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Common Supplements

Supplements are often recommended for symptoms. Be wary. Most have little data on safety and whether they work.

It’s important to discuss any supplement you are considering with your health care provider in case its contraindicated with something else you are taking.

And please check out Supplements: Before you Buy for a quick overview on what can be mixed in with supplements and how the various forms differ. A quick guide to becoming a wise shopper!

Vitamin D

WHAT IT DOES

Vitamin D is not a direct fix for a specific symptom, but keeping vitamin D at adequate levels is important to many aspects of women’s health, so we cover it here.

Vitamin D is made by your body after exposure to sunlight. Vitamin D supports immune function and nerve and muscle health.

Bone health: Vitamin D is also essential for calcium absorption, which is critical for building bone. Here is where it ties into forty-ish women — until approximately age 30, a woman normally builds more bone than she loses. But after age 35, bone breakdown overtakes bone buildup, which causes a gradual loss of bone mass. Estrogen helps preserve calcium in the body and prevent bone breakdown. As a result, the declining levels of estrogen after the final menstrual period (i.e. menopause) contribute to bone loss. A 2010 study suggests that low progesterone levels, common in early perimenopause, also affect cells’ ability to repair bone. As part of the Study of Women Across the Nation (SWAN), researchers found that women with lower than 20 ng/mL of Vitamin D had a higher rate of nontraumatic fracture. An August 2019 study reported that subjects given high doses of Vitamin D (4000 IU per day or 10 000 IU) versus 400 IU/day over 3 years had lower bone mineral density so it could be that too much Vitamin D isn’t good. The 2024 Endocrine Society guideline acknowledges vitamin D’s role in bone health, particularly for building peak bone mass between ages 18-50.

Cardiovascular Disease: It was thought that Vitamin D played a possible role in preventing cardiovascular disease, which is known to increase in menopausal women. However the 2018 VITAL study — a study that looked at the effects of 2,000 IU)/day vitamin D3 supplements with or without 1,000 mg/day marine omega-3 fatty acids or a placebo in 25,000 adults, ages 50 and over for 5.3 years — did not prove this out.  

Cancer: Low vitamin D levels are seen in many autoimmune diseases, some cancers, and other chronic diseases, though it’s not established that low vitamin D causes this. VITAL didn’t find a reduction in cancer incidence (i.e., vitamin D didn’t prevent people from getting cancer), but updated analyses found a reduction in cancer mortality — meaning people who developed cancer while taking vitamin D were less likely to die from it. In the African American subgroup specifically, there was a 23% reduction in cancer incidence itself, though the study authors note this needs confirmation in further research.

Cognition: And another study found that women (ages 55-67) who had Vitamin D levels, greater than 25 nmol/L, had better executive function when tested 10 years later than those with levels below that. 

SOURCES

The sun is your best source, since your body makes vitamin D after exposure to sunlight — experts suggest 10 minutes per day. Careful sun protection is essential to prevent skin damage and cancer. Our bodies can absorb vitamin D from egg yolks, salmon, saltwater fish, and liver. Meanwhile, some foods are fortified with vitamin D (such as milk and some breakfast cereals), but it’s actually difficult to get adequate vitamin D only through diet, so here a supplement is a good option.

NOTES

Take Vitamin D with a meal to maximize absorption. Some products come in oil to maximize absorption.

SAFETY AND DOSAGE

Vitamin D toxicity is very rare. Most people supplement with 1,000 or 2,000 IU per day, and in this range vitamin D is safe. Toxicity actually comes from too much calcium because, as noted above, vitamin D increases calcium uptake, which in large amounts can lead to nausea or vomiting. This FAQ on vitamin D toxicity from the Mayo Clinic puts it into perspective: taking 50,000 international units (IU) a day of vitamin D for several months has been shown to cause toxicity. This level is many times higher than the Recommended Dietary Allowance for most adults of 600 IU of vitamin D a day. Sometimes physicians prescribe 50,000 IU tablets of Vitamin D to be taken weekly, but usually only for up to 3 months and only for people with significant vitamin D deficiency (levels under 20 ng/mL, for example).11

A note on testing and targets: for years, the standard advice was to aim for a blood level of 30-50 ng/mL. In 2024, the Endocrine Society updated its guidelines and stopped endorsing that specific target for the general population, citing a lack of randomized-trial evidence that hitting a number matters for people who aren’t already deficient. Not everyone in the field agrees with this shift, and some experts still recommend testing and aiming for the 30-50 range. If you’re unsure, it’s worth asking your provider what they recommend given your history, rather than assuming a single number applies to everyone.

