Nutrition is always important. But during menopause, your body is particularly reliant on vitamins and nutrients to keep you healthy and strong. Eating a healthy diet and living a healthy lifestyle should always be your first line of defense. Supplements should be viewed as an addition rather than a substitution. Choose wisely as some supplements are more harmful than helpful.
The amount of scientific evidence we have on dietary supplements varies widely—we have a lot of information on some and very little on others. Dietary supplements may interact with your medications or pose risks if you have certain medical problems or are going to have surgery so don't start taking supplements without talking to your doctor. Rules for manufacturing and distributing dietary supplements are less strict than those for prescription or over-the-counter drugs. Some products marketed as dietary supplements may contain ingredients not listed on the label. Manufacturer’s use of terms like “standardized” or “verified” or “certified” do not guarantee product quality or consistency. Many dietary supplements (and some prescription drugs) come from natural sources, but "natural" doesn't necessarily mean "safe." For example, the kava plant is a member of the pepper family, but taking kava supplements can cause liver disease.
Update (11/14/2023): Dr. Jen Gunter, an OB/GYN who authored The Vagina Bible and The Menopause Manifesto wrote a post on alternative medicine/supplements that published in November, 2023. It's excellent and deserves your time and attention if you're interested in more information about alternative medicine, supplements, and other "natural" cures.
Here are some supplements you and your doctor may consider that have good evidence of effectiveness and may provide more benefit than risk:
Calcium - The importance of adequate calcium intake for skeletal health is well established; randomized clinical trials of calcium in combination with vitamin D demonstrate a role in fracture prevention. The main dietary sources of calcium are dairy products (including milk, cheese, and yogurt). If you are unable to achieve adequate calcium intake from food because of gastrointestinal issues or lactose intolerance, your doctor may suggest a supplement. Most women won't need more than more than 500-800 mg per day of calcium supplements to reach a total calcium recommended amount of 1000-1200 mg/day. Be aware that more supplementing is not better. Results do not support a further reduction of fracture risk in women who take higher doses of calcium supplements, and it may increase your risk of kidney stones and/or cardiovascular disease.
Magnesium - Our bodies use magnesium to maintain strong bones, turn food into energy, balance hormones, regulate muscle function, support the cardiovascular system, balance mood, and support the health of our nervous system. Magnesium decreases alongside estrogen levels in postmenopausal women. Menopausal women should eat foods high in magnesium, including leafy green vegetables, fruit, nuts, seeds, whole grains, tofu, and fortified cereal. Magnesium supplements appear to be safe for use in women with normal kidney function, but taking high doses of magnesium can result in diarrhea, cramping, and nausea. Additionally, magnesium can interact with some common drugs like antibiotics, diuretics, osteoporosis medications, and GI treatments so don't start taking a supplement without talking with your doctor. The recommended daily allowance of magnesium for women over 50 is 320 mg, which includes from dietary sources and supplements. Once again, more is not better. Studies have found that magnesium supplementation can positively impact sleep quality and quantity in all older adults which might be particularly beneficial to menopausal women experiencing sleep disruption. Magnesium also may help with heart health and depression, but there is less evidence that it can relieve hot flashes.
Vitamin D - Vitamin D promotes calcium absorption which is necessary for bone growth and bone remodeling. Without sufficient vitamin D, bones can become thin and brittle. Vitamin D has other roles in the body, including reducing colon cancer risk, managing diabetes, and helping decrease high blood pressure. Unlike calcium and magnesium, it is difficult to consume enough Vitamin D through foods, but adequate exposure to sunshine can provide enough Vitamin D to obtain the recommended daily amount of 15 mcg (600 IU) for women age 50-70. Notably, women who live in cold climates who regularly have their skin covered, those with darker skin, those who are obese, and women with diseases like Crohn's, celiac, ulcerative colitis, cystic fibrosis, and liver conditions that limit fat absorption have a more difficult time achieving adequate Vitamin D levels. As with other supplements, more is not better since excessive Vitamin D can result in kidney stones. Vitamin D interacts with common drugs like statins, weight loss drugs, steroids, and diuretics so ask your healthcare provider about taking vitamin D supplements. I recommend 2,000IU daily for long term bone health and protection.
