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Should You Take Supplements to Manage Perimenopause Symptoms?

The short answer: It depends on the symptoms and the supplement.

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Perimenopause — the time when menopausal symptoms take root before menopause even begins — can be more than just a mild nuisance. But how do you know if you need to take perimenopause supplements to help mitigate your symptoms? You can guess the simple answer: It depends on the supplement and your symptoms. To gain a better understanding of what will help you based on your circumstances, however, you’ll need to look at the details.

Perimenopause often comes as a surprise to women, who don’t expect to have issues until they reach at least 50. Symptoms can even last for years before menopause begins. Yet women don’t have to weather the storm without any aid; if a supplement can help ease symptoms such as mood changes, hot flashes, sleep disturbances, brain fog, and painful sex, it’s certainly worth considering.

What supplements should I take if I am perimenopausal?

While many doctors recommend hormone replacement therapy (HRT) to address the root cause of symptoms, HRT is not for everyone. “Depending on where you are in the menopause journey or your medical history, hormone therapy may not be right for you,” Hasti Nazem, the head of product and education at Kindra, previously told Woman’s World. “There may be some risks. These risks can include blood clots, stroke, or even certain types of cancer. But I emphasize the word ‘may,’ because it depends on the person … By having estrogen-free products on the market, you empower women who may not want to take hormone therapy to have some type of relief.” 

Below is a list of perimenopause supplements that may help relieve your symptoms.

Ashwaghanda

Also known as: Indian ginseng and winter cherry. (Don’t confuse ashwagandha with Physalis alkekengi, which is also known as winter cherry.)

Treats: Hot flashes, stress, anxiety, brain fog

Potential side effects: Stomach upset, diarrhea, and vomiting if taken in large doses. Rare cases of liver injury have been reported two to 12 weeks after starting ashwaghanda supplements.

Summary: Ashwaghanda is a shrub plant from India and Southeast Asia. Its roots and leaves are used to treat many conditions, from stress to high blood sugar. Many people claim that it eases an array of perimenopause symptoms, including hot flashes, stress, anxiety, and brain fog. Indeed, an eight-week study from 2021 found that ashwagandha relieved mild to moderate hot flashes in perimenopausal women. An eight-week study from 2019 found that it significantly reduced stress and anxiety in healthy adults. And another eight-week study from 2017 found that the supplement improved memory in participants with mild cognitive impairment.

Black Cohosh

Also known as: Snakeroot, black bugbane, rattleweed, macrotys, rheumatism weed. (Don’t confuse with blue cohosh, or Caulophyllum thalictroides, which may not be safe to consume.)

Treats: hot flashes, night sweats, vaginal dryness, irritability

Potential side effects: stomach upset, cramping, headache, rash, vaginal spotting and/or bleeding, weight gain

Summary: Black cohosh is a plant that belongs to the buttercup family, and it grows in North America. Some clinical trials have shown that it reduced participants’ perimenopause and menopause symptoms, including hot flashes, night sweats, vaginal dryness, and irritability. Since it is mild, the National Institutes of Health (NIH) determined that it’s safe to consume — in some trials, participants have taken it for 12 months with no serious, harmful effects.

A word of caution: Some commercial black cohosh products have been found to contain the wrong herb, or mixtures of black cohosh and other herbs that are not listed on the label. If you purchase a black cohosh product, make sure that the ingredients have been verified by an independent third party. (The label will usually tell you that it has been independently tested.)

B Vitamins

Most importantly: thiamin (B1), riboflavin (B2), niacin (B3), pyridoxine (B6), folate (B9), and cobalamin (B12)

Treats: hot flashes, loss of energy, depression, strengthens bones, improves neurological function

Potential side effects: B1 supplements may cause hives and nausea, B2 may darken the color of urine, B3 may cause headaches and gastrointestinal distress, B6 may cause heartburn and nausea in large doses, B9 may cause nausea, loss of appetite, and confusion, and B12 may cause headaches and nausea.

Summary: Women nearing menopause are more likely to become deficient in vitamin B12, which is key for making red blood cells and promoting healthy digestion. A deficiency can cause a loss of energy and brain fog. In addition, a lack of vitamin B6 can affect serotonin levels, which may contribute to mood swings and depression. And increasing B9 levels may reduce the severity, duration, and frequency of hot flashes. Other B vitamins, including B1, B2, B3, may help stabilize mood, reduce inflammation, and boost energy levels, respectively.

