Introduction
Perimenopause, the transitional period before menopause, often begins in a woman’s 40s and can last several years. During this time, fluctuating hormone levels, particularly declining oestrogen and progesterone, can cause a range of symptoms such as hot flushes, night sweats, mood changes, sleep disturbances, and accelerated bone loss (Santoro et al., 2015). While hormone replacement therapy (HRT) is considered the most effective treatment for perimenopausal symptoms, some women seek alternative options, including supplements for perimenopause.
However, experts caution that the science supporting many supplements for perimenopause is limited and inconsistent (Minkin; Santoro). It is crucial for women to consult with a healthcare provider before taking any supplements to ensure safety and rule out potential interactions with medications or health conditions. This article aims to provide a comprehensive overview of the most commonly used supplements for perimenopause, their potential benefits and risks, and the importance of a holistic approach to managing symptoms during this transitional period.
Understanding Perimenopause
Perimenopause is the transitional phase leading up to menopause, typically beginning in a woman’s 40s and lasting an average of 4-8 years (Santoro et al., 2015). During this time, the ovaries gradually produce less oestrogen and progesterone, leading to hormonal fluctuations that can cause a range of physical and emotional symptoms (Santoro et al., 2015). Common perimenopausal symptoms include hot flushes, night sweats, mood changes, sleep disturbances, vaginal dryness, and accelerated bone loss (Santoro et al., 2015).
The decline in oestrogen levels during perimenopause can have significant impacts on a woman’s health. Oestrogen plays a crucial role in maintaining bone density, and its decrease can lead to accelerated bone loss and an increased risk of osteoporosis (Santoro et al., 2015). Additionally, the hormonal changes can contribute to cardiovascular risk factors, such as unfavourable changes in lipid profiles and endothelial function (Sathyapalan et al., 2018).
Hormone Replacement Therapy (HRT) and Alternatives
Hormone Replacement Therapy (HRT) is considered the most effective treatment for managing perimenopausal symptoms, particularly vasomotor symptoms like hot flushes and night sweats (Minkin; Santoro). However, some women may have concerns about the potential risks associated with HRT or may not be suitable candidates due to personal or family medical histories. As a result, many women seek alternative options, including supplements for perimenopause (Minkin; Santoro).
It is important to note that while some supplements may show promise in managing certain perimenopausal symptoms, the scientific evidence supporting their efficacy is often limited and inconsistent (Minkin; Santoro). Additionally, supplements are not regulated by the Therapeutic Goods Administration (TGA) in Australia for safety and efficacy, making it crucial for women to consult with a healthcare provider before starting any supplement regimen.
Commonly Used supplements for Perimenopause
Soy Isoflavones
Soy isoflavones are compounds found in soybeans and soy products that have a similar structure to oestrogen and can mimic its effects in the body (Chen et al., 2019). Some studies suggest that soy isoflavones may help reduce the frequency and severity of hot flushes in perimenopausal and menopausal women (Chen et al., 2019). A systematic review by Chen et al. (2019) found that isoflavone supplements significantly reduced hot flush frequency and severity compared to placebo.
In addition to their potential benefits for vasomotor symptoms, soy isoflavones may also have favourable effects on cardiovascular risk factors in perimenopausal women. A study by Sathyapalan et al. (2018) found that soy isoflavone supplementation improved lipid profiles and endothelial function in women during early menopause.
However, there are concerns about the safety of soy isoflavones for women with a history or increased risk of oestrogen-sensitive breast cancer (Wright). As soy isoflavones can mimic oestrogen in the body, some experts advise caution in using these supplements for women with such risk factors (Wright).
Black Cohosh
Black cohosh (Actaea racemosa) is an herb native to North America that has been traditionally used to treat menopausal symptoms. Some studies have investigated the effectiveness of black cohosh for reducing hot flushes in perimenopausal and menopausal women, but the results have been mixed.
A Cochrane review by Leach and Moore (2012) concluded that there was insufficient evidence to support the use of black cohosh for menopausal symptoms, citing a lack of high-quality, consistent evidence. However, some individual studies have reported positive results. For example, a study by Drewe et al. (2016) found that a specific black cohosh extract (Ze 450) significantly reduced the frequency and severity of hot flushes compared to baseline in perimenopausal and postmenopausal women.
Despite these mixed results, the North American menopause Society (NAMS) does not recommend black cohosh for treating hot flushes due to uncertainty about appropriate dosage, preparation, and potential safety concerns (NAMS, 2023).
