Maca Root for Menopause

A 2011 systematic review found four placebo-controlled trials of maca for menopausal symptoms. All reported favourable effects on standard symptom scores, but the reviewers judged the evidence limited: the trials were too few, too small and too low in average quality for firm conclusions, and safety had not been proven [1]. The largest trial, in 168 early-postmenopausal women, reported that 2 g a day of pre-gelatinised maca lowered Kupperman index scores from 22 to 10 and reduced hot flashes and night sweats [2].

Trials run by other researchers tell a narrower story. In 14 Australian and 29 Hong Kong Chinese postmenopausal women, 3.3-3.5 g of maca a day for 6 weeks eased depression in both trials and anxiety in the Australian one, and neither trial found any change in oestradiol or FSH [3][4]. For hot flashes, the North American Menopause Society's 2023 position statement does not recommend supplements or herbal remedies, and it names hormone therapy as the most effective treatment [5]. The society's 2022 hormone therapy statement finds the benefit-risk balance favourable for bothersome hot flashes in women under 60, or within 10 years of menopause, who have no contraindications [6].

Maca (Lepidium meyenii) is an Andean root of the brassica (mustard) family, used for centuries in the Andes for anaemia, infertility and female hormone balance [1]. The research group behind most menopause trials proposed that their pre-gelatinised preparation acts as a 'toner' of the hormone axis between the brain and the ovaries.

Their results were not consistent with each other, though. In early-postmenopausal women, oestradiol rose and FSH (follicle-stimulating hormone) fell [2][7]. In perimenopausal women, oestradiol and FSH both rose [8]. In a smaller pilot, FSH fell and LH rose, while oestradiol and progesterone increased only after eight months [9].

Independent trials found no hormone effect. In the Australian trial, oestradiol, FSH, LH and SHBG did not change on maca, and maca extracts showed no physiologically significant oestrogenic or androgenic activity in yeast-based tests [3]. The Hong Kong trial also found no change in oestradiol, FSH or SHBG [4]. Memorial Sloan Kettering sums it up: maca appears to modulate some hormone levels in women in some studies but not in others [10].

Lab work is just as divided: in human breast cancer (MCF-7) cells, methanolic and aqueous maca extracts showed oestrogenic activity comparable to silymarin [11]. Maca's distinctive compounds, macamides and glucosinolates, are credited with its effects, but a 2018 review found this cannot be confirmed for lack of data [12]. So whether maca acts like oestrogen in the body is unsettled, which matters most for women who have been told to avoid oestrogen.

The trials of the pre-gelatinised preparation used 2 g a day, taken as two 500 mg capsules twice daily with meals, for two to four months [2][7][8]. The independent trials used 3.5 g a day of maca powder [3] and 3.3 g a day [4], each for 6 weeks. One uncontrolled pilot followed eight women on 2 g a day for eight months [9].

Maca products are not interchangeable. A 2024 review counted up to 17 colours of maca and found that colour, root size, growing location, cultivation and processing can all change its nutrient and plant-compound content, while research comparing colours remains limited [13]. Another review warned that mass production, including cultivation outside the Andes, may affect the quality and safety of maca products [12].

Four of the trials came from the same research group, testing the same pre-gelatinised preparation and published in the same journal. The largest randomised 168 early-postmenopausal women at five sites to 2 g a day or placebo for three or four months; 124 finished. Maca raised oestradiol (P < 0.001), lowered FSH, raised HDL cholesterol and reduced hot flashes and night sweats, with the Kupperman index falling from 22 to 10 (P < 0.001) [2].

A four-month crossover trial in early-postmenopausal women reported similar symptom relief (P < 0.001) and hormone changes, and also lower T3 (a thyroid hormone), ACTH and cortisol and higher LDL cholesterol, none of it replicated elsewhere; the abstract is unclear on how many of its 34 women were analysed, as it describes two groups of 11 [7]. A crossover pilot in 20 perimenopausal women aged 41-50 found symptoms eased in 74-87% of them after two months, with a distinct placebo effect early on [8]. An earlier pilot was not randomised: women took placebo for a month and then maca, and placebo again had a clear effect [9].

