Supplements in Perimenopause and Menopause: What the Evidence Shows

Short answer: NIH sources say no dietary supplement is proven to relieve perimenopause or menopause symptoms. The 2017 overview from the National Center for Complementary and Integrative Health (NCCIH) says many have been studied, "however, none has clearly been shown to be helpful," and newer NCCIH pages report modest, inconsistent hot-flash findings for black cohosh and soy. The most realistic supplement questions at midlife are about getting enough calcium and vitamin D, and about checking anything you add against the medicines you already take.

What changes in perimenopause

Perimenopause, also called the menopausal transition, is the time leading up to menopause. The National Institute on Aging (NIA) says most women begin it between ages 45 and 55, that it may last several years, and that menopause itself is confirmed only after a full year without a period or spotting. Symptoms vary widely: some women have none, while others notice hot flashes, night sweats, trouble sleeping, mood changes or changes in their periods.

NIA lists period changes that call for a visit to your doctor, including heavy bleeding, bleeding between periods and any bleeding after more than a year without one. Those are questions for a clinician, not for a supplement.

Hot flashes: what has been studied

Many supplements are marketed for hot flashes. The NIH pages carry different dates, so here is what each says.

• Overall: NCCIH's in-depth page on menopausal symptoms (last updated in 2017) says phytoestrogens, herbs and other dietary supplements "haven't been clearly shown to relieve menopause symptoms." NIA's hot-flash page says black cohosh, DHEA and soy isoflavones "are not proven to be effective, and some carry risks such as liver damage."
• Black cohosh: NCCIH's newer black cohosh fact sheet (updated November 2024) describes a 2023 review of 22 studies that found black cohosh products potentially beneficial for overall menopause symptoms, with improvements in hot flashes but not in anxiety or depressive symptoms. The same page reports cases of liver damage, some very serious, in people taking products labeled as black cohosh; NCCIH says these cases are rare and it's uncertain whether black cohosh caused them. It also notes that some products were found to contain the wrong herb.
• Soy and other phytoestrogens: NCCIH's soy fact sheet (updated April 2025) says soy isoflavones or soy protein "may help to reduce the frequency and severity of menopausal hot flashes, but the effect may be small, and research results have not been completely consistent." NCCIH's menopause page adds that because phytoestrogen supplements may act like estrogen, "they may not be safe for women who shouldn't take estrogen."
• Vitamin E: NCCIH describes a small amount of research with a small effect, and warns that vitamin E in the high doses found in supplements may increase the risk of bleeding and interact with blood thinners such as warfarin.

Black cohosh, red clover, soy isoflavone supplements and kava are not in our catalog. We mention them because they are widely marketed for menopause, and their cautions matter if you already take one.

Bone health: calcium and vitamin D

NIA's menopause page says that after menopause women are more vulnerable to conditions including osteoporosis, and that it is important to "get enough calcium and vitamin D for optimal bone health." NIA's page on dietary supplements for older adults says "calcium works with vitamin D to keep bones strong at all ages" and gives these daily amounts:

• Calcium: "Women over age 50 need 1,200 mg (milligrams) each day. Men need 1,000 mg between age 51 and 70 and 1,200 mg after 70, but not more than 2,000 mg a day."
• Vitamin D: "600 IU (International Units) for people age 51 to 70 and 800 IU for those over 70, but not more than 4,000 IU each day."

NIA asks you to count what you get from food and drinks as well as from any supplements you take. It lists milk and milk products, canned fish with soft bones, dark-green leafy vegetables and fortified cereals as calcium sources, and fatty fish and fortified milk and cereals for vitamin D. If you are under 51, ask your doctor what applies at your age.

Calcium and vitamin D often appear in more than one product, such as a multivitamin plus a separate calcium supplement. Add up every label before you add another; our guide explains how to check for duplicate supplement ingredients.

On screening, MedlinePlus says "most women age 65 or older should have a bone density scan," and that women of other ages may also be at risk, for example with a family history of osteoporosis or a fracture after age 50. Ask your doctor when a scan makes sense for you.

If you take thyroid medicine, calcium timing matters. MedlinePlus's levothyroxine page says that if you take calcium carbonate (Tums) or ferrous sulfate (an iron supplement), "take it at least 4 hours before or 4 hours after you take levothyroxine." Ask your pharmacist how that applies to the products you use, and read our guide to calcium and thyroid medication.

