Perimenopause Supplements: What Works and What to Avoid

Last updated November 15, 2026. Educational information, not medical advice: see our Medical Disclaimer.

Walk down any pharmacy aisle and you’ll find shelves of “menopause support” blends promising fewer hot flashes, better sleep and calmer moods. But which perimenopause supplements actually have evidence behind them? Here’s what US and UK health agencies say about the most popular ones, which carry real risks, and what to try first.

The Short Version

The US National Center for Complementary and Integrative Health (NCCIH) reviewed the research and found that most herbal and dietary supplements for menopause symptoms either haven’t been shown to work or have only weak, inconsistent results (NCCIH). The NHS similarly advises talking to a doctor before taking herbal supplements, because their quality varies and some interact with medicines (NHS).

Supplement	What the evidence says	Main concern
Black cohosh	Not shown to relieve hot flashes consistently	Rare reports of liver damage
Soy isoflavones	Mixed results; small benefit in some studies	Generally safe as food
Flaxseed	No better than placebo for hot flashes	Few side effects
Vitamin E	About one fewer hot flash a day in one study	High doses can raise bleeding risk
Red clover	No consistent benefit	Unknown long-term safety
Dong quai	Not shown to help	Interacts with warfarin
DHEA	Uncertain	Possible liver harm
Kava	May ease anxiety, not hot flashes	Serious liver damage

Black Cohosh

Black cohosh is the most popular menopause herb, but NCCIH says the research doesn’t consistently show it reduces hot flashes or night sweats. There have been rare cases of liver damage in people taking it. Stop and see a doctor if you notice tummy pain, dark urine or yellowing of the skin or eyes. If hot flashes are your main problem, our guide on how to stop hot flashes covers the treatments with stronger evidence.

Soy, Red Clover and Flaxseed

Soy and red clover contain isoflavones, plant compounds that act a little like weak estrogen. Results for hot flashes are inconsistent: some studies show a small effect, others none. Soy foods such as tofu, edamame and soy milk are a safe part of a healthy diet. Flaxseed has been tested too and, according to NCCIH, worked no better than a placebo for hot flashes.

Vitamins and Minerals Worth Knowing

• Vitamin D: the NHS recommends that adults in the UK consider 10 micrograms a day, especially in autumn and winter. It supports bone health, which matters more as estrogen falls (NHS).
• Calcium: aim to get it from food first, such as dairy, fortified plant milks, tinned fish with bones and leafy greens. Ask a doctor before high-dose supplements.
• Vitamin E: one study found about one fewer hot flash a day, a small effect. Avoid high doses, especially if you take blood thinners.
• Iron: only if a blood test shows you need it, for example after heavy or irregular periods.

Magnesium is often marketed for perimenopause sleep and mood, but there’s little research specific to menopause. It’s generally safe at normal doses, though too much can cause diarrhoea and it isn’t suitable for people with kidney problems.

Supplements to Be Careful With

“Natural” doesn’t mean safe. NCCIH flags these risks:

• Kava has been linked to serious liver damage.
• DHEA has uncertain benefits and may harm the liver or raise hormone levels.
• Dong quai can interact with the blood thinner warfarin.
• St John’s wort, sometimes used for low mood, interacts with many medicines, including the pill and some antidepressants.

Supplements aren’t checked for effectiveness before they’re sold, and products can contain more or less than the label says. Always tell your doctor or pharmacist what you take.

What Works Better Than Supplements

For moderate or severe symptoms, hormone therapy is the most effective treatment for hot flashes and night sweats, and there are non-hormonal prescription options too. Our guide to HRT in perimenopause explains the choices. Lifestyle steps also help: regular exercise, cutting back on alcohol and caffeine, a cooler bedroom and stress relief. CBT (cognitive behavioural therapy) is recommended by the NHS for hot flashes, low mood and perimenopause anxiety.

Not sure what’s causing your symptoms? Start with our perimenopause symptoms checklist, then take it to your appointment.

When to See a Doctor

• Your symptoms affect your sleep, work or relationships.
• You take prescription medicines and want to add a supplement.
• You’ve had breast cancer or another hormone-sensitive condition, as some herbs act like estrogen.
• You notice signs of liver trouble: yellow skin or eyes, dark urine or tummy pain.

Keep reading: How to Stop Hot Flashes and What Is Perimenopause?

Frequently Asked Questions

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Sources: Menopausal symptoms: in depth — NCCIH · Things you can do — NHS · Vitamin D — NHS · Black cohosh — NCCIH

Sources cited in this article

1. NCCIH: Menopausal symptoms in depth (nccih.nih.gov)
2. NHS: Things you can do (nhs.uk)
3. NHS: Vitamin d (nhs.uk)
4. Black cohosh — NCCIH (nccih.nih.gov)

Last checked November 8, 2026. Spot an outdated source? Tell us.

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