What Are the Best Supplements for Perimenopause?

⏱ 7 min read✅ Reviewed by the Enavec Pharmacy pharmacist teamLast Updated: November 2026

The best-supported supplements for perimenopause are vitamin D when sunlight is low, magnesium for sleep, and creatine for muscle if you lift weights.^[1][2][3] But none reliably relieves hot flushes (hot flashes in the US), and the Menopause Society’s 2023 statement does not recommend supplements for them.^[4] Hormone therapy remains the most effective treatment.^[4]

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What is perimenopause, and why do people take supplements for it?

Perimenopause is the stage before menopause when you still have periods but symptoms have started. The NHS says they usually last 7 to 9 years.^[5] NICE lists the common ones:^[6]

• Cycle changes
• Hot flushes and night sweats
• Joint and muscle pain
• Low mood
• Vaginal dryness

At our pharmacy, the question we hear most is whether a “menopause blend” can stand in for hormone therapy. Nothing in the trials says it can.^[4] Our pillar guide, Supplements for Women: Magnesium, Inositol, Creatine, and What the Evidence Shows, gives the wider picture. But first, check whether your symptoms need a clinician.

When should you see a doctor about perimenopause symptoms?

Some changes need an examination, not a supplement.

If none of that applies, speak to your pharmacist or doctor about the symptom that bothers you most. Then match the supplement to it.

What are the best supplements for perimenopause?

Three have enough research to discuss.

Vitamin D for bone health when sunlight is low

UK government advice is that adults consider 10 micrograms (400 IU) a day in autumn and winter, and that up to 25 micrograms (1,000 IU) suits everyone.^[1] The US upper limit is 100 micrograms (4,000 IU).^[8] But the 2024 Endocrine Society guideline suggests against routine extra vitamin D for healthy adults under 75.^[9] Evidence label: guideline-backed for low sunlight, unproven for symptoms.

We see this go wrong most often when a vitamin D tablet joins a multivitamin and a calcium product that also contain it. Nobody adds up the total.

Magnesium for sleep

Three small trials in 151 adults aged 55 and over with insomnia found they fell asleep about 17 minutes sooner on magnesium than on placebo.^[2] Total sleep time did not change significantly, and the evidence was rated low to very low quality.^[2] Those were older adults, so the result may not carry over. Evidence label: modest, low quality.

The US upper limit for supplemental magnesium is 350 mg a day, and the NHS says 400 mg or less is unlikely to cause harm.^[10][11] Space it from osteoporosis tablets and some antibiotics, and ask a doctor first if you have kidney disease.^[10] Unsure which form? See whether magnesium glycinate is better than magnesium citrate.

Creatine for muscle if you lift weights

A 2026 meta-analysis (a pooled review of trials) of seven trials in 608 postmenopausal women found creatine added about 0.37 kg of lean mass and 7.5 kg of leg-press strength over placebo. Gains appeared at 5 g a day or more plus resistance training, and bone density was unchanged.^[3] We found no large trial in perimenopause, and our guide covers whether creatine helps during perimenopause. Evidence label: modest for muscle with training, unproven for symptoms.

The International Society of Sports Nutrition found no compelling evidence that creatine harms healthy people.^[12] It can raise creatinine (a kidney blood marker) without kidney damage, so mention it before kidney tests, and ask your doctor first if you have kidney disease.^[12] And look for NAFDAC registration in Nigeria, and NSF or USP certification for international purchases.

Which perimenopause supplements are best avoided or checked first?

The rest of the shelf has weaker evidence or interaction risks.

