Do I need supplements during menopause?

Supplements for the perimenopause and menopause: what does the science say?

• There’s been an explosion of menopause-related supplements and products in recent years
• But which could be actually beneficial and what should you avoid?
• Advice on the vitamins and minerals that can support you during menopause

Masses of glossily packaged vitamins and other supplements can be found on the shelves of many high street shops and advertised online. With their promises of health-boosting properties, the appeal of popping a tablet is easy to understand. Many of the products are now clearly branded to target women in the perimenopause and menopause – but which could be actually beneficial and what should you avoid?

Here, balance takes a look at the issue.

Vitamins and minerals during menopause

It is generally best to try and get the vitamins and minerals you need by eating a wide and varied diet, and you should be cautious in seeing herbal medicines or supplements as a cure-all for menopause.

If you are thinking about taking supplements, look beyond the marketing and think about your health in a holistic way, focusing on the key areas of bone, heart and brain health, as falling hormone levels can all have a detrimental effect on these.

It’s worth bearing in mind that for a lot of products aimed at women in the menopause, the same supplement may be available for less if it doesn’t carry such branding.

Check the back of the pack to see what it contains and see if a basic vitamin is available offering a similar combination.

The explosion in menopause-related products has even extended to items such as chocolate and shampoo, and for many of these there is little, if any, evidence that they make any difference.

If you are experiencing symptoms that you think may be related to the menopause, then the best starting point is to make an appointment to discuss this with your healthcare professional.

Menopause-related symptoms are due to low hormones rather than being low on certain vitamins and minerals, and HRT is usually the first-line treatment to manage menopause-related symptoms, and it also has benefits for your long-term health.

Find out what the evidence says about what might help you – and what might not.

RELATED: How the Mediterranean diet can help menopausal symptoms

Vitamin D and menopause

Vitamin D is a key nutrient during perimenopause and menopause – and post-menopause, too.  This vitamin is essential for the health and strength of your bones because it helps your body to absorb and use calcium.

Protecting your bones is crucial as your oestrogen, which helps bones remain strong, starts to decline in perimenopause onwards. Vitamin D may also have an important role in brain function and mood regulation.

RELATED: Vitamin D

There are three ways to get this vitamin: it can be made by the body when your skin is exposed to the sun; through eating food high in the vitamin; and by taking a supplement.

Everyone in the UK is recommended to take a vitamin D supplement, as it can be hard to top up levels when the weather is gloomy.

UK government guidelines recommend that everyone takes 10 micrograms of a vitamin D supplement daily, throughout the year, but especially in the autumn and winter months [1].

RELATED: Osteoporosis: How to protect your bones in menopause and beyond

Calcium and menopause

Calcium also helps keep your bones strong, and this is so important in perimenopause and menopause. Your risk of fragile bones, called osteoporosis, increases as your oestrogen levels decline.

Adults aged 19 to 64 need 700mg a day, according to UK government guidelines [2].

You should be able to get all the calcium you need from your diet. Items high in calcium include dairy products, nuts and seeds and green leafy vegetables. If you’re not sure you are getting enough, the Royal Osteoporosis Society recommends an online calcium calculator developed by the University of Edinburgh. You can use this to check whether you are getting enough calcium from what you eat and drink [3].

RELATED: Healthy eating for the menopause

Iron

Iron is a mineral which is an essential part of your red blood cells and helps carry oxygen around the body.  If you don’t have sufficient levels of iron, your body can’t carry enough oxygen, leading to fatigue. This can affect everything from your brain function to your immune system’s ability to fight off infections.

Women need more iron than men when they are having periods as they lose iron in menstrual blood.  After the menopause, women’s needs drop as they no longer have a cycle. The UK government recommends a daily iron intake of 14.8mg a day for women aged 19  to 50 (or older, if still having periods) and 8.7mg a day for men and for women over 50 who are no longer having periods [2].

If you have symptoms of low levels of iron, which include fatigue, shortness of breath, cold hands and feet, and brittle nails, discuss with a healthcare professional before buying a supplement.

Diagnosing iron deficiency anaemia usually requires a blood test and your healthcare professional will advise on appropriate iron supplements and eating iron-rich foods. Iron supplements can cause diarrhoea, dark stools or constipation. Adding extra fibre to your diet or taking a stool-softener remedy can help to relieve the constipation.

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Black cohosh

Black cohosh, which is the root of a North American herb related to the buttercup, is a supplement often taken by women in the perimenopause and menopause. It comes in tablets and gummies, and is widely available.

National Institute for Health and Excellence (NICE) menopause guidance states that that there is some evidence that supplements of the herb may have an impact on hot flushes and night sweats [4]. However NICE also notes that the quality and safety of these supplements is uncertain and there may be interactions with other medication. Research has been very mixed with some studies, including a gold standard Cochrane review, finding no evidence it works on menopausal symptoms [5].

Black cohosh contains plant phytoestrogens, which are plant-derived compounds that have a similar structure to your oestrogen but they don’t have the same potency so will not have the same effect – plus there isn’t the evidence to show they have the same long-term health as HRT.

Cancer Research UK recommends that women with breast cancer, liver problems or high blood pressure don’t take black cohosh as there is a lack of research on the impact it could have [6].

