The Role of Supplements in Menopause: What to Take, What to Skip
Visit any health food store in your menopause years and it is like the supplement section was made just to cater to you. They have products that will balance your hormones, calm your hot flushes, make you feel good, keep your bones healthy, and make your skin younger, all in one capsule, twice a day.
The menopause supplement business is massive and expanding. And although part of what it has to say is actually helpful, much of it is actually trading on the anxiety and exhaustion of the menopause transition rather than hard evidence.
This post gives a clear, straight forward overview of the most popular supplements that are discussed in the context of menopause, what they actually do, what the evidence tells us, and where you would be much better saving your money and energy than on something that actually works.
The supplements may compensate real nutritional deficiencies. Others may assist in certain organs of the body especially where a deficiency is present. Only a few have small data on symptom-relief.
The hormonal changes of menopause cannot be substituted by supplements and cannot serve as an alternative to medical treatment in case of serious symptoms. It is only better to consider them as the supporting actors, rather than the star of the show.
Another significant safety consideration that does not receive the attention it deserves is that supplements are not necessarily safe due to the fact that they were sold in a health food store and not in a pharmacy. There are those that react with prescription drugs in a hazardous manner. Others have the potential to be dangerous at high doses. Never forget to inform your GP and pharmacist of what you are taking including those which you purchase over the counter.
Vitamin D deficiency is quite shocking in Australia despite the level of sunshine the country gets. This is partly due to the fact that the amount of sun exposure needed to synthesize vitamin D is not about the total amount of time spent in the out-of-doors environment but rather about the angle at which the sun is located, the time of the year, and the presence of clouds as well as the use of sunscreen. The winter months in the south especially can make very little vitamin D even to individuals who go out regularly.
Vitamin D is required in absorption of calcium thus its direct connection with bone health. The body is unable to use calcium effectively without sufficient vitamin D no matter the amount taken. This coupleing is more crucial than ever before in life and after menopause when bone loss is growing at a faster rate.
Vitamin D also has a wider role in immune, muscle strength and there is an increasing evidence that it is involved in mood regulation. Lack has been linked to heightened chances of depression, heart disease and impaired thinking.
The empirical advice to the majority of postmenopausal women is to get your vitamin D level checked via a simple blood test, and to supplement in case it is low. When it comes to supplementing, it is worthwhile to be guided by a blood test to determine the precise amount of a particular nutrient required and not by guesswork.
The predominant mineral in the bone is calcium, which the postmenopausal women require as compared to younger women. Healthy Bones Australia recommends 1,300 mg per day to women aged above 50. It is a significant portion, which is approximately three to four portions of dairy per day.
This is the clue that most women are not informed; that the best way to achieve calcium intake is to do so using food wherever it is possible, and supplements should only be used to cover an actual deficiency, rather than as a kind of top-up on an already calcium-fortified diet.
The importance of this is because high dose calcium supplements contain a controversial but actual cardiovascular warning. Various studies, one being a re-analysis of Women Health Initiative data, have reported such associations between high dose calcium supplementation and increased cardiovascular events in certain groups. This is not the case with food calcium.
The latest recommendation of the Australasian Menopause Society is that in case of inadequate dietary calcium, 500 to 600 mg of calcium supplements should be taken daily. Not 1,000 to 1,200 mg over an already dairy-containing diet. The supplement is not a replacement of the food calcium that is already present but is a supplement to fill the gap.
In case you are not aware of the amount of calcium that you are now receiving in your diet, a few days of online food diary will give you a fair idea. The primary sources of diet are dairy products, fortified plant milks, tinned fish with bones, and leafy greens.
In the body, magnesium participates in more than 300 biochemical reactions, some of which are nerve signalling, muscle relaxation, blood sugar regulation, and serotonin production. It is also a supporting structure of the bone together with calcium.
It is not a secret that many women lose magnesium in the process of perimenopause transition, and it is partly due to the fact that stress, disturbed sleep patterns, and changing hormones all put additional strain on the body in question. Contemporary farming methods have also left the food magnesium content lower than it used to be in the past decades implying that diet is usually not sufficient.
There is limited evidence as to magnesium as a specific reduction of hot flushes. A single small clinical trial showed some effectiveness, but the findings were not always consistent. What has far greater support is that magnesium can improve the quality of sleep, decrease anxiety and muscle tension, and mood, which are all applicable in the menopause transition.
The most commonly regarded form is magnesium glycinate, which is the easiest to absorb and most frequently tolerated, especially when it comes to sleep and nerve system support. The most common and the most inexpensive type of magnesium in supplements is magnesium oxide, which is the least absorbed and most probable to cause digestive discomfort. The shape really counts in this case.
The evidence base of cardiovascular health of omega-3 fatty acids, specifically the forms in oily fish (EPA and DHA), is strong. Heart Foundation of Australia suggests fish oils as part of an adult diet to lower the risk of coronary heart disease, which is more of an urgent issue after menopause because the protective effect of oestrogen on blood vessels reduces.
The omega-3 specifically in reducing hot flushes is inconsistent. In a systematic review, there was no significant difference in the frequency or severity of flushes in omega-3 and placebo. But this is a case where the benefit of taking it does not depend on the hot flush question. Still, it maintains the health of the heart, aids in inflammation, and is part of the brain activity, as well as might alleviate mood and pain in the joints that many women experience throughout the transition.
Consumption of oily fish two or three times a week is better than supplements in providing EPA and DHA. A good-quality fish oil or an omega-3 supplement made of algae is a decent replacement in women who do not consume fish regularly. Reading labels, consider the actual EPA and DHA contents instead of the total omega-3, which are the active ingredients.
