Many of my patients are not yet ready to start on hormone replacement therapy, that could be for a variety of reasons. Any of which are fine and still leave me lots of options for treatment. One of my most-used herbal supplements contains Motherwort (Leonurus spp.), Dong quai (Angelica sinensis), Licorice root (Glycyrrhiza glabra), and Burdock (Arctium lappa). It’s not for everyone – licorice can impact your blood pressure, so it’s important to talk with a trained professional.
I did a search of Google and social media for recommended supplements for perimenopause and came back with a wide variety of suggestions. So here’s mine for what I think would be beneficial for most, which ones are potentially overhyped, and which ones I wouldn’t suggest.
Magnesium
This is popular for good reason. We don’t get a lot of magnesium in our diets, and it can be really beneficial for sleep, muscle tension, constipation, and stress and anxiety. But, not all magnesiums are alike. Magnesium citrate is easily found and it’s great for constipation, but beware – too much will definitely get your bowels moving. Magnesium oxide is also poorly absorbed by the gut, so it’s great for constipation. Magnesium glycinate is very bioavailable and great for mood and sleep. Magnesium malate is well absorbed and gentle on the stomach, it’s helpful in cellular energy production and helps with fatigue and muscle health.
Vitamin D
Vitamin D is one of the most common nutrient deficiencies in the US, but it is possible to take too much so a simple blood test can tell you if you’re low, and if so, by how much. Vitamin D is strongly tied to bone health, which is very important during perimenopause.
Vitamin D3 increases calcium absorption and promotes bone mineralization and simultaneously prevents soft tissue calcification. This is often simplified to saying that Vitamin K2 directs the calcium to the bones and teeth which is an oversimplification. However, they are frequently taken together.
But, Vitamin K can interfere with certain medications for anticlotting (Vitamin K is given to newborn babies to prevent Vitamin K deficiency bleeding) so it’s not the right combination for everyone.
Calcium
Ideally, you’re getting enough calcium through your diet. Foods high in calcium include canned fish (with the bones), cooked collard greens and kale, and dried figs.
Diary products are also high in calcium, although I’m finding many patients are sensitive to dairy, and there’s a growing link between Parkinson’s and dairy, so if you’re not interested in a sardine snack with cooked spinach then calcium supplementation might be a good option.
Fiber
I put almost everyone on fiber. Ideally, we should be getting about 35 grams of fiber in our diet daily. Most Americans are getting around 5-6 grams of fiber. Usually I have patients aim for 15 grams daily and as they get used to eating more veggies and legumes, start working towards 35.
And, I have almost everyone start on whole psyllium fiber. It helps with cholesterol, blood sugar, satiety, constipation, gut health, and hormone processing. It really is a work horse and one of my favorites.
Omega-3 Fish Oil
Omega-3’s are great for cardiovascular health, triglycerides, inflammation, anxiety, and joint health. It’s not a miracle, and fish burps can be annoying. However, freezing your Omega-3’s or taking with food can help reduce the fishy aftertaste.
Creatine
This is a new-ish and trendy one. A lot of women notice a loss of muscle mass as they progress through perimenopause and menopause, and creatine can be helpful counteracting that.
It’s also been shown to help muscle recovery (so you’re not as sore the next day after a big workout). Use caution if you’re someone with preexisting kidney disease, double check with your renal specialist.
Siberian/Rhaponic Rhubarb
Recent research is promising for use as a selective estrogen receptor-beta (ERβ) agonist to help with menopausal symptoms of hot flashes and mood changes. It’s an interesting herb that I anticipate will be integrated into more formulas in the future.
Black Cohosh
Probably the most well-known herbal supplement for menopause, and for good reason, it’s been studied longer than most. The evidence for hot flashes is mixed, but there are women who swear by it. What I want patients to know is that despite a lot of assumptions, it doesn’t appear to work by mimicking estrogen, which changes the risk conversation. That said, there are some concerns about liver toxicity with long-term use, so I don’t recommend it indefinitely without monitoring. It’s one to try thoughtfully, not just grab off the shelf.