We recommend boosting your B vitamin intake with a daily spoonful of nutritional yeast. One tablespoon of Bob’s Red Mill Nutritional Yeast contains:

  • Thiamin (B1): 2.95 milligrams (mg), or 245% of your daily value (DV)
  • Riboflavin (B2): 2.4 mg, 187.5% DV
  • Niacin (B3) 11.5 mg, 72.5% DV
  • Folate (B9) 457 micrograms (mcg), 114% DV
  • Pyridoxine (B6) 1.5 mg, 87.5% DV
  • Cobalamin (B12): 4.4 mcg, 182.5% DV

Calcium

Treats: Bone loss

Side effects: gas, constipation, and bloating (though supplements tend to cause few side effects)

Summary: The loss of estrogen during perimenopause accelerates bone loss and increases a person’s risk of fractures. However, calcium supplements (along with vitamin D supplements) can counteract those effects, according to the North American Menopause Society (NAMS). Now, certain medications are more effective than calcium. (These are known as anti-resorptive agents. Fun fact: Estrogen is a natural anti-resorptive agent, meaning it encourages bones to absorb calcium.) Still, the NAMS argues that it is an important part of any treatment plan. Perimenopausal women should take at least 1,200 milligrams (mg) daily.

Vitamin D

Treats: bone loss, brain fog

Side effects: in excessive amounts, it can cause nausea, vomiting, poor appetite, and confusion

Summary: While vitamin D doesn’t directly ease perimenopause symptoms, it’s an important part of any treatment plan because it will help your body function optimally. For example, it helps the body absorb calcium and phosphorus, improves immune system function, and reduces inflammation. Since it is difficult to get enough vitamin D through diet alone, experts suggest that you take a daily supplement. The recommended dietary allowance is 600 IU, or 15 mcg, daily. The maximum daily limit (the amount you can take without suffering side effects) is about 4,000 IU, or 100 mcg.

Note: There are two forms of vitamin D that exist on the market — D2 and D3. Experts are still debating which form is better, though most agree that D3 is preferred.

Foods With Phytoestrogens

Treats: hot flashes, night sweats, brain fog, mood swings

Side effects: no serious side effects (come from food)

Summary: As Dr. Bruce Dorr, OB/GYN told FIRST for Women, it’s important to address the root cause of perimenopause and menopause symptoms: hormone loss, and primarily, estrogen loss. While Dr. Dorr strongly recommends hormone replacement therapy, phytoestrogens may also help.

Phytoestrogens are plant nutrients that mimic estrogen in the human body. More research is needed to determine whether they can truly reduce the symptoms of menopause — they do not bind to estrogen receptors in the body the same way that estrogen does. Still, many sources agree that they may ease symptoms caused by estrogen loss, including hot flashes, night sweats, brain fog, and mood swings. Foods that contain phytoestrogens include soybeans, garlic, onion, cabbage, spinach, sprouts, plums, and pears.

Do perimenopause supplements work?

Here’s the short answer: It depends on who you ask. Some people in perimenpause swear by supplements, while other people say that they don’t help at all. There’s enough evidence to suggest that supplements help with certain symptoms, so if you do not want to (or cannot) use hormone replacement therapy, they are worth a try.

Keep in mind that the Food and Drug Administration (FDA) does not regulate supplements, so consumers must trust that supplement companies are making products that are safe and effective. And while many supplements are backed by scientific research, that research is sometimes questionable. (In general, it’s very difficult to prove that a supplement works, and it’s very easy to prove that a supplement doesn’t work.)

Bottom Line

Ultimately, your best course of action is to talk with your doctor about your symptoms and the supplements that you’d like to try. There’s no guarantee that perimenopause supplements will work, so you may need to try different products before you find one that works for you. Working with a healthcare professional will help you determine which products to test, and how many to take at any given time. And if you decide to go without supplements, one of the best ways you can help yourself is to commit to a healthy lifestyle. Eating a balanced diet that’s rich in whole grains, fruits, vegetables, and lean meats, and exercising regularly, may help balance your hormones to reduce symptoms.

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

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