Vitamin D and Calcium
Vitamin D and calcium are essential nutrients for maintaining bone health, which is particularly important during perimenopause when oestrogen levels decline, and bone loss accelerates. The National Institutes of Health (NIH) recommends that women aged 51-70 years consume 600-800 IU of vitamin D and 1200 mg of calcium daily through diet or supplements if necessary.
Adequate vitamin D and calcium intake can help slow bone loss and reduce the risk of osteoporosis and fractures in perimenopausal and postmenopausal women. However, it is important to note that excessive intake of these nutrients can have adverse effects, such as kidney stones and cardiovascular problems (NIH). Women should consult with a healthcare provider to determine their individual needs and the most appropriate sources of vitamin D and calcium.
Magnesium
Magnesium is a mineral involved in numerous bodily functions, including nerve and muscle function, energy production, and bone health. Some evidence suggests that magnesium supplementation may help alleviate certain perimenopausal symptoms, such as sleep disturbances, mood changes, and headaches.
A review by Parazzini et al. (2017) found that magnesium supplementation improved insomnia symptoms in postmenopausal women. Additionally, a study by Quaranta et al. (2007) reported that magnesium supplementation reduced the frequency and severity of migraine headaches in perimenopausal women.
Magnesium glycinate is often considered the best form of magnesium supplement due to its high bioavailability and lower risk of gastrointestinal side effects compared to other forms, such as magnesium oxide (Pure Encapsulations).
Vitamin E
Vitamin E is a fat-soluble antioxidant that has been suggested to help with hot flushes and vaginal dryness in perimenopausal and menopausal women. However, the evidence supporting its effectiveness is limited and inconsistent.
A systematic review by Mohammady et al. (2018) found that vitamin E supplementation significantly reduced the frequency and severity of hot flushes compared to placebo in some studies, while others showed no significant difference. The authors concluded that more research is needed to confirm the effectiveness of vitamin E for managing menopausal symptoms.
Limitations and Inconsistencies in Supplement Research
One of the main challenges in recommending supplements for perimenopause is the limited and often inconsistent evidence supporting their efficacy (Wright; Ward). Many studies on supplements for perimenopausal symptoms have been small, short-term, or of low methodological quality, making it difficult to draw firm conclusions about their effectiveness and safety.
Furthermore, supplements are not regulated by the TGA in Australia for safety and efficacy, meaning that product quality and potency can vary widely between brands and batches. This lack of regulation underscores the importance of choosing high-quality, third-party tested supplements from reputable brands and consulting with a healthcare provider before starting any supplement regimen.
Lifestyle Modifications for Managing Perimenopausal Symptoms
While supplements may offer some potential benefits for managing perimenopausal symptoms, lifestyle modifications are often considered the first-line approach and may be more effective than relying on supplements alone (Wright; Ward). Some key lifestyle strategies for managing perimenopause include:
- Regular exercise: Engaging in regular physical activity, such as aerobic exercise and strength training, can help reduce hot flushes, improve sleep quality, maintain bone density, and support overall physical and mental well-being during perimenopause (Santoro et al., 2015).
- Balanced diet: Consuming a balanced diet rich in whole foods, such as fruits, vegetables, whole grains, lean proteins, and healthy fats, can provide essential nutrients and help manage perimenopausal symptoms (Santoro et al., 2015). Limiting processed foods, added sugars, and excessive caffeine and alcohol intake may also be beneficial.
- Stress management: Practicing stress-reduction techniques, such as mindfulness meditation, deep breathing exercises, or yoga, can help alleviate mood changes and promote relaxation during perimenopause (Santoro et al., 2015).
- Healthy sleep habits: Establishing a consistent sleep schedule, creating a cool and comfortable sleep environment, and avoiding stimulating activities before bedtime can help improve sleep quality and reduce the impact of sleep disturbances during perimenopause (Santoro et al., 2015).
The Importance of a Holistic Approach
Navigating perimenopause can be a challenging and unique experience for each woman. A holistic approach that incorporates lifestyle modifications, guidance from healthcare professionals, and carefully considered use of supplements or other treatments is often the most effective way to manage symptoms and support overall health during this transitional period.
It is essential for women to work closely with their healthcare providers to develop a personalised plan that addresses their individual needs, concerns, and medical histories. Regular check-ins and adjustments to the management plan may be necessary as symptoms and priorities change throughout perimenopause.
By adopting a holistic approach and maintaining open communication with healthcare providers, women can successfully navigate the challenges of perimenopause and optimise their physical and emotional well-being during this transformative life stage.
