Choosing the right supplements to help you manage your hormone-related symptoms in perimenopause can be overwhelming. Let’s make it easier- check out this guide to the top 5 picks for your perimenopause supplement stack!
Perimenopause can feel a lot like riding a hormonal rollercoaster—one day you’re fine, the next you’re hit with hot flashes, brain fog, or those dreaded 2 a.m. wake-ups. It’s frustrating, but you’re not alone. The good news? The right supplements can make this change smoother and help you feel more like yourself again. With a carefully chosen supplement routine (AKA supplement stack), you can ease symptoms, support your hormones, and reclaim some balance during this phase of life.
Key Takeaways
- Probiotics support gut health and can alleviate mood swings and sleep issues during perimenopause.
- Magnesium is helpful for reducing anxiety and improving sleep quality in women experiencing hormonal changes.
- Omega-3 fatty acids help combat inflammation and may improve cognitive function and mood during perimenopause.
- Adaptogens like ashwagandha, shatavari, rhodiola, and maca can help the body manage stress and hormonal fluctuations effectively.
- Herbal blends or single herbs including Black Cohosh, Vitex, and DIM, offer natural alternatives for symptom relief and hormonal balance.
Perimenopause Phases and Symptoms
Perimenopause typically begins in your 40s (though sometimes earlier) and can last anywhere from 4-10 years before menopause officially arrives. During this transitional phase, your estrogen levels begin their gradual decline, but not in a neat, predictable pattern.
Instead, they fluctuate wildly, causing those infamous perimenopausal symptoms that can affect your quality of life. Estrogen dominance (where estrogen surges and/or is high in relation to progesterone) is in fact a very common stage of perimenopause.
Common symptoms include: – Hot flashes and night sweats (those lovely vasomotor symptoms) – Irregular menstrual cycles (surprise periods, anyone?) – Mood swings and irritability (sorry, family!) – Sleep disturbances and insomnia – Brain fog and memory issues – Vaginal dryness and decreased libido – Weight gain, especially around the midsection – Bone loss and decreased bone density
While hormone therapy remains an option, many perimenopausal women seek natural alternatives first. Let’s explore the five supplements (including my favorite blends) that I use in my supplement stack, as do many of my patients.
1. Probiotics
The gut-hormone connection might be the missing piece in your perimenopause puzzle. Research increasingly shows that gut health plays a crucial role in hormone regulation, making probiotics a foundational supplement for perimenopausal women.
Your gut microbiome helps metabolize and eliminate hormones, so when it’s out of balance, those hormonal fluctuations can feel even more intense.
Studies show specific probiotic strains can help: – Reduce inflammation that worsens perimenopause symptoms – Improve mood swings and anxiety – Enhance sleep quality – Support immune system function – Aid in weight management
When choosing a probiotic, look for formulations with multiple strains (I usually recommend 12 different strains) and at least 10 billion CFUs. Many women report noticeable improvements in overall wellbeing within 4-6 weeks of consistent use.
Here are two of my favorite probiotic blends:
- 2-in-1 Prebiotic + Probiotic: Seed DS-01 Daily Synbiotic is formulated with 24 clinically and scientifically studied probiotic strains and a patented, plant-based prebiotic outer capsule to deliver benefits in and beyond the gut. 53.6 Billion AFU.
- Whole-Body Benefits: In addition to bloating relief and improved regularity, DS-01 is formulated for digestive and whole-body benefits, including gut health, digestive health, gut barrier integrity, immune support, skin health, and hearth health.
- Engineered to Survive: Seed’s patented capsule-in-capsule ViaCap delivery technology protects probiotics through digestion to ensure the full probiotic dose reaches the colon. DS-01 is shelf-stable and no refrigeration is required.
- Getting Started: If it's your first time taking DS-01, or its been more than a week since your last dose, take 1 capsule daily for three days before moving on to 2 capsules daily. You may notice mild gastrointestinal discomfort or changes in digestion. Any discomfort typically resolves in 1-2 weeks.
- Customer Support: DS-01 goes through extensive third party testing for safety and quality. If you have questions about DS-01, or aren't satisfied with your purchase, reach out to us directly and we'd be happy to help.
