Navigating the Supplement Landscape 

If you've been experiencing perimenopause symptoms, you've likely encountered the vast and often confusing world of supplements promising relief. From hot flashes and mood swings to sleep disturbances and brain fog, the transition to menopause can bring challenging symptoms that prompt many women to seek solutions beyond conventional hormone therapy.

The supplement industry has responded with countless products claiming to ease perimenopause discomfort. But with so many options and often conflicting information, how do you know what actually works? More importantly, which supplements are backed by legitimate scientific evidence rather than clever marketing?

In this evidence-based guide, we'll cut through the noise and examine what the latest research says about perimenopause supplements. We'll explore which ingredients show genuine promise and how to make informed decisions about what might work for your unique symptoms.

The Science Behind Perimenopause Supplements

Before diving into specific supplements, it's important to understand what happens during perimenopause. This transitional phase typically begins in a woman's 40s (though sometimes earlier) and is characterized by fluctuating hormone levels, particularly estrogen and progesterone (as the ovaries gradually decrease their hormonal production.)

These hormonal shifts are responsible for the wide range of symptoms that can make perimenopause challenging, from vasomotor symptoms (hot flashes and night sweats) to mood changes, sleep disturbances, and cognitive effects.

Most perimenopause supplements work through one of several mechanisms:

1. Phytoestrogenic activity: Some plant compounds have structures similar to estrogen and may produce mild estrogenic effects.

2. Adaptogenic support: Certain herbs help the body adapt to stress and may support hormonal balance.

3. Nutritional support: Specific vitamins and minerals become particularly important during hormonal transitions.

4. Gut-hormone connection: Emerging research suggests that supporting gut health may influence hormone metabolism.

5. Hormone precursors: Some supplements provide building blocks for hormone production.

Let's examine the evidence for the most promising ingredients.

Top Evidence-Based Supplements for Perimenopause

1. Black Cohosh: The Gold Standard for Hot Flash Relief 

What It Is: Black cohosh (Cimicifuga racemosa) is one of the most studied herbs for menopause symptoms and has been used traditionally for centuries.

The Evidence:

A 2024 study in Journals LWW found that black cohosh may be effective for treating vasomotor symptoms like hot flashes and night sweats [1]. The Cleveland Clinic noted in a recent review that black cohosh offers various benefits for menopausal women [2].

What makes black cohosh particularly interesting is its enhanced effectiveness when combined with other supportive herbs. A 2024 study found that black cohosh combined with rhodiola was more effective than black cohosh alone for menopausal symptom relief [3], suggesting that comprehensive formulas may offer superior benefits.

Bottom Line: Black cohosh has substantial evidence supporting its use for hot flashes and other menopausal symptoms. It appears to work best when combined with other supportive herbs in a comprehensive formula.

2. Maca: Nature's Hormone Balancer

What It Is: Maca (Lepidium meyenii) is a Peruvian root vegetable that has been used traditionally to enhance fertility, energy, and hormonal balance.

The Evidence:

A 2025 review in Medical News Today reported that maca shows significant promise for alleviating menopausal symptoms [4]. Clinical trials with perimenopausal women found improvements in hot flashes, night sweats, and mood disturbances. One particularly impressive study found that 74-82% of perimenopausal women experienced reduced menopausal symptoms with maca supplementation [5].

Banner Health reported in 2024 that menopausal people who consumed maca had fewer hot flashes and night sweats than they did when they weren't taking it [6]. The research consistently shows maca's potential for supporting hormonal balance during the perimenopause transition.

Bottom Line: Maca shows impressive results for supporting overall hormonal balance and reducing multiple perimenopause symptoms, with particularly strong evidence for hot flashes, night sweats, and mood support.

3. Ashwagandha: The Stress-Hormone Connection

What It Is: Ashwagandha (Withania somnifera) is an adaptogenic herb with a long history of use in Ayurvedic medicine for stress management and vitality.

The Evidence:

Recent research on ashwagandha for perimenopause is particularly promising. A 2025 study reported in GoodRx Health found that ashwagandha may help with perimenopausal symptoms, including hot flashes [7]. 

The Better Menopause reported in 2024 that clinical trials involving perimenopausal women have found that ashwagandha may improve mood and help with symptoms of brain fog [8]. This is particularly significant as cognitive symptoms are often overlooked but can be among the most distressing aspects of perimenopause.

Bottom Line: Ashwagandha offers impressive support for stress management, mood, and cognitive function during perimenopause, with emerging evidence for its benefits on hot flashes and bone health as well.

4. Rhodiola: The Energy and Mood Supporter

What It Is: Rhodiola rosea is an adaptogenic herb that has traditionally been used to combat fatigue and enhance mental performance during times of stress.

The Evidence:

A 2024 study published in the Journal of Nurse Practitioners found that Rhodiola rosea combined with black cohosh was more effective for menopausal symptom relief than black cohosh alone [9]. A 2025 review confirmed Rhodiola's effectiveness in alleviating stress-related symptoms, which can be particularly beneficial during perimenopause [10].

