Navigating the highs and lows of perimenopause and menopause can be a challenging and complex journey. As the body goes through hormonal changes, it's common to experience a wide range of normal symptoms that can impact wellbeing.

One option that some people turn to is supplements to help ease common symptoms and support their general health. If you’re thinking about taking supplements during menopause, consider the potential benefits and risks. And of course, always have a conversation with your doctor if you have any questions or concerns and discuss what may be right for you.

What are supplements?

According to the U.S. Food & Drug Administration (FDA), a supplement, or dietary supplement “is a product intended for ingestion that, among other requirements, contain a ‘dietary ingredient’ intended to supplement the diet.”. These ‘dietary ingredients’ can include vitamins, minerals, probiotics, and herbal products (also known as botanicals). They come in many forms including tablets, capsules, power, or liquid form.

Are dietary supplements regulated?

There is a regulatory system for dietary supplements in the United States. Dietary supplements are considered a subset of food and are regulated by both the U.S. Federal Trade Commission (FTC) and the U.S. Food and Drug Administration (FDA). Dietary supplements are regulated by the FDA as foods, not drugs. Labels can claim qualified health benefits, but can’t claim to cure, treat, or prevent disease (which are what drugs should do).

The FTC has primary responsibility for claims in advertising. Their role in regulating dietary supplements includes:

• Challenging and stopping advertising that isn’t adequately substantiated (i.e., there needs to be evidence to back up the claims made about the supplement)
• Investigate complaints and follow up with the correct legal process if evidence is found that a company is using “unfair or deceptive acts or practices”.

The FDA has the primary responsibility for regulating dietary supplements and requires companies to register with the FDA and follow manufacturing requirements called Current Good Manufacturing Practices (cGMP). cGMPs help ensure the quality of the dietary supplement and that it’s packaged and labeled as specified during manufacturing. These regulations also help ensure the identity, purity, quality, strength, and composition of the ingredients and the final dietary supplement.

The cGMPs represent the extensive requirements that manufacturers must follow. Standards are set in the following areas:

• Raw materials
• Quality assurance
• Record-keeping throughout the manufacturing process
• Standards for cleanliness and safety
• Qualifications of manufacturing personnel
• Product testing
• Production and process controls
• Warehousing and distribution

The FDA has the authority to stop the sale of products that are toxic, unsanitary, make false claims, or pose a risk of injury or illness. Unfortunately, due to limited resources, this often takes time.

The FDA also mandates that manufacturers, packers, and distributors of dietary supplements report information about serious adverse events associated with the use of supplements. A “serious” adverse event is defined as one that results in:

• Death.
• A life-threatening experience.
• Inpatient hospitalization.
• Persistent or significant disability of incapacity.
• A congenital anomaly or birth defect.
• Requires, based on a reasonable medical judgment, a medical or surgical intervention to prevent an outcome described above.

Why do people take supplements?

Let’s start with the overarching idea that supplements are not a substitute for bad habits. For example, if you drink caffeine before going to sleep and are scrolling on your phone for hours in bed, a supplement to help with sleep will likely not be very helpful. Supplements can, however, be helpful as part of a tool kit of healthy habits.

Supplements may be helpful if you’re generally healthy but are looking for a boost or a way to proactively help yourself optimize your health. They can be used to “level-up" your health with a bit of extra help. And the data shows that these are the most common reasons that people take supplements (improve overall health and maintain health).

Some examples of cases where this may be true:

• If you’re a healthy eater, but are a picky eater, are gluten-free, or have some minor food intolerances, you may need supplements to give you that extra bit of help to ensure you’re getting all the nutrients you need.
• You may not be clinically deficient in a nutrient but could also benefit from extra levels. One example is magnesium. Certain people may benefit from extra levels of magnesium to help maintain their health.
• Some people may also have nutrient inadequacy. You may be getting the right nutrients, but not enough for your body to work at an optimal level.
• Some people may have nutrient deficiencies. This can come from not eating enough of the nutrient. Your doctor can share with you whether supplementation may be helpful.
• Help ease occasional, mild symptoms. For example, ginger can help with nausea and vomiting, and lemon balm, sage, and spearmint have showed positive outcomes on sleep and occasional or mild anxiety.