Testing isn’t routinely recommended for otherwise-healthy adults under current guidelines, but if you have risk factors for deficiency (limited sun exposure, darker skin, obesity, malabsorption issues, or you’re over 75), it’s worth discussing testing with your provider.

EXPERTS, RESOURCES AND THINGS TO EXPLORE

B Vitamins

WHAT THEY DO

B vitamins as a group (B1, B2, B3, B5, B6, and B12) are often dubbed “the anti-stress vitamins” for their ability to combat anxiety, irritability, and poor memory. B vitamins are a major contributor to brain and cellular health, emotional well-being, conversion of food to energy, neurotransmitter production, and memory.

B vitamins are necessary for the conversion of tryptophan to melatonin, which is used to treat sleep disruption. They also help your adrenal glands produce hormones after your ovaries have stopped producing them.

Specifically, vitamin B6 (pyridoxine) is known to have positive effects on PMS.6 It helps make serotonin, a chemical responsible for transmitting brain signals. As we age, our serotonin levels decrease. These fluctuating serotonin levels may be a contributing factor in the mood swings and depression common in perimenopause and menopause.

Vitamin B12 is found in many foods and is an important component for bone and neurologic health. As we age, we lose some of our ability to absorb vitamin B12.

Since some of the most common perimenopausal symptoms include anxiety, irritability, and increased stress, it’s not surprising that we continue to see the recommendation for perimenopausal women to take a B complex supplement. However, most of the direct clinical trial evidence comes from studies on B6 and PMS in women of reproductive age, not from trials specifically designed around perimenopausal anxiety. Researchers haven’t extensively studied B complex as a treatment for perimenopausal mood symptoms in its own right. The recommendation carries over mainly because the biological mechanism — B6’s role in serotonin production — doesn’t change with age, so it’s a reasonable extrapolation, just not yet a directly tested one.

SOURCES

Generally, the following foods are good sources for B vitamins: beef, seafood, eggs, poultry, peas, asparagus, nuts, spinach, and sunflower seeds. This article does such a great job of detailing how to get specific B vitamins from food.

SAFETY AND DOSAGE

Vitamins are separated into two categories based on how they are absorbed and whether or not they are stored in the body. Along with vitamin C, the B vitamins are water-soluble. Water-soluble vitamins dissolve in water upon entering the body, and your body doesn’t store large excess amounts for later use — good, because you’re not accumulating them long-term, but it also means you need to be sure you’re getting enough through food and supplements.

One exception worth knowing: vitamin B6 does have a real upper limit. Chronic high-dose intake — generally in the range of hundreds of milligrams to grams per day, sustained over a year or more — can cause peripheral neuropathy (tingling, numbness, or unsteadiness in the hands and feet), and there are even case reports of neuropathy at doses under 10 mg/day in sensitive individuals. Regulatory upper limits vary by country and have been trending more conservative: the NIH sets 100 mg/day as the ceiling for adults, while European food safety regulators set theirs at around 12 mg/day. If you’re taking a B complex supplement, it’s worth checking the B6 dose on the label rather than assuming any amount is automatically safe. Symptoms typically improve after stopping supplementation, but it’s a good reason to use B6 at reasonable doses rather than mega-dosing.

EXPERTS, RESOURCES AND THINGS TO EXPLORE

Dr. Andrew Weil: Can any B vitamins be harmful?
Medline Plus on B vitamins
NIH Office of Dietary Supplements on vitamin B6

Magnesium

WHAT IT DOES

Magnesium is a mineral that enables cells to make energy, stabilizes cell membranes, and causes muscles to relax. It is responsible for over 600 enzymatic reactions throughout the body, primarily in bones, muscles, and the brain. Among many other things, magnesium helps bones remain strong, helps regulate blood glucose levels, and aids in the production of energy and protein.7

National surveys indicate that over half of US adults don’t get enough magnesium from their diet. It’s worth noting this reflects inadequate intake relative to the RDA, not necessarily a diagnosed clinical deficiency — but it does mean a meaningful share of people are running on the low side. Low magnesium has been linked to insomnia, heart palpitations, and leg cramps.

Magnesium has been shown to help with the perimenopausal symptoms of migraines and PMS, and newer research continues to back this up — a 2025 study looked specifically at magnesium intake and migraine frequency across pre- and post-menopausal women, and a 2024 study of nearly 700 patients found that magnesium paired with riboflavin meaningfully cut migraine frequency and pain intensity. When the body responds to stress, adrenaline is released, and its job is to move magnesium into the bloodstream to calm things down. If you are low in magnesium, the calm doesn’t come. So for people in chronic stress, it’s possible that magnesium is low.