Omega-3 fatty acids - The therapeutic benefits of omega-3 fatty acids – which are abundant in certain fish oils – have long been known. Omega-3s improve brain development, mood, and heart health, can reduce joint pain, and help produce healthier and stronger bones. Some studies also suggest that omega-3 helps reduce the frequency of hot flashes in menopausal women, but more studies are needed. There are many foods that contain omega-3, including oily fish such as tuna, salmon, herring, sardines, and mackerel; flaxseed, canola, hempseed, and walnut oils; chia seeds, spinach, soybeans, and eggs. Women should consume 8-12 ounces of a variety of seafood per week. If supplementation is necessary, 1100 mg of omega-3 per day (which includes food sources and supplements) should be sufficient for women over 50. Skip the products that smell fishy since the omega-3s in those products probably have oxidized. Be aware that omega-3 can interact with some medications, like anticoagulants (Warfarin), so talk with your doctor.
Multivitamins - Menopausal women may benefit from a multivitamin since Vitamin B12 absorption can decrease with age, and menopausal women need more calcium and vitamin D than reproductive age women. Additionally, a multivitamin may help prevent hair loss and improve hair brittleness. There doesn't appear to be much health risk associated with taking a multivitamin, but avoid taking products that contain megadoses. Use USP or NSF verified products, and check the label to ensure other ingredients like herbs or enzymes haven't been added. Talk with your doctor to decide if a multivitamin is right for you.
Melatonin - Melatonin is a hormone that your brain produces in response to darkness. It helps with the timing of your circadian rhythms (24-hour internal clock) and with sleep. Melatonin production decreases as women age. Foods that contain melatonin or increase natural melatonin production include tart cherry juice, gogi berries, eggs, milk (recall the warm milk before bed recommendation from your grandmother), nuts, and fish. In adults, research studies have found the clearest potential benefits from melatonin supplements are for people who have sleeping problems related to jet lag and delayed sleep-wake phase disorder, a condition in which a person's sleep schedule is shifted a few hours later. In some studies, low doses of melatonin improved mood and sleep onset in postmenopausal women, but more research is needed. Most experts recommend a dose of 0.5 to 3 milligrams for sleep issues - higher doses can cause daytime drowsiness. There appear to be few safety risks with taking low-dose melatonin; however, women with epilepsy and those taking blood thinner medications should talk with their doctor before taking melatonin supplements.
Acupuncture - It's obviously not a supplement, but it's added here because you might consider it as a complementary therapy. In a review of 12 studies of women during menopause transition, acupuncture positively impacted both the frequency and severity of hot flashes. Menopausal women can expect hot flashes to decrease by approximately 30% with acupuncture. There were inconsistent findings on the effects of acupuncture on menopause-related symptoms such as sleep problems, mood disturbances and sexual problems, but it may help some women . There are few risks associated with acupuncture if performed by a certified practitioner.
These supplements have limited data supporting their effectiveness and have safety risks for some women - the risks may outweigh any benefit:
Ashwaghanda - Ashwagandha is an evergreen shrub that grows in Asia and Africa. Taking Ashwagandha by mouth seems to improve overall sleep and sleep quality in some people, reduces stress, and helps reduce stress-related weight gain. Ashwaghanda can be taken at 300-500 mg twice once or twice per day. The safety of long term use has not been studied. Be aware that Ashwaghanda interacts with many common prescription drugs, including medications for thyroid conditions, high blood pressure, diabetes, immune disorders, and sedatives. It is also very important to note that Ashwagandha may induce abortion in animal models, so pregnant women or those who intend to be should not take it! Talk with your doctor before starting Ashwaganda.
Holy Basil - Holy Basil is a plant that is native to India. It is commonly used in the traditional Indian medicine system, Ayurveda. Preliminary studies show that Holy Basil may reduce anxiety and relieve the stress and depression that accompany anxiety; decrease blood sugar levels; decrease symptoms of stress (for example, sleep problems, exhaustion, forgetfulness); improve breathing function and reduce attacks in people with asthma; improve the immune system's response to viral infections; and reduce inflammation and joint pain. More studies are necessary to confirm the preliminary findings. Avoid Holy Basil if you're allergic to mint, a close relative. In addition, be aware that an excess of eugenol, one of the compounds in Holy Basil can cause an overdose, expressed as shallow breathing, blood in the urine or mucus, nausea, racing heartbeat, seizures, dizziness, coma or other health problems. Holy Basil may interfere with thyroid medications and slow blood clotting. It should not be used by women who are pregnant or intend to be. You can try Holy Basil at 500 mg twice per day but not for more than 8 weeks since long-term safety has not been studied. If you want to take Ashwagandha with Holy Basil, start with Holy Basil and add Ashwaghanda after three weeks. As with all supplements, talk to your doctor to ensure that you don't have dangerous contraindications.