• Black cohosh. NICE says some evidence suggests it may relieve vasomotor symptoms, but preparations vary and interactions are reported.^[6] The Menopause Society found insufficient evidence, and the NIH notes rare cases of liver damage with an uncertain cause.^[4][13] The MHRA had received 50 suspected adverse reaction reports since 1998 linked to unlicensed products, including jaundice and hepatitis. Those are reports, not rates.^[14]
• St John’s wort. NICE warns of serious interactions with tamoxifen, anticoagulants and anticonvulsants.^[6] The Irish regulator HPRA adds hormonal contraceptives and SSRI antidepressants, and Australia’s TGA raises similar concerns.^[15][16] NICE advises contraception information in perimenopause, so that interaction matters.^[6]
• Soy isoflavones, omega-3 and vitamin E. The Menopause Society rated the evidence for hot flushes as mixed, inconclusive or negative, and did not recommend them.^[4]

The detail people most often miss at the counter is that herbal products belong on the medicine list. In the UK, the MHRA recommends registered herbal medicines, which carry a THR mark.^[14] Bring your full list to your pharmacist before adding anything.

Frequently asked questions

References

1. UK Health Security Agency (formerly PHE) and NICE. Statement on vitamin D supplementation during winter. www.gov.uk/government/publications/vitamin-d-supplementation-during-winter-phe-and-nice-statement/statement-from-phe-and-nice-on-vitamin-d-supplementation-during-winter
2. Mah J, Pitre T. Oral magnesium supplementation for insomnia in older adults: a systematic review and meta-analysis. BMC Complement Med Ther. 2021;21:125. pubmed.ncbi.nlm.nih.gov/33865376/
3. Naddafha S, Antonio J, Kreider RB, Stout JR. Creatine monohydrate for lean mass, strength, and bone density in postmenopausal women: a systematic review and meta-analysis. J Int Soc Sports Nutr. 2026;23(1):2668435. doi.org/10.1080/15502783.2026.2668435
4. The 2023 nonhormone therapy position statement of The North American Menopause Society (The Menopause Society). Menopause. 2023;30(6):573-590. doi.org/10.1097/GME.0000000000002200
5. NHS. Symptoms of menopause and perimenopause. www.nhs.uk/conditions/menopause/symptoms
6. NICE. Menopause: identification and management (NG23), recommendations. www.nice.org.uk/guidance/ng23/chapter/recommendations
7. NutraIngredients. UK herbal sector agrees black cohosh liver warning (MHRA label wording), 2006. www.nutraingredients.com/Article/2006/08/10/UK-herbal-sector-agrees-black-cohosh-liver-warning/
8. NIH Office of Dietary Supplements. Vitamin D: Fact Sheet for Consumers. ods.od.nih.gov/factsheets/VitaminD-Consumer/
9. Demay MB, et al. Vitamin D for the prevention of disease: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2024;109(8):1907-1947. pubmed.ncbi.nlm.nih.gov/38828931/
10. NIH Office of Dietary Supplements. Magnesium: Fact Sheet for Health Professionals. ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
11. NHS. Vitamins and minerals: Others (magnesium). www.nhs.uk/conditions/vitamins-and-minerals/others/
12. Kreider RB, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. 2017;14:18. doi.org/10.1186/s12970-017-0173-z
13. National Center for Complementary and Integrative Health (NIH). Black cohosh. www.nccih.nih.gov/health/black-cohosh
14. MHRA. Press release, 9 December 2011: importance of using registered herbal medicines (black cohosh safety notice), as reproduced by Women’s Health Concern. www.womens-health-concern.org/wp-content/uploads/2011/12/MHRAPressrelease_1211.pdf
15. Health Products Regulatory Authority (Ireland). St John’s wort traditional herbal medicine product information, 2023. assets.hpra.ie/products/Human/34892/Licence_TR23157-003-001_01122023130132.pdf
16. Therapeutic Goods Administration (Australia). St John’s wort: important interactions with prescription medicines. www.tga.gov.au/safety/safety-alerts/st-johns-wort-important-interactions-between-st-johns-wort-hypericum-perforatum-preparations-and-prescription-medicines

Related guides

This article is for informational purposes only and does not constitute medical advice. Always consult your pharmacist or doctor before starting any medicine or supplement.