SOURCES

Cooked spinach, black beans, pumpkin seeds, many nuts, avocados, salmon, and brown rice are all good sources of magnesium. You will often see dark chocolate listed as a source for magnesium, though we appreciated this article that put that recommendation into perspective. An Epsom salt bath is relaxing and soothing for sore muscles, though the evidence that meaningful amounts of magnesium actually pass through the skin from a bath is thin — it’s best thought of as a nice way to unwind, not a reliable magnesium source.

SAFETY AND DOSAGE

The RDA of magnesium for women is 320 milligrams (mg), while the daily value is 420 mg. There is an upper limit of 350 mg, but that is for the supplement portion of magnesium intake. Too much magnesium from food does not pose a health risk in healthy individuals, because the kidneys eliminate excess amounts in the urine.

NOTES

There are many formulations of magnesium. Magnesium oxide is the least expensive form but can have a laxative effect in some people. For some people, this is a benefit of magnesium! However, for those not in need of a laxative, magnesium chelate, magnesium malate, and magnesium glycinate are all formulated to avoid loose stools. Because magnesium can have a muscle-relaxing and calming effect, it’s a good supplement to take at bedtime — though it’s worth knowing the sleep research is still fairly early-stage: some small trials (especially with magnesium L-threonate and bisglycinate) show promise for sleep quality, but results across studies are inconsistent, so it’s reasonable to try it without expecting a guaranteed fix.

EXPERTS, RESOURCES, AND THINGS TO EXPLORE

NIH Office of Dietary Supplements on magnesium

Probiotics

WHAT IT DOES

As with vitamin D, probiotics don’t fix a specific perimenopausal symptom, but research increasingly links gut health to other aspects of health. Probiotics are strains of live bacteria and yeast that can help keep your gut microbiome healthy.

Many of the mood-related neurotransmitters we used to think of as sourced from the brain — serotonin, for example — are actually produced in large part in the gut. This connection, known as the gut-brain axis, has become an active area of perimenopause-specific research: a 2023 meta-analysis of nearly 40 studies found probiotics improved not just mood but a range of menopausal symptoms, including hot flashes, and Oxford researchers are currently running a trial looking specifically at how probiotics affect mood and cognition during perimenopause. It’s a promising area, but still an emerging one — researchers studying it note that more perimenopause-specific trials are needed before drawing firm conclusions.

SOURCES

Any fermented food is a probiotic: yogurt, sauerkraut, pickled vegetables, and kimchi are some examples. Kombucha, a popular beverage made from fermented tea, is also a probiotic. This article from Science-Based Medicine, a site written by MDs, takes on the question we’ve all been wondering about: can you get adequate amounts of probiotics from food or do you need a supplement?

NOTES

There are many opinions about how many and which probiotic strains are important, or the number of active live cultures. Many experts suggest that rotating brands of probiotics is important to keep introducing new strains to your system — though it’s worth noting this is more common wisdom among practitioners than a claim backed by clinical trials.

SAFETY AND DOSAGE

Unless you have a compromised immune system, probiotics are generally considered safe for the general population. This link to Consumer Lab answers the question: how many CFUs should you look for in a probiotic? There has been a recent explosion in the number of probiotic products marketed to consumers as having health benefits. And while there are demonstrated health benefits of some strains, particularly with respect to the effects of antibiotics, there are no studies supporting the use of many of the strains used. A recent article in JAMA outlines some of the potential risks and suggests more FDA involvement in manufacturing regulation and labeling.10

EXPERTS, RESOURCES AND THINGS TO EXPLORE

The National Center for Complementary and Integrative Health on probiotics
If you didn’t catch it above, we thought this article about getting probiotics from food was well-researched and worth reading
“Gut-Check.” an article from Science-Based Medicine, calls into question the hypothesis that probiotics work

Omega 3 & 6

WHAT IT DOES

What’s the deal with omega-3s and omega-6s? They are called the essential fatty acids. They are essential because we don’t make them in our bodies, but have to get them through food.

Isn’t one good and one bad? Which is which? It really confused us, too. Here’s the deal: we need both omega-3s and omega-6s. The American diet tends to be much higher in omega-6 than omega-3, which is why the advice to supplement with omega-3 is so common.

