The Best Supplements for Perimenopause: What Actually Works (and What Doesn't)

You've probably seen the lists. "Top 20 supplements every perimenopausal woman needs!" Shelves full of bottles with vague promises. Social media influencers swearing by adaptogenic blends that cost more than your grocery bill. It's a lot. And when your hormone levels fluctuate and your symptoms feel unpredictable, you just want something that actually helps.

Here's what makes this confusing: some supplements genuinely do have solid research behind them. Others are riding a wave of marketing hype with very little clinical evidence. And a few sit somewhere in between, showing promise in early studies but not yet proven at scale. You deserve to know the difference before spending your money.

This guide breaks down the best supplements for perimenopause based on what the research actually says. No exaggerated claims. No miracle cures. Just honest information to help you make choices that support your body during this transition.

How we evaluated these supplements

Not every supplement that shows up in a Google search deserves a spot on this list. We used four criteria to evaluate each one, and we'll be transparent about where each supplement lands.

Clinical research quality. We looked at whether a supplement has been studied in randomized controlled trials, ideally in perimenopausal or menopausal populations specifically. A single small study is different from multiple large trials. We'll tell you which is which.

Safety profile. Supplements are not inherently safe just because they're "natural." Some interact with medications, including hormone replacement therapy. Some carry risks at high doses. We flag these clearly for every supplement on this list.

Bioavailability and form. The form of a supplement matters enormously. Magnesium oxide is cheap but poorly absorbed. Magnesium glycinate costs more but your body can actually use it. We recommend the forms that give you the most benefit per dose.

Real-world feedback. Clinical trials tell one story. The lived experience of thousands of people navigating perimenopause tells another. Where we see consistent patterns in real-world reporting that align with the research, we note it. Where anecdotal reports outpace the evidence, we say that too.

Every supplement below gets an evidence rating: strong (well-supported by multiple quality studies), moderate (promising research but some inconsistency or limited scope), or emerging (early-stage evidence or primarily traditional use with limited clinical data).

The top supplements for perimenopause symptoms

Magnesium glycinate This is arguably the single most impactful supplement you can take during perimenopause. Magnesium supports over 300 enzymatic processes in your body, including sleep regulation, mood stability, muscle relaxation, and stress response. Many people are already deficient without knowing it, and that deficiency worsens during this transition.

Magnesium glycinate is the preferred form because glycine itself has calming properties, and this form is gentle on your stomach. It targets sleep disruption, anxiety, muscle cramps, headaches, and restless legs. Taking 200 to 400 mg before bed is a common starting point.

Evidence level: Strong. Multiple studies confirm magnesium's role in sleep quality, mood regulation, and stress response. Deficiency is well-documented in perimenopausal populations.

Caution: High doses can cause loose stools. Start at 200 mg and increase gradually. Avoid magnesium oxide for sleep or mood purposes, as absorption is poor.

Vitamin D3 Vitamin D is essential for calcium absorption, bone health, immune function, and mood regulation. As estrogen declines during perimenopause, your bones lose density faster. Vitamin D helps your body hold onto the calcium it needs to slow that process. It also plays a role in serotonin production, which is why low levels are linked to depression and fatigue.

Vitamin D3 (cholecalciferol) is the form your body produces naturally from sunlight and is better absorbed than D2. A dose of 1,000 to 2,000 IU daily is standard, but many providers recommend getting your blood levels tested first. Optimal levels are generally between 40 and 60 ng/mL.

Evidence level: Strong. Extensive research supports vitamin D supplementation for bone health, immune function, and mood. Deficiency is extremely common, especially in northern latitudes.

Caution: Vitamin D is fat-soluble, meaning it accumulates in your body. Don't megadose without testing. Take it with a meal containing fat for best absorption.

Omega-3 fatty acids (EPA/DHA) Omega-3s are powerhouse anti-inflammatory compounds that support brain health, cardiovascular function, joint comfort, and mood stability. During perimenopause, systemic inflammation often increases, contributing to joint pain, brain fog, and mood changes. Omega-3s directly counter this.

Look for a supplement that provides at least 1,000 mg of combined EPA and DHA per day. EPA is particularly important for mood support, while DHA supports cognitive function. Fish oil and algae-based supplements are the best sources. Flaxseed oil provides ALA, which your body must convert to EPA and DHA at a very low rate, making it a less effective option.