- WOMEN'S PROBIOTIC: Includes one 30-count bottle of Renew Life Women's Care Probiotic Capsules 25 Billion CFU for vaginal, urinary, digestive and immune support (1)
- CLINICALLY TESTED STRAINS: Women's health probiotic supplement with a blend of 12 different strains to support pH balance along with vaginal, urinary, digestive and immune health
- DIVERSE FORMULA: Daily probiotic pills with more clinically studied strains than the leading brand (2) to provide science-backed benefits
- 12 DIVERSE STRAINS: Renew Life womens probiotic contains 12 diverse strains, including the No. 1 most studied strain, the L. rhamnosus GG - for gut health and healthy immune response (3)
- MULTIPLE BENEFITS: Womens health probiotic helps maintain healthy vaginal bacteria and yeast levels, supports digestive, urinary and immune health, and preserves pH balance for women
Remember that fermented foods like yogurt, kimchi, kefir, miso, tempeh, and sauerkraut can complement your probiotic supplement as part of a balanced diet, as can high fiber foods- which help to feed the good bacteria.
2. Magnesium: Your hidden perimenopause supplement tool
If perimenopause had a magic mineral, magnesium might be it. This essential nutrient plays a vital role in over 300 biochemical reactions in your body, yet studies show that up to 75% of women don’t get enough through diet alone.
The hormonal changes of perimenopause can further deplete your magnesium stores, creating a vicious cycle.
Magnesium supplementation can help address multiple perimenopause symptoms: – Reduces frequency and intensity of hot flashes – Promotes deeper, more restorative sleep – Eases muscle tension and cramping – Supports mood regulation and reduces anxiety – Helps prevent bone loss and maintains bone density – Regulates heart rhythm and supports heart health
When selecting a magnesium supplement, consider magnesium glycinate or magnesium malate, which tend to be better absorbed and gentler on the digestive system than other forms. Start with 200-300mg daily and gradually increase if needed.
If you find you do need support to have softer and more regular bowel movements then magnesium citrate might be a better choice for you. Check out this blog that highlights the differences.
Taking magnesium before bed can be particularly helpful for sleep issues and night sweats that disrupt your rest.
- Heart Health Supplements: This magnesium glycinate capsule activates the enzymes necessary for neuromuscular contractions, cardiac function, and more*
- Energy & Bone Support: Magnesium supports metabolism of carbs and amino acids; supports energy production and use of calcium, phosphorus, sodium, and potassium*
- Overall Health & Nutrient Metabolism: This magnesium glycinate supplement helps the metabolism and utilization of vitamin B6, vitamin C, vitamin E, and more*
- Sleep & Relaxation Aid: Magnesium glycinate may help to support the sleep cycle and aid a sense of relaxation by increasing total dietary magnesium intake daily*
- Pure Difference: Our supplements are made with premium ingredients sourced from trusted suppliers, then manufactured and tested to verify potency and purity; Pure Encapsulations products are free from common allergens, unnecessary binders, fillers, and preservatives, and GMOs
3. Omega 3
Those fatty acids aren’t just good for your heart—they’re perimenopause powerhouses too! Omega-3 fatty acids, particularly EPA and DHA found in fatty fish and high-quality fish oil supplements (or ALA, which can be converted into these beneficial omega-3s and are derived from vegetarian sources like algae, walnuts, chia, and flax), have impressive anti-inflammatory properties that can address multiple perimenopausal symptoms.
As estrogen levels decline, inflammation often increases, exacerbating everything from joint pain to mood swings.
Research shows that omega-3 supplements can help: – Reduce hot flashes and night sweats – Improve mood stability and decrease depression risk – Support brain health and reduce brain fog – Maintain skin elasticity and hydration – Protect against bone loss – Support heart health during hormonal transitions – Reduce vaginal dryness
Quality matters tremendously with omega-3 supplements. Look for products that have been third-party tested for heavy metals and oxidation. A daily dose of 1,000-2,000mg combined EPA/DHA is typically recommended for perimenopausal women. Or choose algae based omega 3’s if you are vegetarian, but be sure to take a higher dose as the body has to convert these and the process is not 100% efficient).
