Magnesium (glycinate or citrate)
Sleepanxietymuscle crampsmigraine
Modest; stronger if you're low
Menopause & Perimenopause Guide to Supplements
Most supplements sold for perimenopause and menopause have little evidence behind them. A few have modest evidence for specific symptoms: magnesium for sleep and anxiety, vitamin D and calcium for bone, omega-3 for mood, creatine for muscle, and black cohosh or soy for hot flashes in some women.
Evidence, supplement by supplement.
Evidence shelfVitamin D + calcium
Bone densityfracture prevention
Good for deficiency and bone
Omega-3 (EPA/DHA)
Low mooddry eyesjoint comfort
Modest for mood; not for hot flashes
Creatine
Muscle and strength with resistance training
Good in midlife women who lift
Black cohosh
Hot flashes
Mixed; helps some women modestly
Soy isoflavones
Hot flashes
Small effect in some women
L-theanine
Acute anxietyfalling asleep
Modest
Vitamin B6
PMS-type mood symptoms
Modest
Six things worth knowing.
- Modest trials support magnesium for sleep quality, anxiety and cramps, and it may be a reasonable first step for 3 a.m. waking.
- Vitamin D and adequate calcium (mostly from food) are the one supplement combination with guideline backing, dosed by your blood level.
- Recent trials in midlife and older women show that creatine helps preserve muscle and strength when paired with resistance training.
- There is no evidence that L-theanine raises or lowers estrogen or any other hormone, so it won't change hormone test results or interfere with hormone therapy.
- A supplement may take the edge off a symptom. It cannot replace the hormones that perimenopause removes.
- If a supplement is recommended, it is optional and available at member pricing through Fullscript, close to cost.
The short list: supplements with evidence
A supplement may take the edge off a symptom.
| Supplement | What it may help | Evidence | Notes |
|---|---|---|---|
| Magnesium (glycinate or citrate) | Sleep, anxiety, muscle cramps, migraine | Modest; stronger if you're low | Oxide form is poorly absorbed; citrate loosens stools |
| Vitamin D + calcium | Bone density, fracture prevention | Good for deficiency and bone | Dose by blood level; calcium mostly from food |
| Omega-3 (EPA/DHA) | Low mood, dry eyes, joint comfort | Modest for mood; not for hot flashes | Fish or algae oil |
| Creatine | Muscle and strength with resistance training | Good in midlife women who lift | 3–5 g daily; a sports supplement, not a hormone |
| Black cohosh | Hot flashes | Mixed; helps some women modestly | Rare liver reports; tell your provider |
| Soy isoflavones | Hot flashes | Small effect in some women | Food sources count |
| L-theanine | Acute anxiety, falling asleep | Modest | Does not affect estrogen |
| Vitamin B6 | PMS-type mood symptoms | Modest | Keep under 100 mg/day; nerve damage at high doses |
It cannot replace the hormones that perimenopause removes, and when hormone therapy is the right treatment, no supplement stack substitutes for it.
Five supplements in more detail.
Magnesium
Glycinate
One of the most useful supplements on this list for many women. Magnesium is involved in muscle relaxation, nerve signalling and sleep, and intake is often low. Modest trials support it for sleep quality, anxiety and cramps, and it may be a reasonable first step for 3 a.m. waking. Choose glycinate (gentlest) or citrate (helps constipation); skip oxide, which is poorly absorbed. Food sources include pumpkin seeds, leafy greens, black beans, almonds and dark chocolate.
Vitamin B6
Under 100 mg
B6 has modest evidence for the mood and bloating symptoms of PMS, which can resurface in perimenopause as cycles become erratic. It does not raise progesterone or "detox" estrogen, despite what you may read. Stay under 100 mg a day; higher doses over time can cause nerve damage.
Vitamin D, calcium and bone
By blood level
Estrogen protects bone, and bone loss speeds up in the years around menopause. Vitamin D and adequate calcium (mostly from food) are the one supplement combination with guideline backing, dosed by your blood level. Resistance training does as much as any pill.
Omega-3
EPA + DHA
Fish or algae oil has modest evidence for low mood and for dry eyes and joints. It does not reduce hot flashes.
Creatine
3–5 g
Recent trials in midlife and older women show that creatine helps preserve muscle and strength when paired with resistance training. Muscle supports metabolism, blood sugar and bone after menopause. Take 3–5 g a day; it is not a hormone and does not cause weight gain beyond a little water in muscle.
Does L-theanine increase estrogen?
No.
L-theanine is an amino acid from green tea with a mild calming effect; it is used for anxiety and falling asleep.
