The Best Perimenopause Supplements: Vitamins & Minerals for Symptom Relief

best perimenopause supplements Sep 30, 2025

Vitamins and minerals can play an important supportive role in navigating perimenopause, though they are not a stand-alone solution. Nutrient demands shift during this transition, and research shows that certain micronutrients help buffer against bone loss, cardiovascular risk, and mood changes that accompany fluctuating estrogen and progesterone levels. In this blog post, I go over some of the best perimenopause supplements that we use at Naturopathic by Design™.

Vitamin D

Vitamin D is especially critical. Adequate levels support bone mineral density, calcium absorption, and muscle strength—protective factors against osteoporosis, which accelerates after estrogen declines. Low vitamin D status has also been linked with greater risk of depressive symptoms and anxiety in midlife women, possibly due to its influence on serotonin pathways and inflammatory modulation. Supplementation has been shown in randomized controlled trials to improve musculoskeletal health and may play a modest role in mood regulation when deficiency is present.

Calcium

Calcium remains a cornerstone nutrient for bone health. As estrogen declines, bone resorption outpaces bone formation, increasing the risk of osteoporosis. Adequate dietary calcium, combined with vitamin D to enhance absorption, is strongly associated with maintaining bone density and reducing fracture risk. While food is the preferred source, supplementation may be considered when intake is insufficient.

Magnesium

Magnesium supports over 300 enzymatic processes, many of which are relevant during perimenopause. It works synergistically with calcium and vitamin D to maintain bone strength and proper muscle contraction/relaxation. Beyond skeletal health, magnesium plays a role in nervous system regulation, sleep quality, and mood stability—areas commonly disrupted in midlife women. Studies also suggest that magnesium may help improve insulin sensitivity, an important factor as metabolic risk increases post-menopause.

Other Supportive Nutrients:

Other supportive nutrients include:
• Vitamin B12 and Folate: critical for red blood cell formation, methylation, and cognitive function. PMID: 38769717
• Vitamin K2: works in synergy with vitamin D to direct calcium into bones and away from arterial walls, protecting both skeletal and cardiovascular health.

Because nutritional gaps are common with aging-related changes in absorption and metabolism, a targeted supplement strategy can be a useful adjunct to diet. However, testing and individualized care are essential. Not every symptom is caused by nutrient deficiency, and over-supplementation carries risks.

When tailored appropriately, micronutrient support—including vitamin D, calcium, and magnesium—can help preserve bone strength, stabilize energy and mood, and contribute to long-term health resilience during the menopausal transition.

Hormone-Balancing Supplements

Current research indicates that Black Cohosh and Red Clover are safe but not reliably effective for relieving perimenopausal hot flashes or other symptoms. Red clover’s weak estrogenic effects do not translate into clear clinical benefits although some report it’s effectiveness clinically. Women considering these botanicals should be aware of the limited efficacy and consult healthcare providers for personalized advice.

On the other hand, Siberian Rhubarb (ERr 731) shows promising benefits for perimenopausal symptoms. Siberian rhubarb extract (ERr 731), derived from Rheum rhaponticum, is increasingly studied as a non-hormonal option for managing perimenopausal symptoms. Evidence suggests ERr 731 can significantly reduce menopausal complaints, especially vasomotor symptoms like hot flashes, with a favorable safety profile.

Omega-3 Fatty Acids

Omega-3 fatty acids, known as heart-healthy fats, are essential for cardiovascular health and managing perimenopausal symptoms. Studies indicate that omega-3 supplements can positively affect vasomotor symptoms like hot flashes and night sweats in menopausal women.

Beyond cardiovascular benefits, omega-3 fatty acids help maintain healthy blood sugar and lipid levels, promoting overall metabolic health. Incorporating sources of omega-3s, such as fish, seafood, flaxseeds, chia seeds, and walnuts, into your diet can provide these essential nutrients and support your body’s health during perimenopause.

Scientific evidence highlights the importance of omega-3 fatty acids in reducing brain fog, improving skin elasticity, and supporting heart health. These supplements are valuable for managing a range of perimenopausal symptoms.

Prebiotics, Probiotics, and Postbiotics

The gut microbiome is an often-overlooked regulator of hormone balance. Through the estrobolome—a collection of bacterial genes that influence estrogen metabolism—gut microbes directly affect circulating hormone levels. When dysbiosis occurs, excess β-glucuronidase activity can lead to the reabsorption of estrogen metabolites, contributing to symptoms like heavy bleeding, PMS, fibroids, and endometriosis flare-ups.