Vitamin B12 is needed in nerve functioning, energy metabolism, blood cell production and brain health. The absorption of B12 in food by the body decreases slowly with age, hence deficiency is more prevalent in women above the age of 50. Female vegetarians or vegans have a significantly greater risk because B12 is virtually present only in animal food.
Deficiency of B12 may lead to fatigue, brain fog, and low mood, which are very similar to the menopause symptoms. This renders it truly worth investigating since a deficiency can enhance cognitive and energy symptoms of menopause in a manner that can be cured completely.
B12 levels can be easily checked with the help of a blood test, which is available through a GP. Where necessary, supplementation is cheap and efficient. In women with diverse diet, which contains animal products, deficiency is less prevalent yet still possible especially when stomach acid is diminished by drugs or aging effects.
Collagen is the structural protein that provides the skin with its elasticity, the joints with their cushioning, and bones with a portion of their strength. The natural production of collagen in the body decreases between approximately the middle of the 30s, and the reduction in oestrogen at menopause hastens the disappearance. This leads to the skin becoming thin, more wrinkled, the joints sore and some of the bone fragility experienced postmenopause.
Supplements of hydrolysed collagen (especially those with specific peptide fragments (small collagen fragments)) have an accumulating body of evidence. Research on individual collagen preparations has indicated improvement in skin elasticity and hydration and certain bone density parameters in postmenopausal women.
The caveat of great importance is the quality and specificity. Not every collagen supplement is identical and the evidence shows that certain formulations are better than generic collagen powder. Find products with some supporting evidence on the use of hydrolysed collagen peptides and not a generic bulk powder. Collagen production needs vitamin C and therefore supplementing collagen with vitamin C enhances their efficacy.
It has been discovered that the gut microbiome, the assembly of bacteria residing in the digestive tract, is involved in the mechanism of oestrogen processing and recycling in the body. This means that the menopausal transition can alter the gut microbiome composition in a manner that influences hormone metabolism, immune response and even the mood.
Probiotic supplements possess small evidence of lessening bloating, boosting digestive health, and possibly some inflammatory markers of menopause. It is a dynamic field of study, and the data is not as solid as to draw a particular suggestion. However, a good quality multi-strain probiotic is a low-risk option that is worth considering in women who are already having these digestive symptoms in addition to menopause.
Ashwagandha, or Withania, gained great popularity as an adaptogen purported to decrease stress, enhance sleep and aid hormonal balance. In 2024, the Therapeutic Goods Administration (TGA) of Australia posted a safety notification relating to products containing Withania somnifera due to severe gastrointestinal symptoms and liver damage in users, some of whom were hospitalised.
The TGA recommends that medicines or herbal supplements containing Withania somnifera should not be used in patients with or who had a previous liver condition. With this new alert by the Australian own medicines regulator, it should be avoided until the safety picture is clearer, despite its popularity in being marketed as widely as possible.
The hormone, DHEA is a precursor to hormones produced by the adrenal glands, which then transforms into oestrogen and testosterone. The levels decrease with age. There have been some small studies that have demonstrated an advantage to libido and a few menopause symptoms, but the evidence is not consistent and mixed. Long-term safety of DHEA supplementation is unproven and the possible impact on hormone sensitive conditions is a cause of concern. This one is squarely in the low enough good evidence, might be risky category.
Vitamin E is occasionally sold to hot flushes. The clinical trial evidence is not impressive. Two small trials reported that high dosage vitamin E (400 to 800 IU per day) had a lowering effect of one hot flush daily than placebo. That is an incidental advantage. Vitamin E may also raise the risk of bleeding and interact with anti-clotting drugs at the high dosage used to achieve this effect. The cost to benefit analysis is not favourable to routine supplementation of menopause symptoms.
As stated earlier in the calcium section above, it is not advisable to take high-dose calcium supplements over a diet with significant amounts of dairy or calcium-rich foods. The evidence on the fracture-reduction value of calcium supplementation is small and weak, and an unexplained message of cardiovascular hazard at higher dosage is not clarified. Observe food sources of calcium. Fill only the actual nutritional deficiency, and maintain supplemental doses at 500-600mg per day instead of increasing supplements up to 1,000 to 1,500mg or higher.
The supplement industry is crowded with products that are being sold as the all-in-one menopause formula; they are products that are made up of various herbs, vitamins, and minerals in one capsule. The advertising is self-evident: a single product, which is allegedly all-encompassing. The issue is that such combinations usually have inadequate quantities of each ingredient to create the impact that isolated studies were conducted to determine some benefit. They also cannot be judged critically as the proprietary blends almost always do not indicate precise dosages. They are likely to be costly in comparison with their real content and are not supported by independent clinical research on the particular combination utilized.
Instead of trying to make a decision about all the supplements simultaneously, it is best to answer a few questions:
Supplements do not substitute good medical attention, a healthy diet, physical activity, or, in some cases, hormone replacement. However, some of them are worthwhile in helping to meet the special nutritional requirements of the postmenopausal years: vitamin D, food-based calcium up to 1,300 mg per day, magnesium, omega-3 fatty acids, and B12 in those at risk of deficiency.
The remainder of the supplement aisle should be looked at with healthy scepticism. It does not imply that all of it has no value. It implies that the onus of the burden of proof should be on the product to prove evidence, not on you to refute the marketing.
Begin with what you really need, according to a blood test and a straightforward examination of what you are eating. Fill genuine gaps. With something that has a safety concern, be careful. And make your physician know what you are taking.