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Background  Natural estrogen decline leads to vasomotor symptoms (VMS). Hormone therapy alleviates symptoms but increases cancer risk. Effective treatments against VMS with minimal cancer risks are needed. We investigate the effects of a highly bioavailable aglycone rich Red Clover isoflavone treatment to alleviate existing menopausal VMS, assessed for the first time by 24hour ambulatory skin conductance (SC)    Methods and results  We conducted a parallel, double blind, randomised control trial of 62 peri-menopausal women aged 40–65, reporting ≥ 5 hot flushes/day and follicle stimulating hormone ≥35 IU/L. Participants received either twice daily treatment with bioavailable RC extract (RCE), providing 34 mg/d isoflavones and probiotics, or masked placebo formulation for 12 weeks. The primary outcome was change in daily hot flush frequency (HFF) from baseline to 12 weeks using 24hr SC. Secondary outcomes were change in SC determined hot flush intensity (HFI), self-reported HFF (rHFF) and hot flush severity (rHFS), blood pressure and plasma lipids. A significant decrease in 24hr HFF (P < 0.01) and HFI (P<0.05) was found when comparing change from baseline to 12 months of the RCE ( -4.3  HF/24hr, CI -6.8 to -2.3;  -12956  μS s -1 , CI -20175 to -5737) with placebo ( 0.79  HF/24hr, CI -1.56 to 3.15;  515  μS s -1 , CI -5465 to 6496). rHFF was also significantly reduced (P <0.05)in the RCE ( -2.97  HFs/d, CI -4.77 to -1.17) group compared to placebo ( 0.036  HFs/d, CI -2.42 to 2.49). Other parameters were non-significant. RCE was well tolerated.    Conclusion  Results suggest that moderate doses of RCE were more effective and superior to placebo in reducing physiological and self-reported VMS. Findings support that objective physiological symptom assessment methods should be used together with self-report measures in future studies on menopausal VMS.    Trial registration  ClinicalTrials.gov  NCT02028702

Combined Red Clover isoflavones and probiotics potently reduce menopausal vasomotor symptoms