Conclusion
In conclusion, navigating perimenopause can be a complex and challenging journey for many women. While hormone replacement therapy (HRT) remains the most effective treatment for managing perimenopausal symptoms, some women may seek alternative options, such as supplements. However, it is crucial to recognise that the scientific evidence supporting the efficacy and safety of many supplements for perimenopause is limited and often inconsistent.
Some of the most commonly used supplements for perimenopause include soy isoflavones, black cohosh, vitamin D and calcium, magnesium, and vitamin E. While individual studies have shown potential benefits for certain symptoms, the overall body of evidence is not conclusive. Furthermore, the lack of regulation of supplements by the TGA in Australia means that product quality and potency can vary widely, emphasising the importance of choosing high-quality, third-party tested products from reputable brands.
Ultimately, a holistic approach that incorporates lifestyle modifications, such as regular exercise, a balanced diet, stress management, and healthy sleep habits, may be more effective than relying on supplements alone for managing perimenopausal symptoms. It is essential for women to work closely with their healthcare providers to develop a personalised management plan that addresses their unique needs, concerns, and medical histories.
By prioritising open communication with healthcare professionals and adopting a comprehensive approach to self-care, women can successfully navigate the challenges of perimenopause and optimise their physical and emotional well-being during this transformative life stage. Remember, while supplements may offer some potential benefits, they should be used judiciously and under the guidance of a qualified healthcare provider to ensure safety and effectiveness.
Key Highlights and Actionable Tips
- Perimenopause is a transitional phase before menopause that often begins in the 40s and can last several years, causing symptoms like hot flashes, sleep issues, and mood changes due to hormonal fluctuations.
- Many over-the-counter supplements claim to help with perimenopause symptoms, but experts say the science supporting their efficacy is often murky or inconsistent.
- Some ingredients commonly found in perimenopause supplements include vitamins B and D, minerals like zinc, herbs such as black cohosh and maca, and phytoestrogens from plants like soy and red clover.
- When considering supplements, look for seals from reputable third-party testing organizations and consult the National Center for Complementary and Integrative Health’s website for safety and efficacy information.
- Experts generally recommend lifestyle changes, hormone therapy, non-hormonal prescription medications, and mind-body techniques over supplements for managing perimenopause symptoms.
- Always consult a knowledgeable healthcare provider to discuss your options and develop a personalized treatment plan.
What lifestyle changes can help manage perimenopause symptoms?
Some lifestyle changes that may help alleviate perimenopause symptoms include:
- Following a balanced diet rich in whole, unprocessed foods to control blood sugar, ensure adequate vitamin intake, and prevent weight gain.
- Engaging in regular exercise, which can improve overall health and well-being, though evidence is mixed on its impact on specific symptoms like hot flashes.
- Practicing stress-reduction techniques such as meditation, deep breathing, or yoga to help manage mood changes and sleep disturbances.
- Maintaining a consistent sleep schedule and creating a cool, comfortable sleep environment to minimize night sweats and insomnia.
- Limiting alcohol and caffeine intake, as these can exacerbate symptoms like hot flashes and sleep issues.
Are there any natural alternatives to hormone therapy for managing perimenopause symptoms?
While hormone therapy is considered the most effective treatment for perimenopause symptoms, some natural alternatives may provide relief for those who prefer to avoid hormonal interventions or are not good candidates for them. These include:
- Phytoestrogens: Plant compounds found in foods like soy, flaxseed, and red clover that mimic the effects of estrogen in the body, potentially reducing hot flashes and other symptoms.
- Mind-body techniques: Practices such as hypnotherapy, which involves deep relaxation and focused attention, and cognitive behavioral therapy, which helps identify and replace unhelpful thought patterns, may help ease hot flashes and improve overall well-being.
- Herbal remedies: Some herbs, such as black cohosh and evening primrose oil, have been studied for their potential to alleviate perimenopause symptoms, though evidence of their effectiveness is mixed.
- Acupuncture: This traditional Chinese medicine technique, which involves the insertion of thin needles at specific points on the body, may help reduce hot flashes and improve sleep quality.
It’s important to note that natural alternatives may not work for everyone and can still carry risks or interact with medications. Always consult a healthcare provider before trying any new treatment.
How can I ensure I’m getting enough calcium and vitamin D during perimenopause?
Calcium and vitamin D are crucial for maintaining bone health during perimenopause, as hormonal changes can lead to increased bone loss. To ensure adequate intake:
- Consume calcium-rich foods such as dairy products, leafy green vegetables, and fortified foods like plant-based milks and juices.
