Best Supplements for Perimenopause: What Research Actually Shows
From creatine to magnesium, learn which perimenopause supplements have scientific evidence behind them and which may be overhyped.
Interest in supplements for perimenopause has surged, with ingredients like creatine and magnesium gaining significant attention. But which supplements actually have research to back them up?
This guide examines the evidence behind popular perimenopause supplements to help you make informed decisions.
Understanding the Supplement Landscape
Before diving into specific supplements, it is important to understand:
- Supplements are not regulated as strictly as medications
- "Natural" does not always mean safe or effective
- Individual responses vary significantly
- Supplements can interact with medications
- Quality varies widely between brands
Always discuss supplements with your healthcare provider, especially if you take medications or have health conditions.
Supplements with Strong Research Support
Creatine
Creatine has emerged as a promising supplement for perimenopausal women.
The Research A review in Nutrients (2021) examined creatine supplementation in women, building on decades of research in athletes and older adults. The findings showed:
- Improved muscle mass and strength (counteracting age-related muscle loss)
- Enhanced cognitive function, particularly for tasks requiring quick thinking
- Potential mood benefits through effects on brain energy metabolism
Earlier research from the 1990s and 2000s established creatine's safety and efficacy, while more recent studies have specifically examined its benefits for postmenopausal women, finding that creatine supplementation combined with resistance training increased lean muscle mass significantly more than exercise alone.
How It Works Creatine supports cellular energy production, which becomes especially important as estrogen (which also supports energy metabolism) declines.
Recommended Dose Research typically uses 3 to 5 grams daily. No loading phase is necessary.
Magnesium (including Magnesium Glycinate)
Magnesium deficiency is common in midlife women, and supplementation addresses multiple perimenopause symptoms.
The Research A systematic review in Nutrients (2017), drawing on studies from the previous two decades, found that magnesium supplementation:
- Improved sleep quality in adults with insomnia
- Reduced anxiety symptoms
- Supported muscle function and reduced cramps
Research specifically examining magnesium in perimenopausal women found improvements in sleep, mood, and hot flash severity. These findings build on earlier work from the 1990s establishing magnesium's role in nervous system function.
Why Magnesium Glycinate? This form is better absorbed and less likely to cause digestive upset than magnesium oxide. The glycine component may provide additional calming benefits.
Recommended Dose 300 to 400 mg daily, taken in the evening for sleep benefits.
Omega-3 Fatty Acids
The Research Multiple studies spanning from the early 2000s support omega-3s for perimenopause:
- A meta-analysis in Menopause found that omega-3 supplementation reduced hot flash frequency and intensity
- Research from the Journal of Clinical Psychiatry showed benefits for mood and cognitive function
- Decades of cardiovascular research link omega-3s to heart protection, important as heart disease risk increases after menopause
Recommended Dose 1 to 2 grams of combined EPA and DHA daily from fish oil or algae-based sources.
Vitamin D
Many women are deficient in vitamin D, which plays crucial roles during perimenopause.
The Research Research dating from the 1990s through recent meta-analyses found that vitamin D deficiency is associated with:
- Higher rates of depressive symptoms
- Increased bone loss
- More severe menopausal symptoms
The Endocrine Society recommends maintaining vitamin D levels above 30 ng/mL.
Recommended Dose 600 to 2000 IU daily, though some women need more. Blood testing can guide dosing.
Supplements with Moderate Evidence
Black Cohosh
This herb is one of the most studied for menopause symptoms, with research spanning over 50 years.
The Research A Cochrane review (first published 2006, updated 2012) found inconsistent results, but some trials show modest benefits for hot flashes. A German study found that a standardized black cohosh extract reduced hot flash frequency by 50% over 12 weeks. Research interest in this herb dates back to Native American traditional use and German clinical studies beginning in the 1950s.
Concerns Rare reports of liver problems have led to warnings in some countries. Choose products that specify the root extract and follow dosing guidelines.
Valerian
The Research Several studies show valerian may improve sleep quality. Research dating back to the 1980s, with a meta-analysis in 2010, found modest benefits for sleep onset and quality, though study quality was variable.
Recommended Use 300 to 600 mg of standardized extract 30 minutes before bed.
Ashwagandha
The Research Studies from 2008 onward in the Journal of Clinical Medicine and other publications found that ashwagandha reduced anxiety and cortisol levels in adults under chronic stress. Research specifically in perimenopausal women found improvements in vasomotor symptoms and sexual function. This herb has been used in Ayurvedic medicine for thousands of years, with modern clinical research beginning in the 1990s.
Recommended Dose 300 to 600 mg of standardized extract daily.
Multi-Ingredient Supplements
Many perimenopause supplements combine multiple ingredients in a single product. While this may seem convenient, there are important considerations:
Potential Issues
- Combination products often contain lower doses of each ingredient than what has been studied
- Research on specific proprietary blends is typically limited
- It becomes harder to identify which ingredient is helping or causing side effects
A Better Approach Consider starting with single, well-studied supplements at research-validated doses. This allows you to:
- Identify what actually works for you
- Adjust doses as needed
- Avoid paying for ingredients that may not help
Supplements with Limited Evidence
Evening Primrose Oil
Despite popularity since the 1980s, research does not consistently support evening primrose oil for hot flashes. Reviews have found no significant benefit over placebo.
Dong Quai
Used traditionally in Chinese medicine for centuries, Western clinical trials have not shown consistent benefits for menopausal symptoms.
Red Clover
Contains phytoestrogens, but studies since the early 2000s show mixed results. May have modest effects on hot flashes for some women.
Creating Your Supplement Strategy
Step 1: Identify Your Main Concerns
- Sleep issues? Consider magnesium, possibly valerian
- Muscle loss and fatigue? Creatine may help
- Mood and anxiety? Magnesium, omega-3s, ashwagandha
- Hot flashes? Black cohosh, omega-3s
- Bone health? Vitamin D, possibly calcium
Step 2: Start with the Basics Begin with well-researched, single-ingredient supplements rather than complex blends.
Step 3: One at a Time Add supplements individually to assess effects and identify any adverse reactions.
Step 4: Give It Time Most supplements require 4 to 8 weeks for noticeable effects.
Step 5: Reassess Track your symptoms to determine if supplements are helping.
Quality Considerations
When choosing supplements:
- Look for third-party testing (USP, NSF, ConsumerLab)
- Choose brands that provide transparency about sourcing
- Avoid products with excessive added ingredients
- Be wary of extravagant claims
The Bigger Picture
Supplements can support your perimenopause journey, but they work best as part of a comprehensive approach that includes:
- Regular exercise
- Balanced nutrition
- Stress management
- Adequate sleep
- Medical care when needed
No supplement replaces the foundational importance of lifestyle factors or the effectiveness of medical treatments like hormone therapy when indicated.
Work with your healthcare provider to develop a personalized plan that addresses your specific symptoms and health goals.
