Perimenopause is the transition period when the female body starts to shift from reproductive age into menopause (when menstrual cycles stop completely). This transition usually begins around the mid-40s but could happen to some people as early as age 30.
During perimenopause, women present with symptoms like hot flashes, night sweats, irregular periods, increased anxiety, poor sleep, altered mood, and vaginal and sexual changes. On average, perimenopause lasts about four years. However, it may last as long as 7-14 years.
Some supplements and natural remedies have been purported to help alleviate perimenopausal symptoms. However, evidence supporting the effectiveness of many of these supplements is lacking.
Black cohosh is an herb that Native Americans have used for decades to manage conditions like cough and muscle pain. Studies suggest it may be helpful in managing menopausal symptoms like hot flashes, night sweats, vaginal dryness, and sleep disturbances.
One small study of menopausal women experiencing hot flashes found that treatment of 40 milligrams of black cohosh twice daily reduced the severity of hot flashes after eight weeks. More research is needed to support the use of black cohosh for treating perimenopausal symptoms.
There is no standard dose for black cohosh in managing perimenopause symptoms. In studies, it was used in doses of between 8-160 milligrams per day, depending on the type of formulation.
Black cohosh is generally safe, especially for short-term use. Side effects may include cramps, stomach upset, vaginal spotting, weight gain, headache, and rash. There have also been reports of liver damage in people who take black cohosh, but this adverse effect is rare.
Ginseng may help improve hot flashes and night sweats. One study found that women who took 1-3 grams of ginseng for 4-12 weeks saw a reduction in menopause symptoms like hot flashes and vaginal dryness.
However, other studies fail to show any significant benefit of ginseng in reducing perimenopause symptoms. Research also shows ginseng may lower the risk of heart disease in pre- and post-menopausal women.
There is no universally accepted dose of ginseng in reducing menopause symptoms. Studies have used doses of 0.2-5 milligrams of ginseng safely for a short period.
Ginseng is likely well tolerated and safe in the short term. You may experience side effects like headache, breast pain, and vaginal bleeding.
The side effects and degree of toxicity you may experience vary depending on the type of ginseng in your supplement. For example, Korean red ginseng has been found to have low toxicity due to the level of processing.
Red clover is often included in herbal supplements that support menopausal women due to its high isoflavone content (a plant compound structurally similar to estrogen).
Some studies suggest that the isoflavone in red clover may help reduce perimenopause symptoms like hot flashes and night sweats.
One study showed that women who took 80 milligrams of red clover daily saw a 30-50% reduction in the frequency of hot flashes, experiencing about 3.63 fewer hot flashes per day compared to a baseline of 7-12 per day. The women who took a placebo treatment did not see the same reduction.
Another study found that the isoflavone content in red clover may help prevent and treat menopause-related osteoporosis.
Findings about the benefits of red clover in relieving perimenopause symptoms are mixed, and there are concerns of bias in studies with positive findings.
Red clover is generally safe. Side effects like headache, cold, nausea, diarrhea, and muscle aches have been reported.
Wild yams contain a compound called diosgenin, which is a natural dehydroepiandrosterone (DHEA). The body uses DHEA to make androgens and estrogens.
Research suggests that wild yam may help reduce menopause symptoms. One study found that wild yam decreased vaginal dryness in women.
Some studies found taking 12 milligrams of wild yam twice daily for a year improved menopausal symptoms, especially psychological symptoms like mood swings and anxiety. However, many other studies did not find this benefit.
Wild yam is generally well tolerated but may have side effects like vomiting, stomach upset, and headache.
Due to wild yam’s DHEA content that can increase estrogen production, avoid using supplements containing wild yam if you are living with hormone-sensitive conditions such as breast, ovarian, and uterine cancer.
During the transition into menopause, fluctuating hormone levels, particularly declining estrogen, can lead to an increased risk of reduced bone density and bone fracture.
Studies have shown vitamin D supplements of 800-1,000 international units (IU) daily can help reduce the risk of osteoporosis and fractures during menopause transition and after menopause.
Research also suggests that vitamin D supplements can help reduce the severity of vaginal dryness in women approaching menopause and postmenopausal women. However, other studies found no benefit in vitamin D supplements reducing menopause symptoms.
Sunlight is an excellent source of vitamin D. Fortified milks and certain fish are also good sources, but getting sufficient vitamin D from food alone may be difficult.
Vitamin D supplements are generally safe. However, high levels of vitamin D in the blood (typically greater than 375 nanomoles per liter of blood) can be toxic, leading to nausea, vomiting, muscle weakness, and neuropsychiatric conditions.
Vitamin D may interact with some medications, such as Orlisat (a weight loss drug sold under brand names like Alli and Xenical) and statins like Lipitor (atorvastatin). If you are on another medication, speak with a healthcare provider before taking vitamin D.
Research suggests that omega-3 fatty acids may help improve vasomotor (blood vessel and blood flow-related) symptoms like night sweats and hot flashes during menopause.
One study found that omega-3 supplements can help reduce night sweats but found no benefit in reducing hot flashes.
Omega-3 fatty acids may also reduce the severity of depression and other cognitive disorders like anxiety that occur during menopause transition. More research is needed to confirm this potential benefit.
