The Menopause Gold Rush on Amazon

The Money in Menopause Supplements Part 952

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In 2023, a group of researchers looked up the 10 most popular “liver cleansing” supplements on Amazon (“liver-cleansing” is in quotations because it is a fake-ass concept). They picked a day, identified the top ten 10 products, and then calculated the number of units sold and the revenue for the previous month using a tool called AMZScout. There were 115,256 units sold with $2,442,963 a month in revenue. None of the ingredients in these 10 products were recommended by the American Association for the Study of Liver Diseases or the European Association for the Study of Liver. So yes, you read that right: $2,442,963 per month for products that are, at best, just a waste of money but could also be a ticket to liver damage or a host of other health problems. The researchers also used Fakespot.com, a Chrome plugin, to look for fake reviews. There was an average of 11,526 reviews per product (that’s a lot!), and the mean rating was 4.42 stars (also a lot). Fakespot.com calculated that only 65.04% of the product reviews were genuine. 

I thought to myself, Jen, this might be illuminating to do with the top 10 menopause supplements! So, we picked August 27, 2024, paid for AMZScout, and got to work. We double-checked the sales data results for accuracy with those published by Amazon (they were quite close). My husband (aka @drjenadjacent, aka Todd), given his lengthy career in tech and marketing, knows a lot about online sales and reviews and wasn’t convinced about the accuracy of Fakespot.com, so I skipped that part and just went straight for the money, as it were. 

What do you think? Is there more money in menopause than liver cleansing?  

The menopause gold rush is real: the top ten menopause supplements generated $3,363,997 in sales on Amazon in one month, easily beating $2,442,963 for “liver cleansing.” In just one month, 93,543 units were sold, which is fewer units sold but much more money to be made. The unit price ranged from $13.99 (Estroven Sleep Cool for Menopause Relief) to $89.00 (BB Company Slim Gut Bundle). The average price per unit for the top 10 menopause supplements was $36.89 vs. $26.45 for the liver supplements. Remember, this is just from one month from Amazon by unit volume; this does not include other online retailers, brick-and-mortar stores, and all of those suppliers with their own Shopify or e-commerce site. 

Take that liver cleansing; menopause wins…or really loses. 

The numbers here represent total sales; profit will be less. You can see how much profit people can make selling supplements on my post here, where I created Dr. Jen’s Menopause Taming Turmeric Supplement. In that experiment, if I were to sell 8333 units of my turmeric supplement for $35 a bottle, I could make a $195,760 profit after covering my expenses. The profit was about 70% a bottle. If we estimate that Amazon takes 15%, that leaves about $2,859,357 for the companies selling these untested, unregulated pharmaceuticals. There is no reason to believe these companies are doing any worse than I would from my turmeric supplement, so that leaves about $2 million a month in profit from selling 10 products for menopause on one e-commerce platform. 

How Bad Are These Top Ten?

Not one product in the top 10 contains an ingredient recommended in the 2023 Menopause Society Guide to Non-Hormonal Therapy, so there’s that. 

I identified some red flags to help spot ingredients and claims that are more likely to be problematic health-wise:

• Green tea leaf extract is associated with liver failure.

• Turmeric is associated with liver failure, and despite extensive study, there is no data to show that it is useful in menopause (or really anywhere except cooking). Read more about turmeric here. 

• Black cohosh is associated with liver failure, and results do not reliably show it is helpful for hot flashes. Also, in one study, 25% of products that claimed to have black cohosh were adulterated with another plant and contained no black cohosh. Yikes!!!

• Proprietary blends or “secret recipes” only have to state the total amount, not how much of each herb or spice, so the consumer has no idea what they are truly taking. These products are all about marketing and focus on making the product look special. In fact, the names of these blends often sound scientific, where no science exists, so they only provide the illusion of science. It’s pure smoke and mirrors. Proprietary blends often contain multiple ingredients, which has also been identified as a risk for liver injury. 