For a long time, omega-6 got a bad rap for supposedly driving inflammation, while omega-3 was framed as the anti-inflammatory one. That theory made sense on paper — omega-6 can convert into a compound involved in inflammatory signaling — but larger, more recent human studies haven’t backed it up. Multiple reviews of human trials, along with a 2024 analysis of over 250,000 people in the UK Biobank, found that higher blood levels of linoleic acid (the main omega-6 in vegetable oils) were associated with lower inflammation and lower risk of death from cardiovascular disease, cancer, and other causes, not higher. So there’s no need to actively avoid omega-6 — most people are already getting plenty of it, and the evidence doesn’t support that it’s working against you. Because of that, we focus here on how to get more omega-3s. Within omega-3s, there are three types: EPA, DHA, and ALA (see sources for each below).

Omega-3 and heart health has been debated for decades, and the evidence is genuinely mixed rather than settled. Some large recent studies find modest reductions in cardiovascular events with omega-3 supplementation, particularly with concentrated prescription forms or in people already at high cardiovascular risk. Other large trials and genetic studies find no benefit. This is one area of nutrition science that’s still actively being worked out.

As for perimenopausal relevance, omega-3 doesn’t have strong evidence for hot flashes specifically. A well-designed trial found no effect on hot flash frequency, severity, sleep, or mood compared to placebo, and a pooled analysis of multiple trials reached the same conclusion. There’s more promising (though still early) evidence for omega-3 helping with depressive symptoms during the menopause transition.

SOURCES

For EPA and DHA, eat 4 ounces of cold-water, fatty fish like herring, sardines, mackerel, salmon, halibut, tuna, or swordfish twice a week. Use this calculator to find fish lowest in mercury but high in omega-3s. For ALA, try more flax seed, hemp oil, and walnuts. Omega-6 doesn’t need to be sought out or avoided — it’s already abundant in vegetable oils and most processed foods.

NOTES

Make sure to choose a product made with small fish (like sardines and anchovies) to avoid the toxin accumulation that happens with bigger fish. Also, be sure to get the triglyceride form when possible — many products use the ethyl ester form, which is a concentrate that’s generally less well absorbed (studies show meaningfully higher blood omega-3 levels from triglyceride-form supplements at the same dose). The product should have both EPA and DHA. As with all supplements, choose a product that has been third-party tested and uses non-GMO ingredients.

SAFETY AND DOSAGE

Omega-3s can reduce blood clotting, so let your doctor know if you’re taking them, particularly if you’re also taking a blood-thinning medication. Similarly, if you’re scheduled for surgery, be sure to let your doctor know how much you’re taking.

Recent research has also identified a dose-dependent increased risk of atrial fibrillation (an irregular heart rhythm that raises stroke risk) with omega-3 supplementation, particularly at doses above roughly 1,500 mg/day combined EPA and DHA, and especially in people who already have cardiovascular risk factors. Lower doses in people without existing heart disease haven’t shown this signal as clearly. This isn’t a reason to avoid omega-3 altogether, but it’s worth not assuming more is automatically better, and worth mentioning to your doctor if you have any heart rhythm history.

The FDA recommends not exceeding 3,000 mg/day of EPA and DHA combined, with up to 2,000 mg/day of that coming from dietary supplements.

EXPERTS, RESOURCES, AND THINGS TO EXPLORE

From the Harvard School of Public Health: Omega-3 Fatty Acids: An Essential Contribution
NIH National Center for Complementary and Integrative Health on omega-3s, and a fact sheet for health professionals
Dr. Weil on balancing omega-3s and omega-6s
Women’s Health Network article on omega-3s
Recent (October 2019) research study: Omega 3s from marine sources reduce the risk of death from heart disease.

Melatonin

WHAT IT DOES

Most of us think of sleep support when we hear melatonin. Yet while melatonin, a hormone produced by both the pineal gland (in our brains) and our gut, is best known for sleep, it also plays a role in bone formation and acts as an antioxidant, anti-inflammatory, pain reliever, and antidepressant. It has even been shown to help with heartburn.

When it gets dark, the pineal gland secretes melatonin. As melatonin levels rise, our body temperature falls, causing us to feel sleepy. When it becomes light again, the blue light from the sun suppresses melatonin production. However, there is also blue light in our television, computer, and phone screens. So if we work inside and in front of screens and continue to use our screens up until bedtime, we are interfering with our natural sleep-wake cycles by suppressing the production of melatonin.

In addition, melatonin levels decline as we age.

SOURCES

There are a few foods that boost melatonin directly: bananas, sweet corn, ginger, tart cherries, figs, tomatoes, and oats.11 Other foods work on the melatonin pathway. Tryptophan, an essential amino acid, is a precursor to melatonin, and vitamin B6 helps convert tryptophan to melatonin. As a result, foods that are good sources of tryptophan (e.g. pumpkin seeds, roasted soybeans, many cheeses) and vitamin B6 (e.g. chickpeas, tuna, salmon) can help boost melatonin. There are also many melatonin supplements. Advisor to Women Living Better, Dr. Paula Witt-Enderby, who does research on melatonin and bone formation, recommends a close look before you buy — find a pure melatonin supplement rather than one combined with other nutrients.