Isoflavones

Isoflavones are a type of phytoestrogen, these are compounds similar to oestrogen produced in your ovaries. These compounds are found in red clover, a flowering plant, which is what you may see named or pictured on supplement packaging.

Isoflavones are often included in combined supplements aimed at those going through the menopause. They are also present in very small amounts in foods such as soy, flax seeds, lentils and oats.

NICE guidance says that while there is some evidence it can reduce hot flushes and night sweats, the strength and quality can be variable, their safety uncertain and interactions with other medication has been reported [4].

Researchers have found that people taking red clover reported fewer hot flushes and less vaginal dryness than women who don’t take it [7]. However isoflavones don’t have the same potency as the oestrogen produced by your body, so will not have the same effect. There is not the evidence to show they have the long-term health benefits which HRT offers.

St John’s wort

Herbal remedies, which includes tablets, teas, tinctures and creams made from this yellow flowered plant are popular with women with menopausal symptoms.

There is some evidence it may be beneficial if you have hot flushes [4]. This could make it seem an appealing option for women who have had or are being treated for breast cancer, as they may not be able to take HRT. However NICE guidance warns against this as it can interfere with some drugs, tamoxifen for example plus medications to prevent blood clots and manage seizures. It is not known what the appropriate doses are, the long term effect and there is likely to be variation in the quality and strength of products [4].

This supplement is also sometimes used by people for depression, and some women find the menopause can be a time of increased anxiety, low mood and depressive symptoms [8]. If you are experiencing  these symptoms, the best approach is to make an appointment with your healthcare professional.

What about magnesium in menopause?

If you’re struggling with sleep during the menopause, which can be due to anxiety or physical symptoms like night sweats and needing the toilet, a magnesium supplement may be beneficial.

Magnesium is a mineral involved with hundreds of processes across the body. It activates the parasympathetic nervous system, which is responsible for making you feel calm and relaxed which in turns helps prepare your body for sleep. It also regulates the hormone melatonin, which guides sleep wake cycles in your body.  Plus magnesium has a role in bone health and appears to influence mood.

While more research is needed, a good­ quality magnesium supplement with vitamin B may improve sleep, as well as lower stress levels. Drinking alcohol and coffee and experiencing stress can reduce your body’s ability to absorb magnesium.

RELATED: Sleep and hormones

Probiotics, perimenopause and menopause

Within your gut are trillions of living organisms, collectively known as the gut microbiome. Teeming with bacteria, viruses and fungi, the gut microbiome can affect your hormones, metabolism and immunity. During and after the menopause, the bacteria in your gut become less diverse, research says [9].

RELATED: Dr Louise Newson Podcast: Spoon-fed with Tim Spector

Probiotics, which are often described as ‘good’ or ‘friendly’ bacteria, come in tablets, yogurts and drinks and are designed to restore the natural balance of your gut biome. Studies have found that probiotics and prebiotics can influence gut immunity so taking a good-quality probiotic may bring benefits [10].

RELATED: Dr Louise Newson Podcast: gut matters with Emma Ellice-Flint

Vitamin C

Eating plenty of food rich in vitamin C (for example broccoli, red peppers, citrus fruits oranges and blackcurrants) has been shown to support your immunity [11]. You should be able to get your daily requirement of 40mg through diet alone.

Zinc

Some studies have shown that the mineral zinc helps support the body’s immune system [11]. Women need about 7mg zinc a day and should be able to get enough through diet alone. Zinc-rich foods to tuck into include:

•  Shellfish (particularly oysters) and fish
•  Meat
• Dairy foods
• Pumpkin seeds
• Walnuts and almonds.  

References

1. Department of Health and Social Care (2021), ‘Vitamin D and clinically extremely vulnerable (CEV) guidance’

2. Public Health England (2016), ‘Government Dietary Recommendations’.

3. University of Edinburgh, ‘Calcium calculator’,

4. NICE (2015) ‘Menopause: diagnosis and management’

5. Leach M.J., Moore V. (2012), ‘Black cohosh (cimicifuga spp.) for menopausal symptoms’, Cochrane Database of Systematic Reviews. Issue 9. DOI:10.1002/14651858.CD007244.pub2

6. Cancer Research UK ‘Black cohosh and cancer’   

7. Ghazanfarpour M., et al. (2016), ‘Red clover for treatment of hot flashes and menopausal symptoms: A systematic review and meta-analysis’, J Obstet Gynaecol, 36(3) pp 301-11. doi: 10.3109/01443615.2015.1049249

8. Apaydin E.A., et al. (2016). ‘A systematic review of St. John’s wort for major depressive disorder’, Syst Rev. 2;5(1):148. doi: 10.1186/s13643-016-0325-2

9. Peters B.A. et al (2022). ‘Spotlight on the Gut Microbiome in Menopause: Current Insights’, Int J Womens Health.10;14, pp 1059-1072. doi: 10.2147/IJWH.S340491

10. Vieira A.T, Teixeira MM, Martins F.S. (2013), ‘The role of probiotics and prebiotics in inducing gut immunity’, Front Immunol. 12;4:445. doi: 10.3389/fimmu.2013.00445

11. Gombart A.F., Pierre A., Maggini S. (2020), ‘A review of micronutrients and the immune system working in harmony to reduce the risk of infection,’ Nutrients. 12(1) pp.236. doi: 10.3390/nu12010236