced in China,’ she says, ‘dirt cheap. All the spend’ – she emphasises the word ‘all’ – ‘was on marketing. We would launch different supplement projects every few months and see what stuck. Stress relief, hair growth, probiotics – all sorts of products.’

We move on to a huge spreadsheet with the details of hundreds of content creators. Mo’s job was to recruit them, asking them, ‘Hey, can you give us 25 minutes of footage?’

I ask where the company found all these people and she shows me a site called Backstage.

‘We use these online platforms that have huge lists of people who make a little money filming content for social media. It’s basically a stay-at-home mom in middle America who has a couple of kids, and this is her side-hustle. You just hire her for small amounts of footage. Lots of brands do it.’

I look at some of them on social media. They’re not influencers; none of them have huge followings. They film generic clips for multiple products. (Since Mo and I spoke, more and more of this kind of content is being generated by AI.)

The request for the 25 minutes of content is very specific: a five-minute spoken introduction, five minutes silent ‘before’ footage (pointing at wrinkles looking sad, showing split ends or pulling hair back to look bald), five minutes of handling the product (stirring, mixing, pouring), five minutes of spoken ‘after’ footage (‘I’ve been using it for weeks!’) and five minutes’ visual ‘after’ footage (good lighting, makeup, maybe a blow dry so you no longer look bald).

Are you allowed to do before and after videos like that, I ask? ‘Yes, yes,’ she assures me. ‘Look at this.’ She points out the disclaimer in minuscule font on one of the videos: ‘paid presenters, simulated results’. It’s so small, I’m not sure anyone would notice unless it was pointed out.

The content creators are paid around $40 for work that takes perhaps 90 minutes or so. Thousands of hours of footage are then sent to video-editing farms in El Salvador and the Philippines.

Warehouses full of poorly paid editors scroll through the footage and find the best before-and-after clips and the best close-ups and so on. The text, captions and links are added here, creating tens of thousands of posts that are then sent back to the US for uploading.

These editing farms typically offer overnight turnaround and can produce market cost savings of 60-80 per cent. It’s hard to even imagine that these are enjoyable, well-paid jobs.

This vast quantity of content is then ‘A/B tested’: two posts with different creators or different before-and-after transformations are released together, targeting the same consumers.

The data is then analysed to work out which post got the better reactions and led to more customers clicking through.

‘The more charged and extreme content usually worked best: the saggiest wrinkles or someone in a bikini shouting, “I’VE NEVER SEEN MY STOMACH SO FLAT,”’ Mo says.

‘But,’ she reminds me, ‘they’re sucking in a tummy that they were puffing out a minute ago to show bloating in the “before” picture.’

Mo is emphatic: ‘You have to understand how lucrative it is!’

She drives the point home: ‘This is a data business, not a health business. It’s a direct-to-consumer, performance-marketing-led business. They only picked supplements because it’s the highest margin, but they could be selling anything!’

Supplements are a perfect product to sell online. ‘You can make really strong claims with relatively little oversight,’ says Mo. ‘You can show visual proof. You can do all these things to really get people to buy, which is trickier with other products.’

What makes performance marketing so powerful is the amount of data it generates. With traditional marketing, like magazine ads or billboards, you’re largely guessing at how exposure leads to sales. With an Instagram ad, you can measure ‘thumb stop’ (when the person stops scrolling to click on it), how far they scroll once they land on a page, and where they drop off.

Mo shows me one of the spreadsheets her former company used to track the data from different content creators. The concepts have names like ‘saggy body skin’, ‘2 types of wrinkles’, ‘I’m finally pooping’, ‘where did my bloating go’ and ‘3 reasons I regret’.

There is a column called ‘common pain points’, which codifies which vulnerability is being targeted. The data confirm what you might suspect about human psychology: negative ‘hooks’ (the opening idea of an online ad) outperform positive ones about 90 per cent of the time.

‘Do you want to look great as you age?’ barely registers. ‘Does everyone think you look ten years older than you are?’ stops thumbs.

‘Playing on people’s anxiety or their worries is good for business,’ Mo tells me. ‘And here’  –  she waves the cursor over some numbers on her screen that represent click-rates  –  ‘you see it in the data.’

The supplement company that Mo worked for is not an outlier but she feels that none of her colleagues respected the products – or the customers: ‘No one in the office took the supplements, even though we got free samples.’

The ultimate truth is that fake science is a huge problem in the supplement industry.

American doctor and mega-health influencer Michael Greger says: ‘The diet and anti-ageing industries are multi-billion-dollar behemoths. With so much money in the mix, the temptation to promote products purporting all sorts of preposterous claims is apparently irresistible!’

The wellness industry wants us to believe that the most important project in our life is the maintenance and optimisation of our own body, that if we just get the right data, take the right supplements, follow the right protocol, we will become the person we are supposed to be.

However, I don’t think they know anything at all about how to become the person we’re meant to be.

Adapted from Make Me Well by Xand Van Tulleken (Cornerstone, £22), to be published September 10. © Xand Van Tulleken 2026. To order a copy for £19.80 (offer valid to 20/09/26; UK P&P free on orders over £25) go to www.mailshop.co.uk/books or call 020 3176 2937.