Supplements That Actually Have Evidence (and the Ones That Don't)
Day 23 of the 30-day Perimenopause Series.
One of the most confusing corners of women's health is the supplement aisle. Every bottle promises hormone balance, brain fog relief, restored energy, and better sleep. The marketing is beautiful. The science is often not.
I do not want to be dismissive here. There are supplements with real, replicated evidence that make a meaningful difference in perimenopause. There are also whole rows of the health-food store that will drain your wallet and change nothing. Learning to tell the two apart is worth doing.
Here is my working framework, based on the evidence and on twelve years of watching what actually helps my patients.
The Ones I Almost Always Recommend Considering
These have the strongest evidence and the clearest role in perimenopausal women. Discuss any new supplement with your own clinician — dose, timing, and interactions matter.
Magnesium glycinate — 200 to 400 mg at bedtime. Supports sleep, muscle relaxation, nervous system calm, and constipation. Widely deficient in modern diets. Very well tolerated.
Omega-3s (EPA/DHA) — 1 to 2 grams of combined EPA+DHA daily from a third-party-tested fish oil. Supports mood, cognition, cardiovascular health, and inflammation. The evidence for mood and cardiac protection is one of the more consistent in nutritional psychiatry.
Vitamin D3 — dose based on your blood level, typically 2,000 to 5,000 IU daily. Aim for a 25-hydroxy D of about 50 to 80. Nearly universal insufficiency in the Intermountain West despite the sun.
B12 — especially over 40, on acid-blockers, or vegetarian. Methylcobalamin 1,000 mcg is a safe, effective baseline. Test your level before high-dose supplementation.
Creatine monohydrate — 3 to 5 grams daily. Not just for bodybuilders. Emerging evidence supports benefits for cognition, mood, and preservation of muscle mass in midlife women. Cheap and well-studied.
Protein — technically a macronutrient, but most perimenopausal women under-eat protein. Aim for roughly 0.8 to 1 gram per pound of goal body weight, spread across meals. Powders count.
Sometimes Worth Trying
These have moderate evidence in select situations. Not universal, but worth a conversation.
Ashwagandha (KSM-66) — 300 to 600 mg. Adaptogen; some evidence for stress, cortisol, and sleep. Contraindicated in thyroid disease and pregnancy — do not take without a clinician if either applies.
L-theanine — 200 mg. Gentle calming without sedation. Well tolerated. Helpful for daytime anxiety in some women.
Curcumin (turmeric extract) — for inflammation, joint pain, and mood. Look for a bioavailability-enhanced form. Check for interactions with blood thinners.
Probiotic — a well-studied multi-strain product if you have gut symptoms or are recently post-antibiotic. Skip the generic ones with no strain data.
Inositol (myo-inositol and D-chiro-inositol) — for insulin resistance, PCOS-adjacent presentations, and some anxiety symptoms.
CoQ10 or ubiquinol — worth considering if you are on a statin, or if you have low energy despite good sleep. 100 to 200 mg.
The Ones That Are Mostly Marketing
The following categories consistently underperform their price tag in the perimenopausal population. This is not a judgment. It is a budget conversation.
"Hormone balance" gummies and blends. Vague claims, proprietary blends, tiny doses of ingredients that would need to be much higher to matter. Save your money.
Detox teas, cleanses, and "liver support" powders. Your liver is doing fine. If it is not, you need labs, not tea.
Collagen powders for joint pain or wrinkles. Evidence is weak; the amino acids you would get from a whole-food protein source are cheaper and equivalent.
Most "perimenopause" branded blends. Expensive, low doses of a handful of decent ingredients you can buy individually for a fraction of the cost.
Elderberry gummies for anything beyond a mild adjunct during a cold. Not a hormone therapy.
Any supplement claiming to "balance your hormones" without labs, without clinical evaluation, and without a licensed provider behind it. Real hormone balancing requires testing and prescriptions when appropriate.
A Word on Quality
The supplement industry is not tightly regulated in the U.S. Third-party testing matters. Look for USP Verified, NSF Certified, or ConsumerLab-tested products. Brands I generally trust for basics include Thorne, Pure Encapsulations, Designs for Health, and Nordic Naturals. That is not an endorsement of a specific product, just a category signal that the quality bar is met.
Amazon can be a graveyard for counterfeit supplements. Buy from the brand's own site or from a professional dispensary when it matters.
Test, Then Supplement
The single biggest mistake I see is women taking a shelf full of supplements they have never tested for. Then in six months they wonder why nothing has changed.
Get the labs first (see Day 1). Then supplement what you are actually low in, at the dose your body actually needs, for the duration your clinician recommends. That is real supplementation. Everything else is expensive urine.
Whole-Person Steps
Empty your supplement cabinet onto a table. Look at what is there. Notice what you cannot even remember buying.
Get the labs from Day 1 before you buy anything else.
Discuss any new supplement with your clinician. Some interact with medications or affect thyroid function.
Start with the strong-evidence basics: magnesium, omega-3, vitamin D, B12, creatine, protein.
Give any new supplement 8 to 12 weeks before deciding whether it is doing anything. Track one metric that matters to you.
If You Are in Utah
At Integrative Mind Body Psychiatry, I look at your labs, your symptoms, and your goals before I recommend a single supplement — and I tell you which ones will actually move the needle for your specific chemistry. Telehealth for adults, adolescents, and women in hormonal transitions across Utah. Insurance accepted through Headway. Learn more at integrativemindbodypsychiatry.com.
This post is educational and is not a substitute for individualized medical advice. Please talk with your own clinician before starting, stopping, or changing any supplement, particularly if you are taking prescription medication.
Respectfully,
Beth Makar, RN, Dual-MSN, PMHNP-BC
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