Vitex (Vitex agnus-castus)
Vitex tends to be more useful earlier in the perimenopause transition, when cycles are still happening but getting irregular, and symptoms like breast tenderness and PMS are more prominent. It works on the progesterone side of the equation rather than estrogen. If you’re further along and past regular cycles, it’s probably not going to do much for you. Context and timing matter here.
Dong Quai
This is a classic in Traditional Chinese Medicine and it shows up in a lot of blended formulas (including the one I mentioned earlier). The standalone evidence is limited, and it can have interactions with blood thinners, so it’s not something I’d suggest people self-prescribe. Best used as part of a thoughtfully formulated blend under the guidance of a trained herbalist or integrative practitioner.
Ashwagandha
This is certainly having a moment, and I do love Ashwagandha for gentle stress support and sleep. It has real adaptogenic properties and some decent evidence behind it.
My hesitation is that the research specifically for perimenopause symptoms is still pretty limited, most of the studies focus on general stress and cortisol, which are certainly relevant, but it’s not a targeted menopause treatment.
I’d also flag two important cautions: it can interact with thyroid medications (relevant since thyroid issues become more common in this life stage), and there are rare but real reports of liver injury. As with anything, quality and dosing matter a lot and it’s worth a conversation with your provider before starting.
More Hype Than Evidence
Resveratrol
If you’ve spent any time in wellness circles, you’ve heard about resveratrol. It’s mechanistically interesting, it interacts with estrogen receptors and has anti-inflammatory properties in lab settings. But human clinical evidence has been consistently underwhelming. It’s a good example of a supplement that sounds compelling on paper but hasn’t yet delivered in practice. I’m not saying never, but I wouldn’t prioritize your budget here.
Wild Yam
Wild yam is marketed heavily as a “natural progesterone” alternative, and this is one that I want to specifically address because the marketing is misleading. Your body cannot convert the compounds in wild yam into progesterone, that conversion requires a laboratory process. Topical wild yam creams are not a substitute for bioidentical progesterone. If you need progesterone support, let’s talk about actual options.
Proprietary Blends
I want to say a word about the many proprietary “menopause support” blends on the market. Some contain genuinely useful ingredients, but because the formulations are proprietary, you often can’t tell how much of each ingredient you’re actually getting. A product can list black cohosh and still contain a very low dose. Read labels carefully, and be skeptical of any supplement that promises to “balance your hormones” without being specific about how.
A Note on Supplements in General
I want to end with something important, because I think it gets glossed over: supplements are not regulated the same way medications are. The FDA does not verify that a supplement contains what the label says it does, in the dose it claims, without contaminants.
This doesn’t mean supplements are bad or useless, many of my patients benefit enormously from targeted supplementation. But it does mean that brand and quality matter, and that “natural” is not a synonym for safe or effective.
It also means that for significant symptoms, especially severe hot flashes, sleep disruption that’s affecting your quality of life, mood changes, or bone loss risk, hormone therapy often has far stronger evidence behind it than any supplement on this list.
Supplements can be a wonderful complement to a broader treatment plan, or a reasonable first step for someone not yet ready for HRT. But they’re not always a substitute, and they work best when they’re chosen based on your specific symptoms rather than picked up because they showed up in your feed.
As always, I’d rather you bring these questions to a provider who knows your history than navigate it alone. My door is open.
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Dr. Jennifer Potter, ND
Naturopathic Doctor San Jose
408-356-1364
Dr. Jennifer Potter, ND provides natural healthcare solutions for families and individuals, focusing on perimenopause/menopause, autoimmune conditions, fatigue, and immune support. She is deeply committed to her patient’s well being, prioritizes patient education and combines natural and conventional therapies to deliver personalized care. Outside of her practice, she enjoys time with her two kids, reading fiction, and crocheting.