Do menopause supplements really work?

Supplements are one resource that people turn to in order to help address common menopause symptoms and support overall health. While individual experiences may vary, there are several types of menopause supplements you may consider taking:

• Hormone-balancing supplements. Certain menopause supplements claim to mimic the effects of estrogen. They may contain plant-derived compounds called phytoestrogens, which are estrogens that naturally occur in certain foods. Although structurally similar, there are pros and cons to consuming foods or supplements that contain phytoestrogens.
• Calcium and vitamin D. Menopause speeds up bone loss and increases the risk of developing osteoporosis. Calcium and vitamin D work together to help support bone health. Ask your doctor whether a supplement might be right for you.
• Omega-3 fatty acids. Omega-3 fatty acids, commonly found in fish oil supplements, have been studied for their potential to alleviate menopausal symptoms such as hot flashes and low mood. They may also have cardiovascular benefits.
• Herbal supplements for menopause. There are around 34 symptoms associated with the hormonal changes during menopause. Some herbal supplements may be helpful for some of those symptoms. For example, rhodiola rosea is an adaptogenic herb, which means it can help the body adapt to stress and has a normalizing effect on some bodily processes. Another example is lemon balm, which has been shown to have calming properties and can be used for the relief of mild symptoms of mental stress and to help with sleep.

Talk to your doctor if you have any questions or concerns about supplements, and always read and follow the product label.

When considering herbal supplements, always consult a healthcare professional, and look for products from reputable brands. For herbal supplements to have the intended effect, they need to contain the beneficial portion of the plant at the clinically studied dosage, so look for products from brands that are sharing this information with you.

Is it safe to take menopause supplements?

While some supplements may be helpful in alleviating menopausal symptoms, it's important to consider the possible risks:

• Efficacy. The scientific evidence supporting the effectiveness of many menopause supplements is limited. You can ask your doctor whether they’ve researched the product and would recommend it based on your health history. Always be sure to buy from a trusted brand or company.
• Safety. Supplements aren’t regulated as rigorously as pharmaceutical drugs. The main reason for this is because they’re intended to support health, not cure a disease. Some may contain impurities or interact with medications, potentially leading to adverse effects. It's important to choose reputable brands, read product labels carefully, and talk to a healthcare professional before starting any new supplements.
• Supplement/drug interactions. Many of us are taking some daily pill – whether it’s a supplement, prescription medication, or other over-the-counter (OTC) medication. And because of this, we need to be aware of what’s in each pill we take. Even though we can buy them over-the-counter, they are still going in our bodies and can have interactions. Unfortunately, not all companies put the supplement/drug interactions on the label. One example you may have heard of is St. John’s wort, which is a supplement that is known to interact with many medications and can have serious side effects. When you go to a doctor’s appointment and they ask about all the medications you’re taking, list everything (medications, supplements, OTC meds, etc.) so they can also keep an eye out for any possible interactions.
• Individual differences. Each menopause experience is unique, and what works for one person may not work for another. Factors such as overall health, lifestyle, and genetics can influence the impact of supplements. How our bodies metabolize supplements can also vary and affect its effectiveness. If you compare this to other medications, some people require higher/lower doses than others for the medication to be effective. Foods we eat are another example – for example, a bowl of ice cream can send some people running for the bathroom, while others can just sit there and enjoy.
• Healthy lifestyle. Supplements should not be considered a substitute for a healthy lifestyle. Prioritizing regular exercise, a balanced diet, stress management, and adequate sleep can contribute significantly to overall wellbeing during menopause. Supplements are there to support your health and wellness.