- As the #1 Doctor Recommended Professional Supplement Brand, Metagenics delivers clinically proven, precision-crafted formulas to support your health at its core—because true wellness starts with integrity, balance, and expertise
- Fish Oil Benefits: Metagenics OmegaGenics Fish Oil EPA DHA 720 mg supports heart, immune, and musculoskeletal health*
- Superior Quality & Purity: Our fish oil supplements are rigorously tested for several hundred contaminants and have guaranteed purity
- Sustainably Sourced Omega-3 Fish Oil: Derived from cold-water fish from fisheries that observe best practices for sustainability and protecting ocean environments
- Antioxidant-Stabilized EPA & DHA Supplement: Ensures freshness and optimal purity; no fishy taste
- THE NUMBER ONE VEGETARIAN OMEGA-3 IN THE U.S. - Research shows that the essential fatty acids EPA & DHA in algae oil support heart, eye, immune & brain health.
- WHY ALGAE OMEGA - Nordic Naturals Algae Omega can help vegetarians & vegans meet their daily recommended serving of omega-3 EPA + DHA.
- PLANT-BASED OMEGA-3 - Derived from microalgae, our Algae Omega is certified vegan by the American Vegetarian Association. This provides a sustainable, fish-free alternative to fish oil supplements.
- PURITY GUARANTEED - At Nordic Naturals, everything we make is non-GMO & third-party tested, surpassing the strictest international standards for purity & freshness. Algae Omega is gluten & dairy free, with no artificial colors or preservatives.
- ETHICAL INNOVATION - Nordic Naturals is proud to be at the forefront of sustainable & ethical practices in the natural products industry. Through science & innovation, we are committed to delivering safe, effective nutrients to support foundational wellness.
4. Adaptogens as a Perimenopause Supplement
When it comes to hormonal balance, adaptogens are nature’s equalizers. These plant-based compounds help your body adapt to stress and promote homeostasis (balance)—exactly what you need when your hormone levels are doing the cha-cha.
During perimenopause, your body experiences significant stress as it adjusts to these changes in estrogen and progesterone. These adaptogens can not only help with the stress, but also with the actual balance of the female hormones, as well as hormones like cortisol and thyroid hormones.
The most research-backed adaptogens for perimenopause include:
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Ashwagandha: Helps reduce cortisol levels, improve sleep, and ease anxiety
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Shatavari: Supports hormonal balance, reduces hot flashes and vaginal dryness, and nourishes reproductive tissues
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Maca root: Supports hormone balance, boosts energy, and may increase libido
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Rhodiola: Combats fatigue, improves mental clarity, and boosts energy
Many women find that adaptogenic herbs provide noticeable relief from the psychological symptoms of perimenopause, like irritability, anxiety, and mood changes. They work gradually, so consistency is key—most women report benefits after 2-3 weeks of daily use.
Consider starting with a single adaptogen rather than a blend to identify which works best for your specific symptoms. But if you prefer to start wtih a blend the following section contains blends I often recommend to my patients.
- Supports a Healthy Stress Response: Adaptogens support the body’s needs to help maintain its balance
- Sleep Support: Organic ashwagandha supports restful sleep while helping maintain daytime energy
- Supports Immune Health: Ashwagandha root supports immune health with antioxidant properties
- Purity-Tested: Our Ashwagandha Root supplement is vegan, gluten-free & proudly made in NC, USA
- Our Story: Since 1987, our purpose has been to connect people, plants, and planet to create healing
5. Perimenopause Supplement Support: Single Herbs and Blends
When targeting specific hormonal imbalances, certain herbs have shown promising results in clinical trials. These plant-based compounds often contain phytoestrogens or compounds that gently support your body’s hormonal systems without the potential risks of hormone replacement therapy.
Always consult your healthcare provider before starting any of these supplements, especially if you have a history of hormone-sensitive conditions.
The most effective hormone-supporting herbs include: – Black cohosh: Studies show it can reduce hot flashes by up to 50% – Dong quai: Often called “female ginseng” for its hormone-balancing effects – Chasteberry (Vitex): Helps regulate menstrual cycles, boost progesterone, and reduce PMS – DIM (Diindolylmethane): Supports healthy estrogen metabolism, very beneficial for estrogen dominance (lowers estrogen) – Red clover: Contains isoflavones that may reduce hot flashes and night sweats
Many women find that combination products containing several of these herbs work synergistically to provide relief from multiple symptoms. Start with the lowest effective dose and monitor your response carefully, as with blends, it can be difficult to determine what you are reacting to if you have a negative reaction.
