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By Dr. Ellen Albertson, PhD, RDN, NBC-HWC
Perimenopause is the beginning of the menopausal transition. It can start in the mid-thirties and last between two to 10 years. Approximately 85% of women experience physical and emotional symptoms triggered by the changes in hormone levels associated with perimenopause.1
Fortunately, there are many things you can do to feel better and stay healthy, from exercising regularly and eating an anti-inflammatory diet to smart supplementation. Read on to learn about some of the best supplements for menopause that can provide natural perimenopause relief.
Perimenopause is the time leading up to menopause when the ovaries begin to shut down and hormone levels decline. While many people use the term “menopause” to refer to the season of life when you start to experience menopausal symptoms like hot flashes, menopause is defined as the point in time when you haven’t had a period for 12 consecutive months. Basically, your menses pause—which makes sense given that the term “menopause” comes from the Greek words pausis for pause and men for a month.
Approximately 46.5 million women worldwide and 1.3 million in the United States reach menopause each year. Most American women hit the menopause milestone between ages 45 and 56, with the mean being 51.
There is no definitive test to determine if you are in perimenopause. You can get a blood test to measure levels of follicle-stimulating hormone (FSH) and estradiol, a form of estrogen. An over-the-counter urine test is also available for FSH. However, since the levels of FSH and estrogen fluctuate widely with your menstrual cycle, it’s hard to determine for certain if you’re in perimenopause from the results.
Most women can self-diagnose perimenopause because of common symptoms and irregular periods. Others discuss symptoms with their doctors, which is why it is important to work with physicians who understand perimenopause and will listen to you.
Everyone experiences perimenopause differently. The most common symptoms are vasomotor, which is related to constriction or dilation of blood vessels. These include hot flashes and night sweats. According to the National Menopause Foundation, 75% of women experience hot flashes during menopause.2
Common symptoms of perimenopause include:3
As you transition through menopause, it’s important to know that as hormone levels decrease, the risk of heart disease, muscle loss, and bone loss increases. That’s because estrogen helps to protect muscles, bones, and the cardiovascular system.
Along with enjoying a healthy lifestyle, taking supplements for perimenopause can help naturally relieve symptoms and optimize well-being so you enjoy the next decades of your life.
Women lose an average of 1% of their bone mineral density each year after menopause.4 So it’s important to prevent bone loss starting in perimenopause. Consuming enough calcium, the most abundant mineral in the body can help maintain bone density and reduce the risk of osteoporosis and fractures.
Research shows supplementation can help preserve bone. A study of almost 1,500 postmenopausal women receiving 1,000 milligrams of calcium citrate supplements or a placebo daily showed that calcium supplements significantly benefited bone density.5
Calcium is also involved in muscle contraction, including contraction of the heart, which means it may help support cardiovascular health.6 A study of over 34,000 women suggests that consuming more calcium from diet, supplements, or a combination of diet and supplements is associated with a reduced risk of coronary heart disease mortality in postmenopausal women.7
After age 50, the RDA for calcium increases by 200 milligrams per day from 1,000 to 1,200 milligrams. Food sources include dairy products, fish with bones, such as canned sardines and salmon, tofu and soybeans, some green vegetables like kale and broccoli, and fortified foods.
As a supplement, calcium is available alone, in combination with vitamin D or other minerals like zinc and magnesium, and in multivitamin-mineral formulas. The two main forms of calcium supplements are calcium carbonate and calcium citrate. Calcium carbonate should be taken with food. Calcium citrate, which is found in over-the-counter antacids, can be taken with food or on an empty stomach. The body can only use a limited amount of calcium at a time, so it’s smart to split the dose and take some at night, which is the best time for bone resorption.
Magnesium is involved in numerous biochemical reactions and supports bone and heart health, hormone levels, and the nervous system. This essential mineral can help alleviate many perimenopausal symptoms and potential health issues, including:
Trouble sleeping? Magnesium may help regulate your circadian rhythms and helping you relax. One randomized clinical trial found that 500 milligrams of magnesium supplementation for eight weeks significantly improved sleep time and quality in older adults.8
Magnesium may also improve your mental health through its involvement in the stress response, mood regulation, and how the brain works. Several studies have linked low dietary intake and blood levels of magnesium with higher rates of depression.9
Estrogen reduces inflammation and lubricates the joints. So, as estrogen levels decrease during perimenopause, pain can increase. Researchers believe the decline in estrogen may cause inflammation by reducing the amount of magnesium in nerve cells. So, upping your intake of magnesium may help reduce pain. An animal study showed that magnesium supplementation prevented or reversed chronic pain, depression-like behaviors, and poor memory in female mice that were older or had no ovaries.10
Like calcium and vitamin D, magnesium is essential for bone health. It affects bone directly by impacting the formation of bone cells and indirectly by affecting the secretion of parathyroid hormone, which stimulates bone remodeling. Results from human and animal studies suggest magnesium deficiency contributes to osteoporosis.11
An estimated half of women don’t get the recommended 310 to 320 milligrams of magnesium daily. Foods rich in magnesium include nuts, seeds, and beans. Taking a magnesium supplement either on its own, in combination with other minerals like calcium, or as part of a multivitamin-mineral formula is an easy way to increase your intake.
