Supplements in perimenopause — what works, what does not, and how to stop guessing
A ranked evidence review of every commonly recommended perimenopause supplement. Tier 1 through tier 3.
14 min · Science
The overwhelm is real
"I always feel like I'd be taking hundreds of pills a day if I were to do what's good for me. In the end I don't take any of them and pray that my diet has some of what I need in it."
This guide ranks the evidence honestly. It tells you what is worth taking, what is probably not, and how to decide for yourself.
Tier 1 supplements — take these seriously
Magnesium (4/5 Strong) — The supplement with the most consistent self-reported benefit. Supports nervous system regulation, sleep quality, and bone health. 200-400mg glycinate in the evening.
Vitamin D (4/5 Strong) — Endemic deficiency in the UK. 1,000-2,000 IU daily for maintenance. Test your 25(OH)D level.
Protein (5/5 Very Strong) — More important than most supplements. 1.2-1.6g per kilogram of body weight per day.
Omega-3 (3/5 Moderate) — EPA and DHA support mood, reduce inflammation, and have modest vasomotor benefits. 1,000-2,000mg combined EPA+DHA daily.
Tier 2 — consider based on your symptoms
B vitamins (3/5 Moderate) — B6 supports serotonin synthesis. B12 deficiency presents as fatigue and brain fog. A standard B-complex covers both.
Creatine (4/5 Strong for cognition) — The 2025 CONCRET-MENOPA trial makes this tier 1 for cognitive symptoms specifically.
Calcium (3/5 Moderate) — 1,000-1,200mg total daily from food plus supplement. Do not exceed 1,500mg.
Tier 3 — limited evidence
Black cohosh (2/5) — Mixed RCT evidence. Give it 8 weeks. Stop if no benefit.
Ashwagandha (3/5 for stress) — No perimenopause-specific RCTs, but mechanism is relevant.
Collagen (2/5) — The evidence for perimenopause is thin. Most trials are industry-funded.
Phytoestrogens (3/5) — A 2023 RCT showed 88% reduction in severe hot flushes with soy. Food sources preferable to supplements.
What does NOT have strong evidence
- Evening primrose oil for hot flushes
- Valerian root for sleep
- Red clover for hot flushes
- Multi-mineral blends marketed for menopause
- "Hormone-balancing" supplements with no identified active ingredient
The practical approach
- Test your vitamin D. If low, take D3 and retest in 3 months.
- Add magnesium glycinate in the evening.
- Increase protein. This makes the biggest difference.
- Add omega-3 if you rarely eat oily fish.
- Consider creatine if cognitive symptoms are your main complaint.
- Everything else: only if you have a specific, tested deficiency.
The women who do best take three to five supplements consistently, not fifteen intermittently.
Evidence summary
| Outcome | Grade | Notes |
|---|---|---|
| Magnesium | Strong | Consistent mechanistic and RCT data |
| Vitamin D | Strong | Endemic deficiency, bone and mood |
| Protein | Very Strong | Fundamental for muscle and brain |
| Creatine (cognition) | Strong | 2025 RCT in target population |
| Omega-3 | Moderate | Mixed but favourable risk-benefit |
| Collagen | Supporting | Thin evidence, industry-funded |
Medical disclaimer
This guide is for educational purposes only. It is not a substitute for medical advice. If you are experiencing symptoms, speak with your GP or a qualified healthcare professional. Summ is not a medical service and does not diagnose or treat any condition.
References
Smith-Ryan et al. (2021). Creatine in women's health. Nutrients.
Frontini et al. (2025). CONCRET-MENOPA. JANA.
Barnard et al. (2023). Vegan diet and hot flushes. Menopause.
EFSA (2010-2012). Scientific opinions on health claims.
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