There is no evidence that it raises or lowers estrogen or any other hormone, so it won't change hormone test results or interfere with hormone therapy.
Supplements for perimenopause anxiety
Anxiety in perimenopause usually comes from swinging estrogen and falling progesterone, and sometimes from cortisol, thyroid or blood sugar.
Supplements with modest evidence for the anxiety itself are magnesium glycinate, L-theanine and, for stress, ashwagandha.
They may work better alongside the basics:
- regular meals,
- caffeine before noon only,
- less alcohol, and
- treating night sweats so sleep improves.
When anxiety tracks with hormone swings, steadying the swing, sometimes with hormone therapy, may help more than a supplement.
Our guides to hormones and anxiety and estrogen and anxiety explain how to tell which is which.
Adaptogens
Adaptogens are herbs marketed for stress resilience.
Ashwagandha
Ashwagandha has modest trial evidence for stress and sleep, with cautions for thyroid conditions and rare liver reports.
Rhodiola
Rhodiola has small studies for fatigue.
Maca
Maca is popular for libido and hot flashes; the trials are small and it does not act on estrogen.
Holy basil, lemon balm and skullcap
Holy basil, lemon balm and skullcap are pleasant as teas and have little clinical evidence for menopause.
Medicinal mushrooms
Medicinal mushrooms (reishi, lion's mane, cordyceps) are widely sold and poorly studied for this purpose.
None of them is dangerous at normal doses, and none of them is a treatment.
What to be careful with
St. John's wort
St. John's wort interacts with antidepressants, contraceptives, some hormone products and blood thinners. Don't start it without telling your prescriber.
Kava
Kava carries a liver warning.
High-dose B6
High-dose B6 causes nerve damage over time.
Black cohosh and ashwagandha
Black cohosh and ashwagandha: rare liver reports; stop and call if you notice yellowing skin or dark urine.
"Hormone balancing" blends
"Hormone balancing" blends: often undisclosed doses of several herbs. Prefer single ingredients so you know what did what.
Bring your full list, including herbal products, to your first visit.
Supplements are optional here
At Golden Leaf Health, supplements are optional and only a supporting treatment.
Golden Leaf Health's care team may suggest a supplement for a specific symptom, and may not.
If one is recommended, it is optional and available at member pricing through Fullscript, close to cost.
The treatment plan is built on your visit, your symptoms and, where needed, labs and prescriptions; supplements sit beside it, never in front of it.
Book a first visit if you'd like your whole picture looked at.
Talk.
A one-on-one video visit about your symptoms, your history and what you want to feel like again. Your first visit is $99, refunded if you cancel at least 24 hours ahead.
Test.
If your provider thinks it will help, a hormone blood panel adds lab results to what you’ve told them. Not everyone needs this step.
Treat.
If treatment is right for you, your plan can include hormone prescriptions, non-hormonal options, lifestyle changes and optional supplements. Then two to three follow-up visits with a doctor and text check-ins through HIPAA-compliant messaging, included in membership at $49 a month, which begins one month after your first visit. Prescriptions and labs are priced separately.
Questions, answered plainly.
What are the best supplements for perimenopause?
The best-supported options are magnesium for sleep, anxiety and cramps; vitamin D with calcium for bone; omega-3 for mood; and creatine with strength training for muscle. For hot flashes, black cohosh and soy isoflavones have mixed, modest results. Most other supplements sold for perimenopause have little evidence. None replaces hormone therapy when it is the right treatment.
Does L-theanine increase estrogen?
There is no evidence that L-theanine raises or lowers estrogen. It is an amino acid from tea with a modest calming effect, so it is used for anxiety and sleep.
What supplements help with perimenopause anxiety?
Magnesium glycinate and L-theanine have modest evidence; ashwagandha has some for stress. They may work best alongside changes to sleep, blood sugar and alcohol use. If anxiety tracks with hormone swings, treating the swing may help more than a supplement.
Do I need supplements to treat menopause?
No. Hormone therapy, non-hormonal prescriptions, and lifestyle changes carry the evidence. At Golden Leaf Health supplements are optional, chosen by symptom if your provider thinks one will help, and sold at member pricing through Fullscript.
Which supplements should I avoid with hormone therapy?
St. John's wort interacts with many medications, including some hormone products and antidepressants. Kava carries a liver warning. High-dose vitamin B6 can cause nerve damage. Tell your provider everything you take, including herbal products.
Supplements, prescriptions or both.
A video visit with a clinician who treats perimenopause and menopause, in 33 states.