These supplements typically take 4-8 weeks to show their full benefits, so patience and consistency are essential parts of your supplement strategy.
My two favorite herbal/nutrient blends for perimenopause are FemGuard Balance, generally most helpful in mid to late perimenopause, and Happy Mammoth Hormone Harmony (click this link to get a discount on your order, great in early to mid perimenopause (but often helpful further in as well). I also love DIM Detox for the symptoms and phase of early perimenopause i/e estrogen dominance.
- FemGuard Balance Complex for Women - FemGuard + Balance contains classic women's health-supportive herbs in the form of vitex, polygonum and black cohosh root, along with DIM and chrysin.*
- Promotes Healthy Estrogen Metabolism - Includes 100 mg of DIM (diindolylmethane) to promote the production of the more beneficial estrogen metabolites over the potentially toxic estrogen byproducts to support estrogen balance for women and optimal health. Calcium-D-glucarate promotes the proper elimination of excess estrogens.*
- Mood Support & More - Black Cohosh supports hormone balance, especially during menopause, and the normal production of neurotransmitters that also offer mood support. Chaste tree extract (vitex supplement for women) supports estrogen and progesterone levels.*
- Premium Nutrients & Botanicals - Features nutrients and phytochemicals to further support overall health and estrogen metabolism, including bioactive B12 folate, P5P vitamin B6, magnesium, resveratrol, green tea extract (EGCg), and broccoli seed extract.*
- Clinically-Trusted Care - DFH is the #1 practitioner supplement brand recommended by functional medicine professionals and the #1 practitioner supplement brand personally trusted by functional medicine professionals.**
- Liver Support: DIM Detox promotes healthy cell cycle function and hormone metabolism to support the liver's natural detoxification process and cellular health.*
- Healthy Detoxification Support: The glucosinolates in broccoli, including indole-3-carbinol, and sulforaphane, help support healthy detoxification BioResponse DIM provides 25 mg per serving of a highly absorbable form of diindolylmethane, an important metabolite of indole-3-carbinol.*
- Antioxidant Support: Silymarin, alpha lipoic acid and n-acetyl-l-cysteine act to support phase II detoxification enzyme activity in the liver and offer antioxidant support for cellular function.*
- Pure Quality: Our supplements are made with only premium ingredients sourced from trusted suppliers and guided by our nutritional experts, then carefully manufactured and tested to verify their potency and purity.
- Pure Difference: What makes us different isn't just our process or what goes into our supplements -- what we leave out matters, too. Pure Encapsulations products are free from wheat, eggs, tree nuts & peanuts, gluten, artificial colors, flavors & sweeteners, coatings and shellacs, GMOs, and unnecessary binders, fillers & preservatives.
Don’t do too much at once
I don’t recommend starting all of these. With the blends it’s best to choose one that fits the stage you are in or symptoms you have, but to keep things really simple add the first three options and then add one single herb, whichever fits your symptom profile best. Take your time and experiment as everyone is unique and your needs may change as you go through different hormonal stages. Always discuss your supplements with your trusted healthcare provider, preferably a provider familiar with perimenopause, menopause, herbs, and supplements.
Conclusion
Creating your personalized perimenopause supplement stack doesn’t have to be overwhelming. Start with foundational supplements like probiotics, magnesium, and omega-3s, then add targeted support based on your most troublesome symptoms.
Remember that supplements work best as part of a comprehensive approach that includes: – A nutrient-dense, anti-inflammatory diet – Regular exercise (especially weight-bearing activities for bone health) – Stress management techniques – Adequate sleep hygiene practices – Regular check-ins with your healthcare provider
The perimenopause journey is unique for every woman, and what works brilliantly for your best friend might not be your perfect solution. Be patient with yourself, track your symptoms, and adjust your supplement regimen as needed.
With the right support, perimenopause can become not just manageable but an opportunity for renewed health and vitality as you move toward the next chapter of your woman’s life.
Dr. Shelley Meyer is a board-certified family physician and Institute of Functional Medicine-certified functional medicine physician, as well as a Registered Dietitian. She is passionate about helping women navigate the roller coaster of perimenopause and postmenopause. She has her own Functional Medicine Practice in Denver, Colorado.
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