Prebiotics are nondigestible fibers (such as inulin, resistant starch, and fructooligosaccharides) that selectively feed beneficial gut bacteria. They enhance microbial diversity, promote short-chain fatty acid (SCFA) production, and reduce systemic inflammation—all of which positively influence insulin signaling, ovarian function, and immune tolerance.

Probiotics introduce live beneficial strains, particularly Lactobacillus and Bifidobacterium, which help maintain a healthy vaginal and intestinal ecosystem, lower inflammation, and improve barrier integrity. Certain strains (e.g., Lactobacillus rhamnosus GG, Bifidobacterium lactis) have been studied for reducing systemic inflammation and supporting metabolic regulation. The effectiveness of probiotics depends heavily on strain specificity and dose, underscoring the need for provider guidance. •

Postbiotics are the beneficial metabolites produced by microbes, including SCFAs like butyrate, acetate, and propionate. These compounds act as signaling molecules, strengthening the gut barrier, lowering inflammation, and even influencing appetite-regulating hormones (GLP-1, PYY). Butyrate, in particular, improves insulin sensitivity and modulates immune pathways that are often dysregulated in hormone-related conditions. Emerging supplements now deliver postbiotics directly, offering therapeutic benefits without requiring live organisms.

A comprehensive gut strategy often layers these approaches: feeding beneficial bacteria with prebiotics, seeding the system with targeted probiotics, and ensuring the downstream benefits of postbiotic production. When tailored appropriately, this triad supports estrogen metabolism, stabilizes blood sugar, enhances stress resilience, and creates the biochemical environment for hormone balance to take root.

Evening Primrose Oil

Evening Primrose Oil is another beneficial supplement, containing gamma-linolenic acid (GLA) with anti-inflammatory properties that can help relieve breast pain and other psychological symptoms.

Flaxseed

Additionally, research shows that daily flaxseed supplementation (typically 10–40g) for 2–3 months can significantly reduce the severity of perimenopausal symptoms—including hot flashes, sleep disturbances, and fatigue—compared to placebo.

Adaptogens

Adaptogens, natural substances that help the body adapt to stress and restore balance, can be valuable. Ashwagandha, for example, is known for reducing stress and enhancing mood during menopause. Consulting your doctor before adding ashwagandha to your routine ensures it is safe and appropriate.

Rhodiola rosea is another potent adaptogen that may alleviate both physical and mental fatigue. These adaptogens can be valuable additions to your perimenopause supplements, promoting relaxation and reducing stress and fatigue.

Choosing the Right Supplement

Finding the best supplements for perimenopause is not one-size-fits-all. The right choice depends on your health history, current symptoms, and any medications you may be taking. That’s why it’s essential to partner with a qualified healthcare provider who can help you tailor a safe, effective plan. Evidence supports certain natural supplements for perimenopause—including black cohosh, red clover, ginseng, vitamin D, calcium, magnesium, and omega-3 fatty acids—for easing common symptoms like hot flashes, mood swings, sleep disturbances, and bone loss.

Always choose third-party tested supplements to ensure purity and safety. This extra step helps confirm you’re getting exactly what’s on the label—and nothing harmful.

Integrating Supplements with Lifestyle Changes

Supplements work best when paired with intentional lifestyle shifts. A nutrient-dense diet, regular movement, and stress management strategies create the foundation for balance during this transition.

• Movement: Exercise enhances nutrient absorption, supports bone density, and improves mood.

• Nutrition: A balanced diet rich in whole foods, fiber, and protein works synergistically with supplements to stabilize blood sugar and support hormone health.

• Stress & Sleep: Practices like yoga, meditation, and circadian rhythm care amplify the benefits of natural supplements and improve resilience. This integrative approach helps you not only manage symptoms but also strengthen your long-term health.

Summary

Perimenopause is a time of profound change—but with the right support, it doesn’t have to be depleting. Essential vitamins, omega-3 fatty acids, probiotics, herbal remedies, and adaptogens each play a role in easing symptoms and promoting vitality.

By combining carefully selected perimenopause supplements with lifestyle practices that nourish your body and mind, you can move through this transition with greater confidence, balance, and energy. The takeaway? Informed choices today set you up for strength and well-being in the decades ahead.

Your body deserves more than a one-size-fits-all supplement plan. At Naturopathic by Design™, our Signature Offering brings together naturopathic physicians, registered nurses, and functional nutritionists to uncover the root of your symptoms and design a plan tailored to your unique needs. From targeted lab testing to integrative strategies that go far beyond supplements, we’re here to help you restore balance, energy, and resilience. Book your free 15-minute Discovery Call today and discover what’s possible when you have a whole team behind you.