- Get regular sun exposure, as the body produces vitamin D when the skin is exposed to sunlight. Aim for 10-15 minutes of unprotected sun exposure a few times per week.
- Include vitamin D-rich foods in your diet, such as fatty fish, egg yolks, and fortified dairy products.
- Consider taking a calcium and vitamin D supplement if you struggle to meet your needs through diet and sun exposure alone. Consult a healthcare provider to determine the appropriate dosage for your individual needs.
- Engage in regular weight-bearing exercise, such as walking, jogging, or strength training, which can help stimulate bone formation and maintain bone density.
What should I do if my perimenopause symptoms are severely impacting my quality of life?
If you’re experiencing severe perimenopause symptoms that are significantly affecting your daily functioning and overall quality of life, it’s important to:
- Schedule an appointment with a healthcare provider who specializes in menopause care, such as a gynecologist or menopause practitioner. They can help you develop a personalized treatment plan based on your specific symptoms, medical history, and preferences.
- Be open and honest about the extent to which your symptoms are impacting your life, including any difficulties with work, relationships, or mental health. This information can help your provider determine the most appropriate course of action.
- Consider hormone therapy or non-hormonal prescription medications, which can be highly effective for managing severe symptoms like frequent hot flashes, night sweats, and mood disturbances.
- Explore complementary therapies, such as cognitive behavioral therapy or hypnotherapy, which can help you develop coping strategies and improve overall well-being.
- Prioritize self-care activities that promote relaxation and stress reduction, such as exercise, mindfulness practices, and spending time with supportive loved ones.
Remember, you don’t have to suffer through severe perimenopause symptoms alone. With the right treatment and support, it’s possible to find relief and improve your quality of life during this transitional phase.
Can I still get pregnant during perimenopause?
Yes, it is still possible to get pregnant during perimenopause, even if your periods have become irregular or less frequent. This is because:
- Ovulation can still occur during perimenopause, though it may be less predictable than in earlier reproductive years.
- Until you have gone a full 12 months without a menstrual period, you are not considered to be in menopause and may still have occasional ovulatory cycles.
- Fertility does decline with age, particularly after age 35, but it is not uncommon for women in their 40s to conceive naturally.
- If you don’t wish to become pregnant during perimenopause, it’s important to continue using contraception until you have reached menopause (12 months without a period).
- If you do wish to become pregnant during perimenopause, consult a fertility specialist who can assess your ovarian reserve and discuss options for increasing your chances of conception, such as fertility medications or assisted reproductive technologies.
Keep in mind that pregnancy during perimenopause can carry increased risks, such as higher rates of gestational diabetes, preeclampsia, and preterm delivery. Close monitoring by a healthcare provider is essential for ensuring the health and well-being of both mother and baby.
References
Chen, L. R., Ko, N. Y., & Chen, K. H. (2019). Isoflavone supplements for menopausal women: A systematic review. Nutrients, 11(11), 2649. https://doi.org/10.3390/nu11112649
Drewe, J., Zimmermann, C., & Zahner, C. (2016). The effect of a Cimicifuga racemosa extracts Ze 450 in the treatment of climacteric complaints – An observational study. Phytomedicine, 23(7), 763–765. https://doi.org/10.1016/j.phymed.2016.03.008
Jiang, K., Jin, Y., Huang, L., Feng, S., Hou, X., Du, B., Zheng, J., & Li, L. (2017). Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric, 20(3), 240–248. https://doi.org/10.1080/13697137.2017.1296427
Leach, M. J., & Moore, V. (2012). Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database of Systematic Reviews, 2012(9), CD007244. https://doi.org/10.1002/14651858.CD007244.pub2
North American menopause Society (NAMS). (2023). The 2023 hormone therapy position statement of The North American menopause Society advisory panel. menopause, 30(7), 767–794. https://doi.org/10.1097/GME.0000000000002028
Santoro, N., Epperson, C. N., & Mathews, S. B. (2015). Menopausal symptoms and their management. Endocrinology and Metabolism Clinics of North America, 44(3), 497–515. https://doi.org/10.1016/j.ecl.2015.05.001
Sathyapalan, T., Aye, M., Rigby, A. S., Thatcher, N. J., Dargham, S. R., Kilpatrick, E. S., & Atkin, S. L. (2018). Soy isoflavones improve cardiovascular disease risk markers in women during the early menopause. Nutrition, Metabolism and Cardiovascular Diseases, 28(7), 691–697. https://doi.org/10.1016/j.numecd.2018.03.007
