Hot flashes are one of the most common symptoms experienced by menopausal women. Red clover has been studied for its potential to alleviate hot flashes and provide relief for women going through menopause. Several studies have investigated the effects of red clover on hot flashes, with mixed results although mostly positive results.
Systematic reviews and meta-analysis of randomized controlled trials (RCTs) generally shows that red clover consumption may lead to a decrease in the frequency of hot flashes, especially in women experiencing severe hot flashes. Other studies have shown varying degrees of improvement in hot flash intensity and duration with red clover, but the evidence is not conclusive. 
The meta-analysis of the included trials showed that the mean hot flashes frequency in the red clover groups was lower compared to the control groups. This suggests a potential positive effect of red clover in reducing the frequency of hot flashes in menopausal women,  which is why red clover makes it's way into a lot of menopause supplements.
Red Clover for Menopausal Symptom Relief
In addition to hot flashes, menopause can bring about various other symptoms, such as vaginal dryness, mood swings, and sleep disturbances. Red clover has been suggested as a potential remedy for these symptoms as well. Some studies have shown that red clover may improve subjective and objective symptoms of vaginal atrophy, including vaginal dryness and maturation value. 
Moreover, red clover has been found to have mild positive effects on anxiety, depression, and sleep disorders in menopausal women. However, the evidence is not consistent, and more research is needed to determine the effectiveness of red clover for these symptoms. 
Bone Health and Red Clover
Osteoporosis, a condition characterized by low bone mineral density and increased risk of fractures, is a common concern for postmenopausal women. Red clover contains isoflavones, which are plant compounds that can weakly mimic estrogen in the body. Estrogen plays a crucial role in maintaining bone health, and the decline in estrogen levels during menopause can contribute to bone loss. 
Some studies have suggested that isoflavone intake, including from red clover, may decrease the risk of osteoporosis by improving bone mineral density. However, the evidence is conflicting, and more research is needed to establish a clear link between red clover consumption and bone health. 
Red Clover and Heart Health
Red clover has also been investigated for its potential benefits in improving heart health, particularly in postmenopausal women. Some studies have shown a decrease in LDL (bad) cholesterol levels and an increase in HDL (good) cholesterol levels after red clover supplementation. However, other studies have failed to find significant improvements in lipid profiles.
It is important to note that most of the research on red clover and heart health has been conducted in postmenopausal women, and the results may not apply to the general population. Further research is necessary to determine the true impact of red clover on heart health.
Red Clover and Hormone Levels
Several studies have researched the effect of red clover on hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), sex hormone-binding globulin (SHBG), estradiol, and testosterone.
In terms of FSH and SHBG levels, the meta-analysis shows larger decreases in the red clover group compared to placebo, although these differences were not particularly large. Similarly, there was no significant difference in LH levels between the red clover and placebo groups. 
However, when it comes to estradiol levels, the meta-analysis revealed a significant increase in the red clover group compared to placebo. This suggests that red clover consumption may have a positive effect on estrogen levels in menopausal women. 
Currently there is no conclusive evidence either way for Red Clover's effect on Testosterone in menopausal women.
Red Clover Side Effects
While red clover is generally recognized as safe, it is not without potential side effects and risks. Some individuals may experience rare side effects such as vaginal spotting, prolonged menstruation, skin irritation, nausea, and headache. There have also been a few reported cases of more serious side effects, including subarachnoid hemorrhage and interactions with certain medications.
Dosage of Red Clover for Hot Flashes
A typical dosage recommendation for red clover is 40-160 mg of isoflavones per day. It is important to note that individual responses and tolerances may vary,
Vaginal dryness and maturation value (an objective measure of vaginal atrophy) showed a significant improvement with an 80-mg dose of red clover. In addition to hot flashes, menopausal women often experience other symptoms such as vaginal dryness, psychological issues, sexual problems, and sleeping disorders.
Red clover has also been studied for it's effect on endometrial thickness, and results were pretty insignificant. While some trials showed no significant change in endometrial thickness with red clover consumption, others reported a range from null effect to a non-significant decrease.
Red Clover for Menopause Conclusion
Red clover has been traditionally used for centuries as a natural remedy for menopausal symptoms, including hot flashes. While some studies have suggested potential benefits in managing hot flashes and other menopausal symptoms, the scientific evidence is mixed and inconclusive.
1 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069620/
2 - https://pubmed.ncbi.nlm.nih.gov/26471215/
3 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206499/
4 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770525/
5 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4523657/
6 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8151026/
7 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1780039/
8 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4678495/
9 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8079722/