Perimenopause Supplements: What the Evidence Actually Says

Why the Supplement Question Is So Complicated

Walk into any health food store or scroll through Instagram for five minutes with a perimenopause-related search and you will encounter a dizzying range of supplement claims. Adaptogens that promise to balance your hormones. Proprietary blends marketed specifically to menopausal women. Individual nutrients presented as the solution to hot flashes, brain fog, weight gain, and sleeplessness, sometimes all at once. The marketing is confident, the packaging is appealing, and the prices are significant. But the evidence behind most of these products is not what the marketing implies.

This does not mean supplements are useless in perimenopause. Some have genuinely meaningful evidence behind them, particularly for specific symptoms. But the evidence landscape is uneven, and the gap between what is well-supported and what is heavily marketed is wide. Navigating that gap requires being willing to look at the actual research rather than the testimonials, and being honest about what is a worthwhile consideration versus what is an expensive placebo.

This guide covers the supplement categories that come up most often in perimenopause conversations, organized roughly by the strength and quality of the evidence. The goal is not to tell you exactly what to take, which depends on your individual situation and should involve your provider, but to give you a realistic framework for evaluating what you encounter.

Supplements with the Strongest Evidence

Magnesium is probably the supplement with the broadest support across multiple perimenopausal concerns. It plays a role in sleep regulation, muscle relaxation, blood sugar metabolism, mood stability, and bone density, all of which are relevant in perimenopause. Magnesium deficiency is common in the general population, and absorption tends to decrease with age. For sleep specifically, magnesium glycinate or magnesium threonate are the forms most commonly recommended because they cross the blood-brain barrier effectively. Research consistently shows that magnesium supplementation improves sleep quality in adults, an effect that is particularly meaningful for perimenopausal women whose sleep is already disrupted by hormonal changes.

Vitamin D warrants serious attention in perimenopause for multiple reasons. It functions more like a hormone than a vitamin, with receptors throughout the body including in bone, muscle, brain, and immune tissue. Deficiency is extremely common, particularly in northern latitudes and in people who spend most of their time indoors, and deficiency is associated with worsened mood, fatigue, bone loss, and immune dysregulation. In perimenopause, when bone density is beginning to be affected by declining estrogen, maintaining adequate vitamin D is directly relevant to long-term skeletal health. Testing your vitamin D level before supplementing is worthwhile, as the appropriate dose depends on your baseline.

Creatine is a newer entrant to the perimenopausal supplement conversation but has a strong and growing evidence base. Creatine monohydrate has been studied for decades primarily in athletic contexts, but more recent research shows meaningful benefits for cognitive function, muscle mass maintenance, bone density, and mood -- all areas that are relevant in perimenopause. Women appear to benefit from creatine supplementation to a greater degree than men in some studies, possibly because baseline creatine stores are lower. Omega-3 fatty acids, particularly EPA and DHA from fish or algae sources, have solid evidence for cardiovascular health, anti-inflammatory effects, and mood support, and the cardiovascular relevance increases in the postmenopause years.

Supplements with Moderate Evidence for Specific Symptoms

Black cohosh is one of the most studied herbal supplements for hot flashes, and while the evidence is mixed overall, there is enough support for it to be worth a conversation with a provider for women who are looking for non-hormonal options. Several randomized controlled trials have found that black cohosh reduces hot flash frequency and severity compared to placebo, though the effect size is generally moderate and not all trials have shown significant benefit. Black cohosh does not appear to act on estrogen receptors directly, which is important for women with hormone-sensitive conditions. It works through a different mechanism, possibly through serotonergic pathways, though this is still being studied.

Valerian root has been studied for sleep in various populations, including perimenopausal women, and some studies show improvement in sleep quality and reduction in time to fall asleep with nightly valerian use. The evidence is not definitive, with some trials showing benefits and others not, but the side effect profile is favorable and the potential benefit for women struggling with sleep makes it a reasonable option to try. Doses used in research typically range from 300 to 600 milligrams taken thirty to sixty minutes before bed. If it is going to help, most women notice some benefit within two to three weeks.

Magnesium (covered under strong evidence) also qualifies here specifically for sleep and mood, with this section noting that its effects can vary significantly by form. Magnesium oxide, the cheapest and most common form in supplements, is poorly absorbed. Magnesium glycinate, threonate, and malate are better choices. This detail matters because many women try magnesium, use an oxide form, notice little benefit, and conclude that magnesium does not work for them, when the issue was the specific formulation rather than the nutrient itself.

The Herbal Supplement Landscape: What to Know Before You Buy

Beyond black cohosh, there is a long list of herbal supplements commonly marketed for perimenopause symptoms: chasteberry (vitex), red clover, maca root, dong quai, evening primrose oil, ashwagandha, and many more. Some of these have limited but promising early research. Many have very little rigorous research at all. The difficulty is that herbal supplements are difficult to study well because the active compounds are hard to standardize, doses vary widely between products, and funding for high-quality trials is limited compared to pharmaceutical research.

Chasteberry has some evidence for premenstrual symptoms and may be more relevant in early perimenopause when progesterone-related cycle symptoms are prominent. Ashwagandha has a growing body of research for stress and cortisol regulation, which is relevant for perimenopausal women whose stress response is more reactive. Red clover contains isoflavones that behave similarly to soy isoflavones and may have modest effects on hot flashes in some women. The effects of all of these are modest at best in the clinical literature, and they work in some women and not others without a reliable way to predict which category you fall into.