Dr. Hyman's 2024 review of natural perimenopause solutions highlighted the effectiveness of Rhodiola combined with other herbs for comprehensive symptom relief [11]. This synergistic approach appears to be particularly effective for addressing the multi-faceted nature of perimenopause symptoms.

Bottom Line: Rhodiola shows promising evidence for supporting energy levels, mood, and stress resilience during perimenopause, with particularly strong results when combined with other supportive herbs like black cohosh.

5. Probiotics and Prebiotics: The Gut-Hormone Connection

What They Are: Probiotics are beneficial bacteria that support gut health, while prebiotics are specialized plant fibers that feed these beneficial bacteria. Emerging research suggests a significant connection between gut health and hormone metabolism.

The Evidence:

A 2025 study published in the Journal of Sage found that prebiotics and probiotics, particularly Lactobacillus strains, can increase bacterial diversity and improve metabolic and overall health during menopause [12]. Another 2025 study in Science Direct reported that probiotic supplementation can modify the gut microbiota and improve menopausal symptoms, possibly by regulating estrogen metabolism [13].

Research from Nature in 2025 suggests that certain gastrointestinal microorganisms can directly metabolize sex hormones such as estrogen and progesterone, highlighting the gut-hormone connection [14]. This emerging field of research is opening new avenues for supporting hormonal health through gut support.

Bottom Line: The gut-hormone connection is an exciting area with promising research. Current evidence suggests that supporting gut health through probiotics and prebiotics may help with hormone metabolism and potentially reduce certain perimenopause symptoms.

6. Vitamins and Minerals: Essential Nutritional Support

What They Are: Specific vitamins and minerals play crucial roles in hormonal health, bone density, mood regulation, and other functions that become particularly important during perimenopause.

The Evidence:

a) Magnesium: 

A 2024 review by The Better Menopause found that magnesium supplements may help with several menopause symptoms, including anxiety, sleep problems, mood disturbances, and reduced bone density [15]. A 2025 article in Hone Health noted that hormone declines in menopause can deplete magnesium, which may affect cognitive function [16].

b) Vitamin D: 

A 2024 study in The Better Menopause reported that increasing vitamin D intake could help with menopause symptoms including bone weakness, vaginal dryness, and low mood [17]. Vitamin D is particularly important for bone health during perimenopause when bone density can begin to decline.

Bottom Line: Magnesium and vitamin D show promising evidence for supporting perimenopause symptoms beyond just bone health. These nutrients appear to influence mood, sleep quality, and possibly vasomotor symptoms.

Other Supplements for Perimenopause Phytoestrogens: Soy and Red Clover

What They Are: Phytoestrogens are plant-derived compounds with structures similar to estrogen that can bind to estrogen receptors in the body, potentially producing mild estrogenic effects.

The Evidence:

A 2025 review published in Medical News Today found that 40mg of soy isoflavones twice daily for 12 weeks reduced the frequency of hot flashes in perimenopausal women [18]. A 2024 study published in the journal Molecules examined commercial red clover supplements and found improvements in various menopausal symptoms [19].

Bottom Line: Phytoestrogens may offer benefits for some women, particularly for hot flashes. They appear safe for most women but should be avoided by those with hormone-sensitive conditions.

DHEA: Hormone Support

What It Is: Dehydroepiandrosterone (DHEA) is a hormone produced by the adrenal glands that serves as a precursor to both estrogen and testosterone. DHEA levels naturally decline with age.

The Evidence:

A Harvards's 2025 review of DHEA highlighted its effectiveness helping improve thinning of vaginal tissue[20]. It may offer support for other areas such as depression and sexual function when used appropriately. 

Bottom Line: DHEA shows promise for specific symptoms, particularly vaginal atrophy and sexual function. As with any hormone-related supplement, it's best used with healthcare provider guidance.

How to Choose Quality Perimenopause Supplements

With so many options available, how do you choose a quality perimenopause supplement? Here are key factors to consider:

1. Evidence-Based Formulations

The most effective supplements are formulated with ingredients that have scientific backing, as discussed above. Look for products from companies that prioritize research- backed ingredients in their formulations.

2. Formulation Expertise

The best supplements are created by companies with expertise in formulation science. These companies understand how ingredients work together synergistically and how to create balanced formulas that address multiple symptoms simultaneously. This expertise is often reflected in proprietary formulations designed for maximum effectiveness.

3. Quality Manufacturing

Choose supplements from companies that follow Good Manufacturing Practices (GMP) and ideally have third-party testing for purity and potency. Quality manufacturers maintain rigorous standards throughout the production process.

4. Comprehensive Approach

Look for formulas that address multiple aspects of perimenopause rather than just a single symptom. The most effective supplements often combine ingredients that work through different mechanisms for more complete support. This holistic approach tends to yield better results than addressing symptoms individually.

5. Ingredient Quality

The source and quality of ingredients matter significantly. Premium supplements use high-quality, well-sourced ingredients that may be more bioavailable and effective than lower-quality alternatives.

Questions to Ask Before Choosing a Supplement

Before starting any supplement regimen for perimenopause, ask yourself:

1. What specific symptoms am I trying to address? Different supplements target different symptoms.

2. Have I had relevant testing done? For example, vitamin D levels can be measured to determine if supplementation is needed.

