Perimenopause supplements: A Full-Guide to Relieving Perimenopause Symptoms

Perimenopause can feel like a whirlwind—a little hot, a little moody, and extremely confusing. Women navigating this transitional phase often wonder if there is a magic pill to make it all better. 

Opt Health’s process starts the same way whether you are just noticing your first changes or are further into the transition. 

Although we can’t promise a one-size-fits-all cure, the right supplements can be a game-changer for alleviating hot flashes, night sweats, mood swings, fatigue, and other unpleasant symptoms. 

Today, we will delve into the best supplements for perimenopause. But let’s face it: hormones are complicated, and supplements can only do so much on their own. Therefore, we will also share tips on finding high-quality options and creating a holistic plan that works. 

• Supplements like black cohosh, red clover, maca, vitex, soy, and calcium might help to alleviate hot flashes, mood swings, and bone loss. However, the scientific evidence on their efficacy is often mixed. 
• Focus on quality by choosing products from reputable brands, verified by third-party certifications, and transparent labeling. Always reach out to a trusted healthcare provider for any questions about the safety and effectiveness of any new supplement.
• Supplements alone aren’t the solution. It’s best to combine a strategic supplementation plan with a balanced diet, regular exercise, a healthy sleep regimen, and stress management techniques.

Seven Signs of Perimenopause

Irregular periods, hot flashes, night sweats, mood changes, sleep problems, vaginal dryness, and decreased fertility are the seven classic signs doctors look for to identify perimenopause. These changes reflect natural shifts in estrogen and progesterone production that often begin several years before periods end.

• Irregular periods
• Hot flashes
• Night sweats
• Mood changes
• Sleep problems
• Vaginal dryness
• Decreased fertility

Spotting these signs early lets you match specific symptoms to the targeted supplement and lifestyle approaches covered below. Partnering with an Opt Health physician to evaluate your baseline blood biomarkers ensures your supplement plan directly addresses what your body needs.

9 Supplements for Perimenopause 

Looking for effective ways to alleviate unpleasant symptoms? Here is a list of the best supplements for perimenopause.

Calcium

As estrogen levels begin to drop, your bones may become more porous and fragile. Consuming enough calcium can help maintain your bone health throughout perimenopause. Although it’s best to obtain calcium through a balanced diet, supplements can help fill the nutritional gaps. For menopausal women, the recommended calcium intake is between 1,000 and 1,200 milligrams per day.¹

Vitamin D

Often asked about for: bone health, mood.

While discussing perimenopause supplements for bone health, let’s not forget about vitamin D. The “sunshine vitamin” is essential for calcium metabolism in the body. Vitamin D synthesis starts in the skin through sunlight exposure and continues in other organs and tissues until the active form is produced, 1,25-dihydroxyvitamin D3 [1,25(OH)2D3]. Deficiencies are common, but diet and supplements can fill in the nutritional gaps.¹ Not only can vitamin D help strengthen your bones, but it might also alleviate mood swings and depressive symptoms. 

DHEA

DHEA (dehydroepiandrosterone) is a steroid hormone used to produce estrogen or testosterone. In theory, supplementing DHEA can help balance your hormones during perimenopause. Some studies have found DHEA to help with vasomotor symptoms such as hot flashes and night sweats, reduce bone loss, increase muscle mass, and even support the immune system during perimenopause.² When administered intravaginally, DHEA appears to help with dryness.^2,3 However, long-term use of DHEA might carry some risks.³

Black cohosh

Black cohosh is one of the best natural supplements for perimenopause. The extract comes from the root of the North American black cohosh plant. Several studies have found it to help balance out hormones and reduce hot flashes and night sweats.⁴

Soy 

You might be wondering—how did soy make it to the list of perimenopause supplements? It contains phytoestrogens, which are plant-based compounds with estrogen-like effects. Some research indicates soy might help with vasomotor symptoms and reduce the risk of cardiovascular disease and various types of cancer.⁵ 

Red clover

Red clover is another herbal supplement that contains isoflavones, molecules that mimic the effects of estrogen in the body. According to a recent review study, red clover supplementation might prevent hot flashes, support heart health, and reduce the risk of various types of cancer.⁶ However, the evidence is mixed.