The most useful approach with herbal supplements is to try one at a time, give it six to eight weeks at a standard dose, and track your symptoms before, during, and after. This kind of systematic personal experimentation, as unglamorous as it sounds compared to the promises on the label, is the only way to know whether something is working for you. Trying three or four supplements simultaneously, which is extremely common, makes it impossible to know which one, if any, is producing an effect.

The Collagen Question

Collagen peptides are one of the most heavily marketed supplements to perimenopausal women, with claims ranging from skin improvement to joint health to gut healing. The marketing often implies that supplementing with collagen will directly replenish the collagen that declining estrogen is depleting from skin and connective tissue. The biology is more complicated than that.

When you consume collagen peptides, you digest them into their component amino acids, the same amino acids that make up the proteins you eat from any food source. Your body then uses those amino acids, along with vitamin C and other cofactors, to synthesize new collagen where it is needed. You do not absorb intact collagen molecules and insert them into your skin. Whether supplemental collagen peptides provide any advantage over adequate protein from food sources is genuinely debated, and the answer probably depends on whether you are already getting enough total protein and amino acids from your diet.

There is some research showing modest benefits for skin hydration and joint discomfort with collagen peptide supplementation, but the studies are often industry-funded and the effect sizes are small. If you are already consuming adequate protein, collagen peptides are unlikely to produce dramatic results. If your total protein intake is low, improving your overall protein intake from whole foods would likely be more impactful and significantly more cost-effective than adding collagen peptides specifically.

Supplement Quality: A Non-Negotiable Concern

The supplement industry in the United States is regulated differently from pharmaceuticals. Supplements do not require pre-market approval from the FDA. Manufacturers are responsible for ensuring their products are safe and that labels are accurate, but independent verification before sale is not required. This creates a situation where the pill in the bottle may contain significantly more or less of the labeled ingredient, or may contain contaminants, without any regulatory check having caught the problem.

Third-party testing certification is the most important quality signal to look for when choosing a supplement. Organizations including NSF International, USP (United States Pharmacopeia), and Informed Sport conduct independent testing of supplements to verify that the product contains what the label claims, in the amount claimed, without contaminants. Products bearing these certifications have been independently verified, which is meaningfully different from a manufacturer's own quality assurance claims.

Price is not a reliable quality indicator. Some expensive supplements are low quality, and some reasonably priced supplements from reputable companies with third-party certification are excellent. The NSF Certified for Sport database and the ConsumerLab database (subscription-based) are useful resources for checking whether specific products have been tested and found accurate. For supplements you take regularly, checking these resources once is a modest investment that reduces the risk of wasting money on something that does not contain what it claims.

Supplements That Interact with Medications

Drug-supplement interactions are a genuine concern and one that is frequently underestimated. Many women assume that because supplements are "natural" they are safe to combine with any medication, but this is not the case. Several common supplements have documented interactions with prescription medications that can either reduce the medication's effectiveness or increase the risk of side effects.

St. John's Wort is perhaps the most important example. It is sometimes used for mood support in perimenopause and has modest evidence for mild depression. But it is a significant inducer of cytochrome P450 enzymes in the liver, which means it accelerates the breakdown of many medications, reducing their effectiveness. The list of affected medications is long and includes hormonal contraceptives, anticoagulants, some antidepressants, thyroid medications, and others. If you are on any prescription medication, checking for St. John's Wort interactions specifically before using it is important.

Fish oil at high doses can increase bleeding risk, which is relevant for anyone on anticoagulants or who is scheduled for surgery. Magnesium can interact with certain antibiotics, reducing their absorption if taken simultaneously. Iron supplements interact with a wide range of medications and should be taken at least two hours apart from most other medications. The most reliable way to check for interactions is to use a pharmacist consultation or a tool like Drugs.com's interaction checker, entering all medications and supplements you are taking together.

Avoiding the Instagram Supplement Trap

Social media has created a category of supplement marketing that is particularly difficult to evaluate because it is delivered through the voice of relatable, trusted-feeling people rather than through traditional advertising. When a woman you follow who seems honest and knowledgeable about perimenopause endorses a specific supplement and describes how it transformed her experience, it carries more persuasive weight than a print ad. The problem is that influencer supplement endorsements are frequently paid partnerships, and the person endorsing the product may have no idea whether it actually works.

The questions worth asking when you encounter a supplement recommendation, regardless of the source, are: Is there peer-reviewed research supporting this specific supplement for this specific symptom? Has it been studied in perimenopausal women specifically, or are the claims being extrapolated from other populations? Is the research independent of the company selling the supplement? Is the claimed mechanism of action biologically plausible? A supplement that cannot answer yes to most of these questions deserves significant skepticism regardless of how compelling the testimonials are.

The best supplements for perimenopause are rarely the most heavily marketed ones. Magnesium, vitamin D, creatine, and omega-3s are not glamorous. They do not have influencer campaigns built around them because the margins are low and the research does not need promotional help. The supplements with the largest Instagram presence are often those with the least robust evidence and the most aggressive pricing. That inverse relationship between marketing intensity and evidence quality is worth keeping in mind as you navigate the space.

Medical Disclaimer

This article is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Supplements are not a substitute for medical care, and the appropriate use of any supplement depends on your individual health history, current medications, and specific symptoms. Before adding any supplement to your routine, discuss it with a healthcare provider who knows your full health picture. Some supplements interact with medications or have contraindications that are not covered in this general overview.