Evidence level: Strong. Well-established benefits for cardiovascular health, inflammation, and mood. Growing evidence specifically in menopausal populations for joint pain and cognitive support.

Caution: Fish oil can thin the blood slightly. If you take blood-thinning medications, discuss dosing with your provider. Choose brands tested for heavy metals and oxidation.

Black cohosh Black cohosh is one of the most widely studied herbal supplements for hot flashes and night sweats. It appears to work through serotonin receptor pathways rather than by mimicking estrogen, which is an important distinction for people with estrogen-sensitive conditions.

Standardized extracts of 20 to 40 mg daily (often sold as Remifemin) are the most commonly studied doses. Some people notice a reduction in hot flash frequency and intensity within four to six weeks.

Evidence level: Moderate. Several randomized controlled trials show benefit for vasomotor symptoms, though results are inconsistent across studies. Quality and standardization of the supplement likely explain some of the variation.

Caution: Rare reports of liver toxicity exist, though these may be linked to contaminated products rather than black cohosh itself. Don't use it if you have liver disease. Time-limit your use to six months and reassess with your provider.

Ashwagandha Ashwagandha is an adaptogenic herb with strong evidence for reducing cortisol and improving stress resilience. During perimenopause, your stress response system often becomes more reactive, and chronically elevated cortisol can worsen sleep, weight gain, anxiety, and hot flashes. Ashwagandha helps modulate that response.

Look for KSM-66 or Sensoril extracts, which are the standardized forms used in most clinical trials. Typical dosing is 300 to 600 mg daily.

Evidence level: Moderate. Good evidence for cortisol reduction, anxiety relief, and sleep improvement in general adult populations. Studies specifically in perimenopausal people are fewer but growing.

Caution: Ashwagandha can interact with thyroid medications by potentially increasing thyroid hormone levels. If you have a thyroid condition, talk to your provider before starting. Avoid during pregnancy.

DIM (Diindolylmethane) DIM is a compound derived from cruciferous vegetables like broccoli and cauliflower. It supports healthy estrogen metabolism by promoting the conversion of estrogen into its less potent forms. During perimenopause, when estrogen levels can spike unpredictably before declining, DIM may help manage symptoms driven by estrogen dominance, including breast tenderness, heavy periods, bloating, and mood swings.

Typical dosing ranges from 100 to 200 mg daily. BioResponse DIM is a well-absorbed formulation used in research.

Evidence level: Moderate. Solid mechanistic evidence for estrogen metabolism support. Clinical trial data in perimenopausal populations is limited but growing. Widely used in integrative medicine.

Caution: Can cause digestive upset in some people. Start at the lower dose. May alter how your body processes certain medications metabolized by the liver. Discuss with your provider if you take HRT or hormonal birth control.

Probiotics Your gut microbiome has a direct relationship with your hormones. A specific subset of gut bacteria, called the estrobolome, helps regulate how your body processes and recycles estrogen. When gut health is compromised, estrogen metabolism can become less efficient, potentially worsening symptoms.

Broad-spectrum probiotics with Lactobacillus and Bifidobacterium strains support digestive health, immune function, and may improve mood through the gut-brain axis. Look for products with at least 10 billion CFU and multiple strains. Taking them consistently matters more than taking a high dose.

Evidence level: Moderate. Strong general evidence for gut health and immune support. Emerging but compelling research on the estrobolome and hormone metabolism. Gut-brain axis effects on mood are well-documented.

Caution: Generally very safe. If you're immunocompromised, check with your provider. Some people experience temporary bloating when starting probiotics.

Evening primrose oil Evening primrose oil contains gamma-linolenic acid (GLA), an omega-6 fatty acid with anti-inflammatory properties. It's commonly used for breast tenderness, skin dryness, and mild hot flashes during perimenopause.

Typical dosing is 500 to 1,000 mg daily. Results, if they come, usually appear after six to eight weeks of consistent use.

Evidence level: Emerging. Limited clinical trial data, but long traditional use and consistent anecdotal reports for breast tenderness and skin health. Large-scale studies on hot flash reduction have been mixed.

Caution: May increase bleeding risk if combined with blood-thinning medications. Avoid if you have a seizure disorder.

Maca root Maca is a Peruvian root vegetable traditionally used to support energy, libido, and hormonal balance. Small but encouraging studies in menopausal populations have shown improvements in energy, mood, sexual desire, and reduced anxiety. It appears to support the endocrine system broadly rather than directly providing hormones.