3. Do I have any medical conditions or take medications that might interact with supplements? Always consult your healthcare provider.

4. Am I looking for immediate relief or long-term support? Some supplements (like adaptogens) work gradually over time.

5. What's my budget? Quality supplements often cost more, but cheaper isn't always better when it comes to effectiveness.

Conclusion: A Decision-Making Framework

When it comes to perimenopause supplements, there's no one-size-fits-all solution. The most effective approach is often personalized and may combine several evidence-based strategies:

1. Start with the basics: Ensure adequate intake of essential nutrients, particularly magnesium and vitamin D, which have good evidence for supporting overall health during perimenopause.

2. Address your most bothersome symptoms: If hot flashes are your primary concern, black cohosh, maca, or a combination formula may help. For stress and mood issues, adaptogens like ashwagandha and rhodiola show promise.

3. Consider the gut-hormone connection: Supporting gut health with probiotics and prebiotics may help with hormone metabolism and overall well-being.

4. Be patient and observant: Most botanical supplements take time to work (often 4-8 weeks). Keep a symptom journal to track changes objectively.

5. Work with healthcare providers: Integrative or functional medicine practitioners can help create a personalized supplement plan based on your specific needs and health history.

Remember that supplements are just one tool in your perimenopause toolkit. Combining them with stress management, regular exercise, adequate sleep, and a nutrient-dense diet will likely provide the best results.

Formulas like Pholia Perimenopause Support, which combines evidence-based ingredients including black cohosh, ashwagandha, rhodiola, maca, and probiotics, offer a comprehensive approach to addressing multiple perimenopause symptoms simultaneously. This multi-faceted strategy aligns with the latest research suggesting that combination approaches may provide enhanced benefits compared to single- ingredient supplements. 

Frequently Asked Questions

Q: How long does it take for perimenopause supplements to work?

A: Most botanical supplements require consistent use for 4-8 weeks before noticeable benefits appear. Adaptogens in particular work gradually to support the body's stress response systems. Vitamin and mineral supplements may work more quickly if you're addressing a deficiency.

Q: Can I take multiple supplements together?

A: Many women benefit from combination approaches, but it's important to be mindful of potential interactions. A comprehensive formula that combines evidence-based ingredients in appropriate doses is often more convenient and cost-effective than taking multiple separate supplements.

Q: Are perimenopause supplements safe?

A: Most botanical supplements discussed in this article have good safety profiles when used as directed. However, even natural supplements can interact with medications or affect certain health conditions. Always consult with a healthcare provider before starting any new supplement regimen, especially if you have existing health concerns or take medications.

Q: Should I stop my supplements if I start hormone therapy?

A: This depends on the specific supplements and your individual situation. Some supplements may complement hormone therapy, while others might be redundant or potentially interact. Discuss this with the healthcare provider managing your hormone therapy.

References

1. Journals LWW. (2024). Exploring the Efficacy and Safety of Black Cohosh (Cimicifuga racemosa)

2. Cleveland Clinic. (2024). Black Cohosh: Uses, Benefits and Side Effects

3. Dr. Tori Hudson. (2024). Black Cohosh plus Rhodiola for Menopause Symptoms

4. Medical News Today. (2025). 8 health benefits of maca root

5. Femmenessence. (2024). Clinical Research on Maca

6. Banner Health. (2024). Everything to Know About Maca Root and Its Benefits

7. GoodRx Health. (2025). What It's Like to Take Ashwagandha for Perimenopause Symptoms
   

8. The Better Menopause. (2024). 5 Best Perimenopause Supplements Backed by Research

9. The Journal of Nurse Practitioners. (2024). Dietary Supplements for Vasomotor Symptoms of Perimenopause

10. Research Gate. (2025). The Effectiveness of Rhodiola rosea L. Preparations in
    Alleviating Various Aspects of Life-Stress Symptoms and Stress-Induced
    Conditions

11. Dr. Hyman. (2024). Stop Suffering: Natural Perimenopause Hacks That Actually Work

12. Sage Journals. (2025). The gut microbiota in menopause: Is there a role for prebiotic and probiotic interventions?

13. Science Direct. (2025). Protective effects of probiotics against menopausal symptoms in women

14. Nature. (2025). Menopausal shift on women's health and microbial niches

15. The Better Menopause. (2024). Magnesium for menopause: benefits, which type is best, dosage

16. Hone Health. (2025). Best Supplements for Menopause Brain Fog in 2025

17. The Better Menopause. (2024). Vitamin D and Menopause: How it Helps and How Much to Take

18. Medical News Today. (2025). Phytoestrogens: Benefits, risks, and food list

19. MDPI. (2024). Effectiveness of Commercial Red Clover (Trifolium pratense L) Supplements

20. Harvard. (2025). DHEA supplements: Are they safe? Or effective? 

Disclaimer: This article is for informational purposes only and does not constitute medical advice. The information provided is based on current scientific research but should not be used as a substitute for professional medical guidance. Always consult with a qualified healthcare provider before starting any supplement regimen, especially if you have existing health conditions or are taking medications.