Best Supplements for Perimenopause

Your hormones are shifting. Here's what can actually help.

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Quick Answer

What are the best supplements for perimenopause?

The top 3 evidence-based supplements for perimenopause are Black Cohosh (6/10), Magnesium (10/10), and Omega-3s (7.5/10). Best studied for hot flashes.

Perimenopause can start in your early 40s. The hormonal rollercoaster brings hot flashes, mood swings, sleep disruption, brain fog. Some supplements have genuine evidence for specific symptoms. None replaces hormone therapy if you need it, but many women find meaningful relief.

For Hot Flashes and Night Sweats

Effective Dose20-40mg standardized extract daily
Time to Effect4-8 weeks

The most studied herbal for hot flashes. Results are mixed but enough women get relief that it's worth trying. Works through unclear mechanisms, possibly affecting serotonin rather than estrogen. Takes 4-8 weeks.

Best for:Hot flashesNight sweats
Effective Dose500-1000mg daily
Time to Effect4-8 weeks

Contains GLA, an omega-6 that may reduce hot flash severity. Evidence is limited but some women swear by it. Often combined with other approaches.

Best for:Hot flashesSkin changes

For Sleep and Mood

Effective Dose300-400mg glycinate before bed
Time to Effect1-2 weeks

Perimenopause often tanks magnesium levels. Low magnesium worsens sleep, anxiety, and mood. The glycinate form is calming and supports sleep. Bonus: protects bone density which becomes more important now.

Best for:Sleep disruptionAnxietyMuscle tensionBone health
Effective Dose300-600mg daily
Time to Effect2-4 weeks

Helps with the cortisol spikes that often accompany hormonal changes. Studies show benefits for stress, anxiety, and even some improvement in sexual function. Good for the "wired but tired" feeling.

Best for:Stress and anxietyEnergy fluctuationsMood stability
Effective Dose1-2g EPA/DHA daily
Time to Effect4-8 weeks

Omega-3s support mood through several pathways. They also become increasingly important for heart health as estrogen declines. Some research suggests they may reduce hot flash severity.

Best for:Mood supportHeart healthBrain fogJoint pain

For Bone and Long-term Health

Effective Dose2000-5000 IU daily
Time to EffectOngoing benefit

Bone loss accelerates during perimenopause. Vitamin D is essential for calcium absorption. Most perimenopausal women are low. Get tested and supplement accordingly.

Best for:Bone healthImmune functionMood support
Effective Dose100-200mcg MK-7 daily
Time to EffectLong-term benefit

K2 directs calcium into bones rather than arteries. Works with vitamin D. Often overlooked but increasingly recognized for bone and cardiovascular health.

Best for:Bone healthCardiovascular protection

Beyond Supplements

  • Strength training is crucial. Muscle loss accelerates and exercise protects bones.
  • Limit alcohol. It worsens hot flashes and disrupts already fragile sleep.
  • Protein needs increase. Aim for 1g per pound of ideal body weight.
  • Consider hormone therapy. It's more nuanced than the old headlines suggested.

Note: Perimenopause symptoms vary widely. Severe symptoms warrant discussion with a healthcare provider about all options, including hormone therapy.

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