Wild yam

Wild yam is a herbal remedy used to alleviate hormonal imbalances in perimenopausal women. Some proponents suggest it can even be used as a substitute for hormone replacement therapy (HRT). Some research shows it might protect against bone mass loss and various types of cancer.⁷ Although it has minimal side effects, there is limited scientific evidence to support its efficacy.⁸

Ginseng

Often asked about for: mood, sleep.

Ginseng is a traditional medicine known for its beneficial effect on stress relief and energy levels. It's also used to support immune health, mental clarity, and overall well-being. During perimenopause, ginseng may help with fatigue, mood swings, libido, and sleep disturbances, though more research is needed to confirm its effectiveness.⁹

Dong Quai

Often asked about for: mood.

A traditional Chinese medicine, dong quai, has a long history of helping women with various reproductive health conditions.¹⁰ Also known as “female ginseng”, dong quai might help with hot flashes and mood swings, but more research is needed to support its efficacy.¹¹

Vitex

Often asked about for: mood.

Vitex agnus castus, also known as chasteberry, is a popular herbal remedy in women's reproductive health. It has been shown to be effective for mild premenstrual symptoms and may also have a role in treating premenstrual dysphoric disorder (PMDD).¹² However, the evidence regarding its effectiveness in perimenopausal women is mixed.¹³ 

The therapeutic effect of vitex may result from its indirect influence on various hormones, particularly prolactin and progesterone. These hormonal effects seem to be dose-dependent; low doses have been shown to decrease estrogen while increasing progesterone and prolactin levels.¹⁴ 

Maca

Maca root, also known as Peruvian ginseng, is a plant native to the Andes. It has been traditionally used as both a food and a natural remedy to enhance libido and fertility in both men and women. Maca may be helpful for alleviating perimenopausal symptoms by influencing hormone levels.14 However, the evidence is limited and further research is needed to confirm its efficacy and safety for this use.15,16 

Finding Quality Supplements 

Opt Health also runs bloodwork before recommending a treatment plan. See how it works. 

Choosing your supplements wisely is essential for maximizing their health benefits. Here are a few tips on how to select high-quality options: 

• Choose reputable brands. 
• Look for third-party testing and certifications. 
• Check the label to see the complete ingredient list (pay attention to artificial additives, sugar, or other unnecessary ingredients). 
• Be wary of products with exaggerated claims.
• Side effects vary by supplement. DHEA carries some long-term risks, and evidence for wild yam’s effectiveness is limited, so talk with a trusted healthcare provider before starting any of them.^3,8
• Calcium and vitamin D have the most consistent backing from doctors, since bone-health guidelines specify daily targets and both are supported by large studies.¹ Herbal options like black cohosh, red clover, ginseng, dong quai, and maca have more mixed evidence, and are typically framed as something to discuss with a doctor rather than a first-line recommendation. For how these natural options compare to hormone therapy itself, see our guide to HRT for menopause.

Are Perimenopause Supplements FDA-Approved or Regulated?

Dietary supplements like the ones on this page are regulated by the FDA as a category of food rather than prescription drugs, so they do not go through FDA pre-market approval for safety or effectiveness the way a prescription medication does. The supplement manufacturer holds legal responsibility for product safety and accurate labeling before an item reaches store shelves, as the agency does not evaluate these formulations prior to sale. This regulatory gap is exactly why the vetting steps above, checking for third-party testing and a full ingredient label before you start any bottle, carry real weight. Working with our physicians and choosing verified products puts the quality decision in your hands instead of the manufacturer's.