Two crossover trials by other researchers tested maca powder without the hormone findings. In 14 Australian postmenopausal women, 3.5 g a day for 6 weeks lowered Greene scores for psychological symptoms, including anxiety and depression, and for sexual dysfunction, compared with both baseline and placebo (P < 0.05) [3]. In 29 Hong Kong Chinese women, 3.3 g a day for 6 weeks lowered depression and diastolic blood pressure [4]. Neither abstract reports fewer hot flashes.

A 12-week placebo-controlled trial in 45 women with sexual side effects from SSRI or SNRI antidepressants reported slightly higher remission rates on 3.0 g a day (30% versus 20% on one scale, with no significance test given in the abstract); of the 42 women analysed, 12 were postmenopausal, and higher remission was linked to being postmenopausal [14]. If low desire is the main problem, see maca for low libido.

The 2011 systematic review is the only one focused on maca and menopause; it rated the evidence limited [1]. A 2014 minireview listed maca among herbal preparations that reduced vasomotor symptoms in randomised trials [15]. A 2019 meta-analysis of herbal medicines for anxiety and depression around menopause included maca among the preparations with a significant effect on anxiety, but heterogeneity between trials was very high [16].

A 2018 review of maca's reproductive-health claims concluded they cannot be fully supported scientifically [12], and Memorial Sloan Kettering notes that systematic reviews rate the evidence for menopausal symptoms as limited [10]. The North American Menopause Society's 2023 statement places supplements and herbal remedies among the options it does not recommend for hot flashes [5]. For comparison, see black cohosh for menopause, red clover for hot flashes and DHEA for menopause.

We found no placebo-controlled trial of maca for menopausal symptoms published after 2015. No randomised trial lasted longer than four months, none compared maca with hormone therapy or prescription non-hormonal treatments, none reports including women with a history of breast cancer, and none compared maca colours. Until a larger independent trial reports, maca's place in menopause symptom relief is unproven.

Maca seems well tolerated in short trials, but its safety has not been proven: the 2011 review called for larger studies of both efficacy and safety [1]. Memorial Sloan Kettering's patient guidance says no side effects have been reported, while its professional summary lists subjective reports of altered menstrual cycles, moodiness, cramps, gastritis and insomnia [10]. The longest trial on this page ran for four months with a placebo group, so long-term safety is unknown.

MSKCC also advises talking to a clinician first if you are pregnant or breastfeeding, as maca may not be safe [10], which matters in perimenopause, when pregnancy is still possible. Maca can distort lab results: in one case report, a woman taking maca extract had prolonged bleeding between periods and a falsely high testosterone reading, which fell to near normal on a more specific assay [17].

No trial has tested maca in women with breast cancer. MSKCC advises anyone with a hormone-sensitive cancer, such as breast or uterine cancer, to talk to their care team because maca may affect treatment [10]. Lab findings add caution: maca extracts showed oestrogen-like activity in a breast cancer cell line [11], and in two lines of triple-negative breast cancer cells, a maca extract increased cell migration and raised expression of MMP-1, a gene involved in spread [18]. These are cell studies only and do not show harm in people.

Few interactions are documented. MSKCC advises people with hormone-sensitive cancers to talk to their clinician because maca may affect treatment, and notes it may interfere with testosterone immunoassays [10][17]. No trial combined maca with hormone therapy, so the combination is untested. Maca lowered diastolic blood pressure in one trial [4], and MSKCC lists a rat study in which it enhanced the blood-pressure-lowering effect of losartan, although the cited study tested a related plant, Lepidium sativum, and its clinical relevance is undetermined [10]. Women in one trial took maca alongside SSRI or SNRI antidepressants and it was well tolerated [14].