Omega-3 fatty acids are found naturally in fatty fish like salmon and are available in supplement form. These supplements are generally safe, but you may experience side effects like diarrhea, gas, muscle weakness, nausea, and indigestion.
Although supplementation is safe, the United States Food and Drug Administration (FDA) recommends limiting intake of omega-3 fatty acids derived from supplements to no more than 2 grams daily.
Dong quai (Angelica sinensis), also known as female ginseng, has been used in Chinese medicine since ancient times to alleviate menopausal symptoms.
Dong quai may help reduce hot flashes and night sweats, but there is not enough evidence to support its use for this purpose. Research suggests dong quai may be most effective when used with other herbal supplements that help reduce menopausal symptoms.
There is no recommended dosage for dong quai for the management of menopause symptoms, but it has been used safely in doses up to 150 milligrams when used with other herbal supplements.
Dong quai is generally safe and well-tolerated. However, it may have some side effects, including an increased risk of bleeding, convulsions, diarrhea, and sun sensitivity. Dong quai may interact with blood thinners like Coumadin (warfarin), aspirin, and Plavix (clopidogrel), as it may increase the risk of bleeding.
The herb St. John’s wort is commonly known for its potential to reduce symptoms of mild to moderate depression. Some studies suggest that St. John’s wort may also help reduce hot flashes and night sweats during menopause.
One small study found that postmenopausal women who received about 270–330 micrograms of St. John’s wort for two months had fewer menopausal symptoms, including hot flashes and depression, than those who took a placebo. More evidence is needed before recommending St. John’s wort for perimenopausal symptoms.
Research suggests that St. John’s wort may be safe in the short term. However, it may not be safe for people who take certain medications.
St. John’s wort can cause serious adverse effects when used with antidepressants. It may also reduce the effectiveness of cancer drugs, HIV medications, birth control pills, and painkillers.
Maca, also known as Peruvian ginseng, has been long used in traditional medicine for improving fertility and increasing sexual desires. Evidence suggests that it exhibits estrogen-like activity and may affect female hormone levels. It may also help reduce menopausal symptoms like hot flashes and night sweats.
There is no standard optimal dose of maca for improving perimenopause symptoms, but the recommended dosage ranges from 3-6 grams daily.
Maca is generally safe and tolerable. Some possible side effects while using maca supplements include stomach pain and headaches.
Due to its estrogen-like effect, maca supplements may not be safe for people with hormone-sensitive conditions like breast, ovarian, or uterine cancer, endometriosis, or uterine fibroids.
There is no clear evidence that supplements or herbal remedies can help alleviate menopause symptoms.
If you are looking to add supplements to manage your symptoms, talk to your healthcare provider about which supplement might be best for you. They can discuss potential side effects and drug interactions to help determine what will suit your needs.
The FDA does not regulate supplements the same way it regulates medications. When buying supplements, look for products tested and certified by third-party companies like Consumer Lab and the U.S. Pharmacopeia, which ensure the product contains the ingredients they claim.
While supplements and herbal remedies may work for some people, research hasn’t proven them to be a reliable treatment for perimenopause symptoms. Other therapies and medications are available to help treat and manage symptoms during the transition to menopause.
Estrogen-based therapy is the most effective treatment for many perimenopause symptoms. It works by providing the body with estrogen to offset decreasing levels of the hormone in the body. This helps reduce symptoms caused by low estrogen.
This treatment is not suitable for everyone. It may not be safe for people with breast cancer, unexplained vaginal bleeding, and untreated endometrial cancer (cancer in the lining of the uterus).
Healthcare providers may sometimes consider a symptom-based treatment approach for managing perimenopause symptoms. For example, the medication Osphena (ospemifene) can help reduce vaginal dryness, while Paxil (paroxetine) can help manage hot flashes and night sweats. Talk to a healthcare provider about your options.
Mind-body exercises like yoga can help improve both physical and mental perimenopause symptoms like bone mineral density, anxiety, depression, and stress. The evidence of the effectiveness of yoga in managing these symptoms is mixed.
Cognitive behavioral therapy (CBT) is one of the most common treatments for mental health conditions like depression and anxiety. The practice involves identifying harmful thought patterns and replacing them with more helpful or positive thoughts and behaviors.
Some studies have found that CBT can help in the treatment of anxiety, depression, and insomnia in women during the menopause transition.
Getting sufficient calcium in your diet or through supplements can help ease perimenopause symptoms. Calcium has a protective effect on bone mineral density loss when used before menopause.
To reduce the risk of bone fracture during and after menopause, people above age 50 should aim to take at least 1,200 milligrams of calcium per day. People younger than 50 should aim to take 1,000 milligrams per day.
Perimenopause is a natural process. While it does not need treatment, it can cause symptoms that may affect quality of life.
Research has found some evidence supporting the use of certain supplements to treat symptoms before and during menopause. These include black cohosh, ginseng, vitamin D, omega-3 fatty acids, and more. However, the research available is minimal, and more robust studies are needed to recommend these supplements as a menopausal treatment.
Look for supplements that have been third-party tested to ensure that they contain the advertised ingredients and are free from contaminants.
Talk to your healthcare provider to see if a certain supplement may be right for you, and let them know if you notice anything unusual while using supplements.
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