Black Cohosh - Black Cohosh is a member of the buttercup family, a perennial plant native to North America. Efforts to study the effects of Black Cohosh have been hampered by the fact that available preparations vary significantly in their composition. There is anecdotal information that Black Cohosh can reduce menopause symptoms like hot flashes, vaginal dryness, heart palpitations, tinnitus, vertigo, sleep disturbances, nervousness, and irritability, but the American College of Obstetricians and Gynecologists (ACOG) concluded that data does not support that herbal dietary supplements like black cohosh" are efficacious for the treatment of vasomotor symptoms" like hot flashes. The North American Menopause Society (NAMS) advises against use of Black Cohosh because it is "unlikely to be beneficial" in alleviating hot flashes. A standard dose is 40-80 mg per day. Some studies suggest that Black Cohosh may cause liver damage in some women so if you decide to take it, limit your use to 6 months and check with your doctor regularly.
Rhodiola Rosea – Rhodiola grows in cold regions and at high altitudes in Europe and Asia. It acts as a selective estrogen reuptake modulator (SERM.) Rhodiola is promoted to increase energy, stamina, strength, and mental capacity, improve athletic performance, resist the effects of stress, and help manage depression, anxiety, and other symptoms. There are few studies done with Rhodiola in people, and the results are not conclusive. If you want to try it, use 150 mg twice per day for not more than 3 months since long-term safety has not been studied. Do NOT take Rhodiola if you take blood pressure or diabetes medications, ACE inhibitors, immunosuppressants, blood thinners, anti-seizure medication, or MAOIs. You also should avoid Rhodiola if you are taking estrogen hormone therapy (MHT). Rhodiola might worsen autoimmune diseases. Talk with your doctor before starting use of any supplement.
Schisandra - Schisandra is a fruit extract used in traditional Chinese medicine. Schisandra works as a phytoestrogen. Some studies suggest it may improve cognition and energy; increase blood vessel compliance; and improve strength. Only a small number of studies have been conducted in humans and are too limited to draw any conclusions. Few safety studies of Schisandra have been conducted, but it appears safe to be taken for short periods. Schisandra can be used at a dose of 13.5 mg/kg body weight per day. Schisandra has significant interaction with a long list of prescription drugs so talk with your doctor before taking it. Schisandra may not be appropriate for people with conditions such as ulcers, gastroesophageal reflux (GERD), or high levels of stomach acid. Schisandra also may cause a reduced appetite so care should be taken in use by women with low BMI. If you want to try Rhodiola with Schisandra, start with Schisandra and add Rhodiola after 2 weeks. Avoid Schisandra if you take estrogen hormone therapy (MHT). As with all supplements, talk with your doctor before you use Schisandra.
Maca – Maca is a plant that grows on the high plateaus of the Andes Mountains. Some studies suggest that Maca improves mood and energy; alleviates brain fog; decreases anxiety and depression; and reduces hot flashes. More studies are needed to conclusively determine efficacy and evaluate safety. If you have any condition that might be made worse by estrogen, like hormone-sensitive cancers, do not use Maca. In addition, women with uterine fibroids should not take it. You also should not use Maca if you take thyroid medication. Note that Maca is listed as a banned substance by WADA so avoid it if you are a drug-tested athlete. Recommended doses are 2g/day for vasomotor and hormonal symptoms and 3.5 g/day for mood and psychological benefits. Take your dose in the morning since it can have stimulant effects. Long-term safety has not been evaluated so limit your use to 3 months. Check with your doctor before taking Maca.
Valerian - Valerian is a perennial plant native to Europe and Asia. Although the results of some studies suggest that valerian may be useful for insomnia and other sleep disorders, results of other studies do not. Interpretation of these studies is complicated by the fact the studies had small sample sizes, used different amounts and sources of valerian, measured different outcomes, or did not consider potential bias resulting from high participant withdrawal rates. Overall, the evidence from these trials for the sleep-promoting effects of valerian is inconclusive. Valerian can have adverse interactions with prescription drugs like benzodiazepines, barbiturates or central nervous system (CNS) depressants, and dietary supplements like St. John’s wort, kava, and melatonin. To avoid most side effects, doses lower than 600 mg should be used. Side effects include decreased libido, nausea, headaches, acne, and rash. Long-term safety data is not available so limit the amount of time you use valerian. Talk with your doctor before using valerian.