• For products that make claims about weight loss, study after study after study has shown there is a higher risk of adulteration, sometimes even with poisonous substances. In one study looking at supplements that were adulterated, 40.9% of them marketed for weight loss were adulterated. What do they contain? Sibutramine, which is a substance included in a drug removed from the market due to cardiac complications, is a common additive, but antidepressants, stimulants, and even oleander (a poison) have been identified. Also, no supplement has been proven to be safe and effective for weight loss. 

*Three proprietary blends = 3X the risk!

An incredible 80% of products triggered my short list of red flags! Only two of the top ten made it past this simple screening: Estroven Multi-Symptom and Gaia Herbs. Estroven Multi-Symptom is 4 mg of Rhapontic rhubarb root extract. The few studies looking at this product are of low quality and can’t be used to draw conclusions. It is not recommended in the 2023 Menopause Society Guidelines. Gaia Herbs contains Vitex agnus-castus (Chaste Berry) extract and agnuside, which is a chemical compound found in Vitex agnus-castus. It is advertised as “hormone balancing,” which is gibberish, as medically, there is no such thing, and I think it’s best to stay away from products advertised with gibberish. The highest quality study showed no difference in reducing hot flashes versus placebo with a product that combined Hypericum perforatum with Vitex agnus-castus. Other studies are of even lower quality. Vitex is also not recommended in the 2023 Menopause Society Guidelines. 

Remember, placebo-controlled trials for hot flashes have a high placebo response rate. For example, in the studies for fezolinetant, 37% of people who took the placebo reported a 50% reduction in hot flashes. And the more someone pays for a product, the more likely the placebo response. In addition, studies for supplements and hot flashes are typically 12 weeks, but a longer duration is needed to help tease out the placebo effect. It is possible that all the glowing anecdotes are placebo responses, and without appropriate studies, we’ll never know. This benefits the manufacturer, not you, the consumer. 

Doesn’t Amazon Require Third-Party Testing?

Yes, they do as of April 2024, which may help ensure that supplements contain the ingredients they claim and are free of contaminants. As an aside, it’s a very sad statement that Amazon is doing more to protect consumers than the U.S. government. While I am sure the motive was protecting Amazon from injuries and, hence, lawsuits related to these products, the consumer does benefit. 

Annual testing is required, but it isn’t known how annual testing compares with batch testing, which is the safest and the standard with pharmaceuticals, but annual testing is far superior to no testing. Products sold for sexual enhancement, weight management, sports nutrition, and body-building must also be tested for “undeclared active pharmaceutical ingredients.” Whether menopause products that advertise themselves with weight loss euphemisms, like “sexy midsection curves,” will fall in the weight loss category isn’t known. This policy also means there is no requirement for products that claim to treat hot flashes to prove that they don’t contain hormones, gabapentin, or any other medication that has been shown to treat hot flashes.

Remember, the third-party testing requirement applies only to retailers that sell on the Amazon platform. If products are being sold on Shopify or some other e-commerce platform or in a brick-and-mortar store, unless the products have an accepted third-party verification label or you’ve checked with the companies that do the verification to see if a specific product has been tested, all bets are off.  

But here’s the thing: Third-party testing here means that the product contains what it claims and isn’t contaminated with bacteria or fungi, not that the product is effective and safe for humans. For example, when researching Amberen, I saw that the web page states that the product can “increase exogenous estrogen levels.” 

I am highly skeptical that a product without hormones can increase estrogen levels. And as expected, the references were not the most, um, inspiring. For example, one is from a journal mostly printed in Russian that I was able to track down (fortunately, the article in question was in English), but my computer would not let me download it for “security reasons.” The study is problematic for many reasons. For example, they provided no demographic data on the participants and included women ages 40-61 but didn’t break them down by menopausal status (pre or post); the authors simply said, “Thus, in general, most participants in this distribution were in the stages of early menopause,” but this is useless information because they did not say how many participants or define early menopause. Issues aside, this article claimed that estradiol levels increase by 4 four, which is not only a bold claim but, if true, would be highly concerning because it could put people at risk for endometrial cancer or be harmful to people with breast cancer. To be clear, I highly doubt Amberen can do this, but third-party testing can’t resolve these safety considerations brought up by the company’s own claims. 