SAFETY AND DOSAGE

While there are many supplements for melatonin, expert Dr. Paula-Witt Enderby (mentioned above in “Sources”) suggests working first to support the natural production of your own melatonin cycles. Here is how: Prioritize sleep. Work with your natural melatonin cycles by going to bed earlier. Try to be in bed around 10pm and if this is not achievable, then try to make incremental steps towards this goal over time. Any movement towards 10pm will be of benefit. Prepare for sleep. Establish a routine to settle the mind and body: (a) turn off extra lights around the house starting around 8pm; (b) minimize things that stimulate the mind like video games, television, talk radio, loud music; (c) turn on soft music or lessen the household “noise”; (d) try stretching poses to release endorphins in the body to begin to relax the body naturally; (e) Try just laying on the floor for 10 minutes – for many people this helps to settle the body. Manage light. Minimize light exposure during the night if there is ambient light in your bedroom by wearing an eye mask; minimize use of electronic devices at night; increase natural light exposure during the day by getting outside as much as you can. Food – what to eat. Add foods rich in melatonin like ginger, tart cherries, walnuts, bananas, sweet corn, figs, tomatoes, and oats. Food – when to eat. Aim to finish eating by 8pm. Drink. Minimize alcohol consumption as this can suppress melatonin levels and aggravate the nervous system.

If you are not feeling any benefit within a few weeks of trying the strategies listed above, you may want to incorporate a melatonin supplement into your daily nighttime routine. As with any supplement you should consult your physician first to see if there are any conditions or drugs that contraindicate its use for you. It’s always best to start low (~0.5-1mg melatonin). Research suggests that melatonin’s sleep benefits tend to plateau around 4mg per day — taking more than that doesn’t appear to help you sleep better, and it does raise your odds of side effects. So rather than continuing to increase your dose over time, it’s better to find the lowest dose that works for you and stay there. Studies have shown that melatonin gets taken up by the body in different amounts by different people. The key thing to remember is to take your melatonin supplement right before bed since you are trying to enhance your nighttime melatonin levels. Keep in mind three main possible side effects: vivid dreaming, daytime grogginess, and sedation. If you’re still experiencing any of those after two weeks, cut your dose in half.

A note on long-term use: melatonin is generally considered safe for short-term or occasional use. However, preliminary research presented at the American Heart Association’s 2025 Scientific Sessions raised a new question worth knowing about. In a five-year study of over 130,000 adults with insomnia, people who used melatonin long-term (12 months or more) had notably higher rates of heart failure, heart failure hospitalization, and death from any cause compared to matched non-users. This finding is important context, but it comes with real caveats: it’s a conference abstract that hasn’t yet been peer-reviewed, it’s observational (meaning it shows an association, not proof that melatonin causes these outcomes), and chronic insomnia itself may be part of what’s driving the risk. Still, if you’ve been taking melatonin nightly for many months or longer, it’s worth a conversation with your doctor about whether continued use makes sense for you, especially if you have any cardiovascular risk factors.

EXPERTS, RESOURCES AND THINGS TO EXPLORE

The National Center former Complementary and Integrative Health on melatonin
Dr. Paula Witt-Enderby writes about the potential of melatonin to manage a broader range of symptoms.
Cruz-Sanabria et al. (2024), “Optimizing the Time and Dose of Melatonin as a Sleep-Promoting Drug,” Journal of Pineal Research — https://doi.org/10.1111/jpi.12985
Du & Tan (2026), meta-analysis of melatonin on bone density, sleep, and mood in menopausal women, Frontiers in Nutrition — https://doi.org/10.3389/fnut.2026.1687221

Skrzelowski et al. (2025), “A Survey of Melatonin in Dietary Supplement Products Sold in the United States,” Drug Testing and Analysis — https://doi.org/10.1002/dta.3823

Nnadi et al., AHA 2025 Scientific Sessions abstract, “Effect of Long-term Melatonin Supplementation on Incidence of Heart Failure in Patients with Insomnia” — https://www.ahajournals.org/doi/10.1161/circ.152.suppl_3.4371606

AHA press release on the above study — https://newsroom.heart.org/news/long-term-use-of-melatonin-supplements-to-support-sleep-may-have-negative-health-effects

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REFERENCES