There are four different forms of magnesium. This article can help you determine which form is best for you.
One of the most important vitamins for perimenopause is vitamin D. Like vitamins A, E, and K, vitamin D is a fat-soluble vitamin. Your skin makes vitamin D from sunlight, and you can also consume it in foods and as a supplement. An estimated half of women at midlife are deficient in vitamin D.12
Being deficient in vitamin D may increase the risk of having hot flashes. A study of 210 postmenopausal women concluded that decreases in vitamin D levels were significantly associated with hot flashes.13
Vitamin D is also important for bone health because it plays a key role in bone mineralization, influencing the amount of calcium and phosphorus the body absorbs and retains. A meta-analysis of a dozen randomized controlled trials concluded that taking about 500 to 800 International Units (IU) of vitamin D daily reduced hip and non-spine fractures by about 20% in people over 65.14
Getting enough D may also help reverse menopausal weight gain. A randomized controlled trial examining six weeks of vitamin D supplementation in younger overweight and obese women found a significant reduction in weight, waist circumference, and body mass index compared to controls.15
Vitamin D may also help increase muscle strength and mass. One study concluded that vitamin D deficiency increases the risk of losing muscle strength by 78%.16
Vitamin D supplements are available as ergocalciferol (vitamin D2), which comes from plants, and cholecalciferol (vitamin D3), which comes from animal foods. Research shows that D3 may be a better choice because it increases blood levels more and for longer than D2.17
The RDA for vitamin D for adults under 70 is 600 IUs. The safe upper tolerable limit for vitamin D is 2000 IU per day. Deficient women, which can be detected by a blood test, may need more. If you are concerned that you are deficient in vitamin D, talk with your doctor and get tested to determine the right dose.
Omega-3 fatty acids—omega-3s for short—are healthy fats that are a great natural supplement for perimenopause. They help all your body’s cells function properly and support mental health, the cardiovascular system, and the endocrine system.
The three main types of omega-3s are:
Women at midlife have the highest rate of depression for any group by age and gender, and omega-3s may help by improving brain structure. Research on postmenopausal women shows that high intakes of omega-3s are significantly associated with lower rates of depression.18
Taking omega-3s may also help reduce hot flashes. A study of 20 peri- and postmenopausal women with major depressive disorder related to the menopausal transition found that supplementing with 2 grams of omega-3 fatty acids for eight weeks reduced depressive symptoms and hot flashes with no adverse effects.
Omega-3s can support heart health by reducing blood pressure, triglyceride levels, and LDL “bad” cholesterol and increasing HDL “good” cholesterol. Omega-3 fatty acids may also alleviate other menopausal complaints, including joint pain, bone loss, menstrual cramps, and vaginal dryness. They are powerful at easing pain because they lower the production of prostaglandins, which cause inflammation.
Fish oil, a source of omega-3s, may also help you lose weight by curbing hunger and appetite, increasing metabolism, and reducing belly fat. A study of older women between the ages of 60 and 70 who took 3 grams of fish oil or a placebo daily for 12 weeks found that fish oil supplementation significantly increased resting metabolic rate by 14%, lowered triglyceride levels by 29%, and increased lean body mass by 4%.19
While there is no RDA established for omega-3 fatty acids, the FDA has set an adequate intake for adult women at 1.1 grams per day. The FDA has concluded that dietary supplements providing no more than 5 grams of EPA and DHA per day are safe when used as directed.20
In Far East Asia, women have much lower rates of menopausal symptoms like hot flashes. An estimated 10 to 20% of women from Far East Asia, where soy is a dietary staple, experience hot flashes.
Soy contains isoflavones, plant chemicals similar to estrogen produced by the body. On average, women in Far East Asia who eat soy regularly have about 12 times higher blood concentration of the isoflavone genistein than women in the United States.
One study of 100 perimenopausal and postmenopausal women showed statistically significant reductions in hot flashes, heart discomfort, joint and muscular discomfort, and sleep problems after 12 weeks of soy isoflavone supplementation. The results were stronger for the perimenopausal women.21
Additional studies have found soy isoflavones may also boost bone mineral density, reduce heart disease risk by lowering levels of LDL “bad” cholesterol, and alleviate osteoarthritis symptoms.