Gelatinized maca (1,500 to 3,000 mg daily) is better tolerated than raw maca. Red and black maca varieties may have slightly different benefit profiles, with red maca showing more promise for mood and bone density.

Evidence level: Emerging. Several small studies show genuine promise, but larger trials are needed. Consistent positive anecdotal reports for energy and libido.

Caution: Generally well tolerated. May affect thyroid function in very high doses. If you have thyroid issues, start low and monitor.

B-complex vitamins B vitamins support energy metabolism, nervous system function, and neurotransmitter production. B6 is particularly important for serotonin and GABA synthesis, which directly affect mood and sleep. B12 and folate support cognitive function and cardiovascular health.

During perimenopause, increased stress, disrupted sleep, and higher metabolic demands can deplete B vitamins faster. A quality B-complex providing methylated forms (methylfolate and methylcobalamin rather than folic acid and cyanocobalamin) is better absorbed, especially if you have MTHFR gene variants that affect folate metabolism.

Evidence level: Strong (for general nutritional support and energy metabolism). Moderate for specific perimenopause symptom relief.

Caution: B vitamins are water-soluble, so toxicity risk is low. Very high-dose B6 (over 100 mg daily) can cause nerve issues over time. A standard B-complex is sufficient for most people.

CoQ10 (Coenzyme Q10) CoQ10 is a naturally occurring compound that supports cellular energy production. Your body's natural CoQ10 levels decline with age, and this drop accelerates around perimenopause. It plays a role in mitochondrial function, cardiovascular health, and antioxidant protection.

For perimenopause, CoQ10 may help with fatigue, brain fog, and cardiovascular support. Ubiquinol is the active form and is better absorbed than ubiquinone, especially after age 40. A dose of 100 to 200 mg daily is common.

Evidence level: Moderate for cardiovascular and energy support. Emerging for perimenopause-specific benefits.

Caution: Generally very safe. May interact with blood-thinning medications. Can lower blood pressure slightly, which is worth noting if yours tends to run low.

Collagen peptides Estrogen plays a significant role in collagen production. As estrogen levels decline, you may notice changes in your skin elasticity, joint comfort, hair thickness, and nail strength. Collagen peptides (hydrolyzed collagen) provide the amino acids your body needs to support its own collagen synthesis.

Look for hydrolyzed collagen peptides containing types I and III. A dose of 10 to 15 grams daily mixed into coffee, smoothies, or water is standard. Results typically become noticeable after eight to twelve weeks of consistent use.

Evidence level: Moderate for skin elasticity and joint comfort. Multiple studies show measurable improvements in skin hydration and joint pain. Emerging for hair and nail benefits.

Caution: Collagen supplements are generally very safe. If you have food allergies, check the source (bovine, marine, or chicken). Marine collagen may be better absorbed but costs more.

How to build your supplement stack

Reading through twelve supplements might leave you wondering whether you need all of them. You don't. In fact, trying to take everything at once is one of the most common mistakes people make. It's expensive, overwhelming, and makes it nearly impossible to tell what's actually helping.

Here's a more practical approach.

Start with the foundations. If you're going to take just two or three supplements, make them magnesium glycinate, vitamin D3, and omega-3 fatty acids. These three address the most common perimenopause concerns (sleep, mood, bone health, inflammation) and have the strongest evidence base. They're also widely safe and well tolerated. Think of these as your baseline.

Add one supplement at a time. Once your foundation is stable for two to three weeks, layer in one additional supplement based on your most bothersome symptoms. If hot flashes are your biggest issue, try black cohosh. If stress and anxiety dominate, consider ashwagandha. If your energy has dropped off a cliff, maca or CoQ10 might be worth exploring.

Wait at least three to four weeks before adding the next one. This gives you a clear window to notice whether each addition makes a difference.

Match supplements to your symptoms. Here's a quick reference:

• Hot flashes and night sweats: Black cohosh, omega-3s, maca
• Sleep disruption: Magnesium glycinate, ashwagandha, B6
• Anxiety and mood changes: Ashwagandha, magnesium, omega-3s (high EPA), B-complex
• Brain fog and fatigue: Omega-3s (high DHA), CoQ10, B-complex, maca
• Joint pain: Omega-3s, collagen, CoQ10
• Heavy or irregular periods: DIM, evening primrose oil
• Low libido: Maca, ashwagandha
• Skin, hair, and nail changes: Collagen, omega-3s, evening primrose oil
• Digestive issues and bloating: Probiotics, DIM

Keep a simple log. Write down what you started, when you started it, and how you feel each week. This doesn't need to be elaborate. A few notes in your phone or a quick check-in with a tracking app is enough. Without this, you're guessing. With it, you're making informed decisions.