Here’s another example that third-party testing doesn't resolve: green tea leaf extract, turmeric, and black cohosh are associated with liver failure, and yet they’re not considered harmful substances by Amazon or, apparently, by many people who make supplements. This is alarming, considering we have no idea about the risk of liver failure with these products or what dose is concerning. We also don’t even know if these products even work. And we don’t know any of this because people who sell these products choose not to do the studies. There is simply no way for the consumer to assess the balance of benefits versus risks for green tea leaf extract, turmeric, or black cohosh, which should be unacceptable but is perfectly legal in the United States and many other countries. 

There is real money in menopause supplements

It’s clear why the market is flooded. Given that no R&D is required, all someone has to do is email a company that makes these products, set up a Shopify site (and they will even hook you up with a designer for your e-store), and, if you have a large media or social media presence, you are on your way to making hundreds of thousands or even millions of dollars a year with less than 40 hours of work. Everything can be outsourced to a 3rd party expert at a relatively minimal expense. I know because I went through the exercise of doing it, and you can read about my Menopause Taming Turmeric Supplements here. And it’s clear that for those who want to expand their market beyond their own social media reach, Amazon is a very attractive place to move product. 

The right answer to insufficient research isn’t to join the patriarchy and sell understudied, unstudied, and potentially harmful products to women. The right answer, when faced with a lack of research, is to raise the money and do the fucking research. It’s clear that almost everyone selling these products is making enough profit to do this. The lack of quality studies means people who sell these products, whether they are a big-name supplement company or a doctor or a celebrity, aren’t champions for women; they are “entrepreneurs” and profiteers who are more concerned about their own bottom line than getting definitive answers to help women. 

References

Eltelbany, Ahmed; Hamid, Osama; Nanah, Rama; Paleti, Swathi. Liver Cleansing Imposters: An Analysis of Popular Online Liver Supplements. The American Journal of Gastroenterology 118(10S):p S1008-S1009, October 2023. | DOI: 10.14309/01.ajg.0000954920.30407.c4

NAMS POSITION STATEMENT. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause 2023;30:573-590.

van Die MD, Burger HG, Bone KM, Cohen MM, Teede HJ. Hypericum perforatum with Vitex agnus-castus in menopausal symptoms: a randomized, controlled trial. Menopause 2009;16:156-163. doi: 10.1097/gme.0b013e31817fa9e0

Rotem C, Kaplan B. Phyto-Female Complex for the relief of hot flushes, night sweats and quality of sleep: randomized, controlled, double-blind pilot study. Gynecol Endocrinol 2007;23:117-122. doi: 10.1080/09513590701200900

Hafizi S, Abbassian A, Tabarrai M. The effect of Jazar supplement on quality of life and sexual function in postmenopausal women: a doubleblind, randomized, placebo-controlled trial. Evid Based Complement Alternat Med 2021:8854182. doi: 10.1155/2021/8854182

Newmaster, S.G., Grguric, M., Shanmughanandhan, D. et al. DNA barcoding detects contamination and substitution in North American herbal products. BMC Med 11, 222 (2013). https://doi.org/10.1186/1741-7015-11-222.

Baker DA, Stevenson DW, Little DP: DNA barcode identification of black cohosh herbal dietary supplements. J AOAC Int 2012, 95:1023–1034

White CM. Continued Risk of Dietary Supplements Adulterated With Approved and Unapproved Drugs: Assessment of the US Food and Drug Administration's Tainted Supplements Database 2007 Through 2021. J Clin Pharmacol. 2022 Aug;62(8):928-934. doi: 10.1002/jcph.2046. Epub 2022 Mar 31. PMID: 35285963.

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Maevsky EI, Peskov AB, Uchitel ML, Pogorelov AG, Saharova NY, Vihlyantseva EF, Bogdanova LA, Kondrashova MN. A succinate-based composition reverses menopausal symptoms without sex hormone replacement therapy. Adv Gerontol. 2008;21(2):298-305. PMID: 18942377.