Perimenopause Supplements: Side Effects and Interactions with Birth Control or HRT

Side effects vary by supplement: DHEA carries the long-term risks noted above, and phytoestrogen-containing options like soy, red clover, and black cohosh work by nudging estrogen activity in the body, which is the same activity hormone replacement therapy and hormonal birth control are dosed around. NCCIH notes that black cohosh's overall interaction risk with medicines appears small, but flags added caution for anyone with a hormone-sensitive condition. Talk with your prescriber before combining any of these supplements with HRT or hormonal birth control, especially if you're also trying to conceive or breastfeeding.

Can You Take Multiple Perimenopause Supplements Together?

Combining more than one perimenopause supplement from this list at the same time is worth reviewing with your healthcare provider first, and you should not assume a stack is automatically safe simply because each compound is fine on its own. Several options on this page, including DHEA, soy, black cohosh, red clover, and wild yam, each influence estrogen-related activity in distinct ways, so stacking them layers multiple hormone-active ingredients at once. We recommend bringing the full list of supplements you are considering directly to your healthcare provider so they can evaluate the entire combination together, giving you a coordinated plan instead of adding products one at a time without guidance.

How Long Does It Take for These Supplements to Work?

How long a perimenopause supplement takes to work varies by supplement, dose, and the symptom you're tracking, and not every trial shows a benefit over placebo at all. Most of the studies behind the supplements on this list measure hot flashes, mood, or bone markers over weeks to months, not days, so a fair trial takes patience. If you notice no change after a few months, treat that as useful information for your next conversation with your doctor. It does not mean you are doing something wrong. Note this is about how long the supplements themselves take to act, not how long perimenopause as a phase lasts or when supplementation typically becomes relevant to begin with. For that timeline, see our guide to the stages of menopause.

Having a Health-Focused Approach for Perimenopause 

You balance your hormones during perimenopause by combining several approaches at once. No single supplement does the job by itself. Diet, exercise, sleep, and stress management each play a role, and supplements work best layered on top of those fundamentals. If weight changes are your main concern, Perimenopause Weight Gain covers the supplements and strategies most often asked about for that specifically.

• Diet: Focus on eating a balanced diet rich in whole foods, such as fruits, vegetables, high-quality animal protein, and healthy fats to support your hormonal balance and overall well-being.
• Harmful substances: Added sugar, caffeine, and alcohol are the foods and drinks that tend to worsen perimenopause symptoms, so cutting back on them and staying hydrated helps. 
• Exercise: You can maintain bone density and improve your mood by exercising regularly. A combination of cardiovascular and strength training is best. 
• Stress relief: Mindfulness practices, such as yoga or meditation, can reduce stress and promote better sleep quality. 
• Sleep: It might be the last item on this list, but sleep is one of the most important interventions for hormonal and overall health. Get enough sleep. Rest is an integral part of balancing out your hormones. 

What Drink Is Good for Perimenopause?

Water is the most useful drink during perimenopause, and swapping it in for sugary drinks, alcohol, and extra caffeine is one of the simplest changes you can make. Calcium- and vitamin D-fortified milk (dairy or a fortified plant-based option) is worth adding too, since it supports the same daily calcium and vitamin D targets that matter for bone health during this transition.¹

The Bottom Line

Perimenopause comes with many unpleasant symptoms. Supplements like calcium, vitamin D, DHEA, black cohosh, soy, red clover, wild yam, ginseng, dong quai, vitex, and maca are widely used by women to relieve discomfort, although some are not fully backed by research. 

You are likely to achieve the best results by combining perimenopause supplements with a nutrient-rich diet, a consistent exercise routine, quality sleep, and stress management techniques. 

Do not start a new perimenopause supplement without checking with your healthcare provider first, especially if you are trying to conceive or are breastfeeding. 

Don’t worry; you don’t have to figure it all out by yourself. You can always reach out to Opt Health physicians for more information and guidance. Together, we can craft a personalized, holistic plan for feeling your best while navigating new chapters of your life. See how it works and check current membership pricing before you get started.