Reassess every three months. Your symptoms will shift as you move through perimenopause. A supplement that helps you now might not be necessary six months from now, and new symptoms might call for a different approach. Build in regular check-in points to evaluate what stays, what goes, and what's next.

What to watch out for

The supplement industry is not well regulated, and that creates real risks for consumers. Here's how to protect yourself.

Third-party testing is non-negotiable. Look for supplements that carry a USP, NSF, or ConsumerLab seal. These independent organizations verify that the product actually contains what the label says, in the amounts listed, and is free of harmful contaminants like heavy metals, pesticides, and microbial organisms. Without third-party testing, you genuinely don't know what you're taking.

Not all forms are equal. We've mentioned this throughout the supplement reviews, but it bears repeating. Magnesium oxide vs. glycinate. Folic acid vs. methylfolate. Ubiquinone vs. ubiquinol. Cyanocobalamin vs. methylcobalamin. The cheaper form is almost always the less effective one. Read labels carefully and understand which forms your body can actually absorb and use.

Watch for interactions with medications. This is especially important if you take hormone replacement therapy, thyroid medication, blood thinners, antidepressants, or blood pressure medication. Several supplements on this list can interact with these drugs:

• Ashwagandha may increase thyroid hormone levels
• Black cohosh may interact with medications metabolized by the liver
• Omega-3s and evening primrose oil can increase bleeding risk with blood thinners
• DIM may affect how your body processes hormonal medications
• St. John's Wort (not on our list for this reason) can interfere with nearly everything

Always tell your healthcare provider about every supplement you take. Bring your bottles to appointments so they can see the exact products and doses.

Red flags to avoid. Be wary of any supplement that:

• Promises to "cure" perimenopause or "balance your hormones" completely
• Uses proprietary blends that don't disclose individual ingredient amounts
• Features dramatic before-and-after testimonials as its primary evidence
• Costs significantly more than comparable products without clear justification
• Makes claims that sound too good to be true (because they are)

More is not better. Taking higher doses does not mean faster or bigger results. Many supplements have a ceiling of benefit, and exceeding recommended doses increases side effects without adding value. Stick to the dosing ranges supported by research.

Track what's actually working

Here's the truth about supplements during perimenopause: your response is highly individual. What transforms one person's sleep might do nothing for yours. The supplement that eases your friend's hot flashes might not touch yours but could unexpectedly improve your mood. Your body, your hormone patterns, and your symptoms are unique to you.

That's why tracking matters so much. Without a consistent way to monitor your symptoms alongside what you're taking, you're flying blind. You might continue spending money on something that isn't helping, or you might stop something that was quietly making a real difference.

PeriPlan makes this easy. The daily check-in captures your symptoms, energy, sleep quality, and mood in under a minute. When you layer your supplement log on top of that data, patterns emerge that you wouldn't catch otherwise. You might notice that your sleep scores improved steadily in the three weeks after starting magnesium. Or that your hot flash frequency dropped once omega-3s had time to build up in your system.

This kind of personal data is powerful. It gives you evidence, not just anecdotes, to bring to your healthcare provider. It helps you make confident decisions about what to keep, what to drop, and what to try next. And it takes the guesswork out of a process that can otherwise feel frustratingly random.

Supplements can be a meaningful part of your perimenopause toolkit. The right ones, chosen carefully and tracked consistently, can genuinely ease symptoms and improve your quality of life during this transition.

But they work best as one layer of a bigger picture. Quality sleep, regular movement (especially strength training), balanced nutrition with adequate protein, and stress management are the foundation. Supplements support that foundation. They don't replace it.

Start small. Choose two or three based on your most pressing symptoms. Give them time to work. Track how you feel. And keep the conversation going with your healthcare provider, because the best supplement plan is one that accounts for your full health picture.

You have more tools available than you might realize. The key is using them thoughtfully, not all at once, and staying curious about what your body needs as this chapter unfolds.

This content is for informational purposes only and does not replace medical advice. Supplements can interact with medications and are not appropriate for everyone. Always consult your healthcare provider before starting any new supplement, especially if you take prescription medications or have existing health conditions.