Fiber, the part of plant foods that we don’t digest, can help lower cholesterol levels, manage blood sugar, support a healthy body weight, control appetite, reduce depression, and help with hot flashes.
Constipation can become a problem during perimenopause because changes in hormone levels can slow down how quickly food moves through your gut. Fiber helps keep you regular.
Also, fiber is a prebiotic. Prebiotics feed the microorganisms in your gastrointestinal tract, creating a healthier microbiome (the ecosystem of microorganisms living in your digestive tract). This is important because estrogen plays a positive role in regulating the gut microbiome. When estrogen levels decrease, so does microorganism diversity. Eating more fiber can increase the number and types of bacteria, helping to keep your gut healthy.
As levels of sex hormones decrease, the body’s cells can become more insulin-resistant. As a result, women may experience blood sugar spikes, which can trigger hot flashes. Fiber slows down digestion, helping stabilize blood sugar and prevent hot flashes.
Surprisingly, fiber may also help reduce depression. A study of 3,054 premenopausal, midlife women found that dietary fiber intake was inversely associated with depressive symptoms—the more fiber women ate, the less likely they were to have symptoms of depression.22
There is a huge fiber gap! Only one in 20 people eat the recommended amount of fiber—25 grams for women and 38 for men. Foods high in fiber include beans, fruits, vegetables, whole grains, nuts, and seeds.
If your diet is low in fiber, a supplement can help you increase your intake. There is a wide variety of fiber supplements, including powders, gummies, and capsules. It’s smart to introduce fiber slowly so your body can get used to it, especially if you are experiencing gas or bloating.
Known as Peruvian ginseng, maca is a powerful superfood that’s high in many vitamins and minerals, including vitamin C, calcium, and iron. It has been used to improve health, energy levels, and mood for centuries. For perimenopausal women, maca may help improve cognition and reduce fatigue, low libido, and vaginal dryness.
A study of 20 women in early post-menopause found that taking 2 milligrams of maca root significantly increased estrogen and progesterone levels compared to controls. The women in the study also experienced substantially reduced feelings of discomfort associated with menopause.23 A systematic review looking at maca for treatment of menopausal symptoms also found favorable effects.24
Supplementing your diet with maca is easy. The superfood is available as a powder that can be added to smoothies or yogurt, as capsules, and as a tea.
Melatonin is a hormone that helps regulate the circadian sleep/wake cycle. It is also available as a safe supplement taken to improve sleep. Melatonin is secreted by the pineal gland at night when it gets dark. Like sex hormones, melatonin also decreases with age—especially during perimenopause.
A review of the impact of melatonin on the health of menopausal women found that doses of more than 3 milligrams improved common menopausal symptoms like hot flashes, insomnia, mood changes, muscle and joint pain, and sexual disorders. The same study found that women with sleep issues who took melatonin experienced better sleep quality.25
Melatonin may also positively affect bone density and strength. One study of perimenopausal women who took 3 milligrams of melatonin nightly for six months found melatonin supplementation was well-tolerated, improved perimenopause symptoms, and may help prevent bone loss.26
Black Cohosh is a popular women’s health supplement initially used medicinally by Native Americans. Made from a flowering plant native to North America, it may alleviate several perimenopausal symptoms, including hot flashes, anxiety, depression, and sexual dysfunction.
A randomized controlled trial of early postmenopausal women found that taking 6.5 milligrams of black cohosh root extract daily for eight weeks significantly improved menopausal symptoms compared to controls without reported side effects.27 An additional study on postmenopausal women with hot flashes found that black cohosh reduced the severity and number of hot flashes, improved quality of life, and was more effective than primrose oil, another commonly used supplement for perimenopause.28
The Spanish Menopause Society concluded that “black cohosh is an effective and safe treatment option for the relieving of vasomotor symptoms.”29
Black cohosh can be taken as a capsule, extract, or tea. It is also available blended with other ingredients like red clover, Saint John’s wort, and soy isoflavones. The most common dose for significantly reducing hot flashes is 40 milligrams daily.
Most women will experience symptoms triggered by hormone changes that occur during perimenopause. Taking supportive supplements during this time of transition can help you feel better, ease symptoms, and keep your bones strong and your body healthy.
While you can take individual supplements like calcium, vitamin D, magnesium, maca, melatonin, and black cohosh, many perimenopause-specific supplements include combinations of ingredients that work synergistically to help relieve menopause symptoms. From perimenopause formulas targeted at decreasing hot flashes to those aiming to improve sleep to general perimenopause-specific multivitamin-mineral formulas that include soy isoflavones, look for a supplement that includes the key components discussed above to support your wellness.
It's always wise to speak with your doctor or registered dietitian before starting new supplements for perimenopause to be sure they are right for you and won’t interact with any medications you are taking.
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