The following supplements have no evidence supporting their use and/or the risks may outweigh the benefit:
Evening primrose oil - Has been used for short term therapy for PMS and breast tenderness. There is no evidence it helps with hot flashes. It has been associated with nausea, diarrhea, and blood clots. It is dangerous to take evening primrose oil if you take blood thinners or have a history of seizures or schizophrenia.
Wild yam - Studies show that wild yam extracts and tinctures have little to no effect on menopause symptoms.
Dong Quai - Studies do not support any benefit for menopausal symptoms. Further, it interacts with multiple prescription drugs and should be avoided by women for whom estrogen is contraindicated. In particular, women with estrogen-sensitive cancers fibroids or bleeding disorders should avoid Dong Quai.
Kava - Kava has been linked to severe liver toxicity (liver failure, hepatatis, and cirrhosis.) Use is not advised.
Sage - There are no documented benefits of sage for menopausal symptoms. Side effects include kidney damage, nausea, vomiting, and convulsions. The oil may cause seizures if ingested.
Over-the-counter estrogen or progesterone creams - Use of estrogen in the absence of progesterone by women with a uterus significantly increases the risk of cancer. Further, use of estrogen creams can result in varying amounts of estrogen absorption and can exacerbate menopause symptoms. Since progesterone creams are fat-soluble (which means they dissolve in fat and are stored in your body’s tissues), long-term use can cause a buildup of too much progesterone that can remain in the body for a long time, potentially causing numerous problems. See your doctor for FDA-approved formulations that will work best for you.
Fluoride - Fluoride will not help with bone loss associated with menopause. In fact, fluoride supplementation can increase fracture risk.
Iron - Many menstruating women experience low iron levels due to the blood lost during their periods. Menopausal women need less iron to counteract the blood loss of menstruation so supplementation is not usually required. Strive to eat iron-rich foods like meat and seafood, nuts, beans, vegetables, and fortified grain. If your doctor suspects your iron levels might be low, she can check with blood tests to ensure that you are getting enough iron in your diet.
Soy - Low levels of soy obtained through foods are safe, but soy supplements provide unregulated amounts of estrogen that are particularly dangerous to women with uteruses and women with estrogen-sensitive cancers.
Strontium - Strontium is a mineral found in seawater and soil. You get it mainly from seafood, but there also are small amounts in whole milk, wheat bran, meat, poultry, and root vegetables. There are much better drugs for osteoporosis available. Strontium ranelate might be prescribed by your doctor if you are unable to take those drugs, but there are serious contraindications for use of strontium ranelate so it should not be used without discussing it with your doctor.
Oral DHEA - DHEA is a hormone. Use of this supplement orally might increase levels of androgen and have a steroid effect, resulting in oily skin, acne, and unwanted, male-pattern hair growth in women. DHEA also might increase the risk of hormone-sensitive cancers, including breast and ovarian cancers. If you have any form of cancer or are at risk of cancer, don't use oral DHEA. Use of oral DHEA also might worsen psychiatric disorders and increase the risk of mania in people who have mood disorders. Note that use of prescription vaginal (not oral) DHEA has been shown to help with vaginal atrophy.
St. John's Wort - St. John's Wort is a flowering shrub native to Europe. It has anti-depression effects because it acts as a selective serotonin reuptake inhibitor (SSRI). But unlike prescription SSRIs, St. Johns Wort is unregulated and overdose could lead to serotonin syndrome. It also causes sun sensitivity and, with sunlight exposure, can contribution to cataract formation Additionally, the list of prescription drugs that interact with St. John's Wort is long, and the interactions can be life-threatening.
It is always better to get the nutrients you need from food, rather than a pill. Talk with your doctor to find out if you are missing any important vitamins or minerals and be aware that supplements have less regulation than FDA-approved drugs and can have dangerous side effects. Make sure your doctor is aware of your supplementation plan so that she can identify and monitor for any unintended consequences.
Disclaimer - Information on this website is provided for informational purposes only. The information is a result of years of practical experience and formal training by the author. This information is not intended as a substitute for the advice provided by your physician or other healthcare professional or any information contained in any product label or packaging. Do not use the information on this website for diagnosing or treating a health problem or disease, or prescribing medication, or other treatment. Always speak with your physician or other health care professional before taking any medication or nutritional, herbal, or homeopathic supplement, or using any treatment for a health problem. If you have or suspect that you have a medical problem, contact your healthcare provider promptly. Do not disregard professional medical advice or delay in seeking professional advice because of something you have read on this website. Information provided on this website and the use of any products or services mentioned on this website by you do not create a doctor-patient relationship between you and any of the physicians affiliated with this website. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.