Sleep changes

NIA's page on sleep problems and menopause notes that night sweats and mood changes can contribute to poor sleep. It says some women use over-the-counter sleep aids such as melatonin, and that these "are not a cure for sleep disturbances, such as insomnia, and should not be used long term." NIA's suggestions start with habits, such as a regular sleep schedule, a comfortable bedroom temperature and less caffeine late in the day. It also says cognitive behavioral therapy for insomnia "has been shown to help improve sleep in women with menopausal symptoms." If sleep is a problem, talk to your doctor before adding a product.

Products with cautions to read first

• DHEA: NCCIH says it is uncertain whether DHEA is useful for menopause symptoms, that "the long-term safety of taking DHEA supplements is unknown," and that "some evidence suggests that even short-term use of these supplements may have harmful effects, including liver damage."
• Ashwagandha: NCCIH's ashwagandha fact sheet lists menopause among the uses without enough evidence. It also says ashwagandha is not recommended for people with thyroid disorders or before surgery, and that it might interact with medicines including thyroid hormone, diabetes and blood pressure medicines. Ashwagandha is in our catalog. Our system never picks it on its own for anyone who reports insulin or another diabetes medicine with a high risk of low blood sugar, and the automated checks read your medicines and conditions before it is included. Our ashwagandha guide covers the research and cautions in more detail.
• Kava: NCCIH says kava supplements "have been linked to a risk of severe liver disease," and its kava fact sheet warns against combining kava with alcohol or other sedating substances.
• DIM: we found no NIH consumer fact sheet on DIM, so we have no reliable summary to give you.

Our engine never picks DHEA or DIM on its own; it includes either one only if you ask for it by name in the assessment, and the checks against your medicines and conditions still run.

Options with stronger evidence belong in a clinician's office

NCCIH calls hormone therapy "the most effective therapy for menopausal hot flashes," and also says it may raise the risk of breast cancer, blood clots and other serious problems. NIA's hot-flash page describes the risks and how they vary with age, and lists two FDA-approved nonhormonal prescription options. Whether any of these fits you depends on your medical and family history, so ask your doctor.

If you already use estradiol or another estrogen hormone therapy, our guide to estradiol and supplements covers what the labels say about St. John's wort, grapefruit, calcium and vitamin D.

Useful questions to bring:

• Are my symptoms likely to be the menopausal transition, or something else worth checking?
• Am I getting enough calcium and vitamin D from food, or should I add a supplement?
• When should I have a bone density scan?
• Does anything I take, including supplements, interact with my medicines?

Bring a list of every medicine and supplement you take, with names and amounts. NCCIH asks you to tell all your health care providers about any complementary approaches you use.

Where VitOptics fits

We don't offer a "menopause formula." The free, three-minute assessment asks for your age range, sex at birth, whether you are pregnant, breastfeeding or trying to conceive, your medicines, your conditions and the supplements you already take. Automated checks review the recommendation; some profiles need additional review by a person on our team. A second automated check reads the whole pack before it is released. Your result lists every formula, the amount of each ingredient and the reason it is there, including any calcium or vitamin D, so you can compare it with what you already take and show it to your doctor or pharmacist. To see what that looks like for you, take the free assessment; it does not start a subscription. For a broader look at choosing a pack, read vitamin packs for women.

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Read more in the VitOptics learning hub.

Sources

1. NCCIH: Menopausal Symptoms: In Depth (last updated May 2017)
2. NCCIH: Black Cohosh
3. NCCIH: Soy
4. NCCIH: Ashwagandha
5. NCCIH: Kava
6. National Institute on Aging: What Is Menopause?
7. National Institute on Aging: Hot Flashes: What Can I Do?
8. National Institute on Aging: Sleep Problems and Menopause: What Can I Do?
9. National Institute on Aging: Dietary Supplements for Older Adults
10. MedlinePlus: Bone Density Scan
11. MedlinePlus: Levothyroxine

This article is for educational purposes and is not medical advice. Supplements are not intended to diagnose, treat, cure or prevent any disease.

Prepared with AI assistance using the sources linked in this article.

Last updated: October 2026