St. John's Wort for Menopause
St. John's Wort may modestly ease menopausal hot flashes and related mood symptoms, but the evidence comes from small, mixed trials and major medical bodies do not recommend it. It is also a potent drug-interaction risk, so it should not be self-prescribed alongside hormones, contraceptives, anticoagulants, or antidepressants.
Why this grade7-layer evidence engine
The grade is Preliminary (Tier B), Disputed, because the human trial data lean positive but are thin and inconsistent. A 2014 meta-analysis (PMID 24188229) found Hypericum preparations clearly better than placebo for menopausal symptoms (SMD -1.08, 95% CI -1.38 to -0.77), and individual RCTs of St. John's Wort alone (PMID 20216274; PMID 31331546) plus a systematic review (PMID 27462550) reported fewer and milder hot flashes.
What keeps this out of a higher tier is the quality of that evidence. The trials are small, single-center studies (n=80-301), some test combination products that cannot isolate St. John's Wort itself, and the largest positive trial (PMID 16449108, St. John's Wort plus black cohosh, n=301) was industry-funded. Crucially, a St. John's Wort plus Vitex trial (PMID 18791483) showed no benefit over placebo, so results are genuinely heterogeneous.
Authoritative reviewers are split or cautious, which drives the Disputed status. Mayo Clinic calls the menopause evidence preliminary ('some research ... might lessen' hot flashes), while The Menopause Society advises against OTC botanicals for vasomotor symptoms. Regulators (FDA, WHO) only recognize St. John's Wort for mild-to-moderate depression, not menopause, and flag it as a strong CYP3A4/P-glycoprotein inducer that can dangerously cut the effectiveness of contraceptives, anticoagulants, and many other drugs.
Scoring transparency
All scores computed by a 7-layer evidence engine — fully auditable▸View the full decision path (audit trail)
- compute_raw_score — 加權公式: L2×0.30 + L3×0.25 + L5×0.25 + L11×0.10 + L1×0.10 = 0.56
- tier_from_score — 依分數區間映射至 tier letter
- apply_hec_rules — 無高階證據可裁決
- tier_strict_requirement_check — Tier 條件達標，未降階
- detect_disputes — 偵測到 1 個 hard + 1 個 soft dispute
- decide_status — 依 tier + dispute 結果決定 status