Perimenopause Supplements UK — What the Evidence Shows

Tom
2026-03-24T21:22:14+00:00

Perimenopause supplements: what the evidence says

Most perimenopause supplements are sold on hope rather than data. A handful have genuinely useful evidence behind them - creatine, for instance, has shown statistically significant improvements in lean mass and cognitive performance in peri- and postmenopausal women in randomised controlled trials. The rest of the shelf is murkier. Here's my honest read of the primary literature, ingredient by ingredient.

In this article

1. What the evidence actually shows

2. What's biologically happening in perimenopause

3. Dosing: what the clinical evidence actually supports

4. The polyphenol question: promising but cautious

5. Bone density: what actually moves the needle

6. Cognitive symptoms: the overlooked part of perimenopause

7. Aged garlic extract and cardiovascular risk

8. What to actually look for on a UK label

9. Frequently asked questions

10. My honest take

What the evidence actually shows

The honest starting point is that perimenopause research is underfunded relative to the scale of the problem. Around 13 million women in the UK are currently peri- or postmenopausal, yet the supplement literature is thin compared to, say, sports nutrition or cardiovascular disease. That said, some signals are strong enough to take seriously.

Creatine monohydrate is the clearest case. A 12-month RCT by Chilibeck et al. (2021) in 220 postmenopausal women found that creatine supplementation combined with resistance training significantly improved lean tissue mass (p<0.001) and bone mineral density compared to placebo. Effect sizes were modest but clinically meaningful in a population where preserving lean mass is a genuine priority. A separate meta-analysis by Smith-Ryan et al. (2021) covering 405 women confirmed creatine's positive effects on upper body strength and lean mass in this demographic.

Magnesium is another area with reasonable evidence. A systematic review by Arab et al. (2023) found that magnesium supplementation was associated with reductions in insomnia severity scores in adults with suboptimal magnesium status - relevant because sleep disruption is one of the most commonly reported perimenopause symptoms. The human data on magnesium and hot flushes specifically is thin, and I'd be overstating it to claim otherwise.

What's biologically happening in perimenopause

Perimenopause typically spans 4-10 years before the final menstrual period. Oestrogen and progesterone levels don't simply decline - they fluctuate erratically. Follicle-stimulating hormone (FSH) rises as the ovaries become less responsive. This hormonal turbulence has downstream effects across multiple systems.

Oestrogen plays a role in mitochondrial function, bone remodelling, serotonin synthesis, and collagen production. When levels become erratic, you can see effects on mood, sleep architecture, musculoskeletal integrity, and skin. Oestrogen also modulates the hypothalamic thermoregulatory centre - which is why vasomotor symptoms (hot flushes, night sweats) occur. The hypothalamus effectively loses its calibration.

Muscle mass is a particular concern. Oestrogen has anabolic signalling properties; its decline accelerates sarcopenia. Maltais et al. (2018) found that the rate of muscle loss in women increases significantly around the menopausal transition compared to premenopausal years. This is the biological context in which creatine's effects on lean mass become relevant - it's not about aesthetics, it's about preserving functional capacity.

Oxidative stress also increases during the menopausal transition. Oestrogen has antioxidant properties - it upregulates endogenous antioxidant enzymes including superoxide dismutase. As levels fall, the oxidative burden rises. This is the mechanistic basis for interest in polyphenolic compounds and antioxidant nutrients during this period.

Dosing: what the clinical evidence actually supports

Dose matters enormously and most supplement labels get it wrong - either underdosing to cut costs or overdosing to look impressive without clinical justification.

Creatine: The most replicated dose in women's health research is 3-5g daily. The Chilibeck trial used 5g/day. There's no meaningful evidence that loading phases (20g/day for 5-7 days) are necessary for long-term outcomes in this context. The formula at Kojo uses 5,000mg of micronised creatine monohydrate - consistent with what the RCT literature supports.

Magnesium: Most RCTs showing sleep benefit used 300-400mg elemental magnesium daily. Glycinate and malate forms have better gastrointestinal tolerability than oxide. If you're buying a standalone supplement, check the elemental magnesium content - a 500mg tablet of magnesium oxide contains only around 300mg elemental magnesium.

Vitamin C: 500mg daily is a well-supported dose for antioxidant support. At this level, Vitamin C contributes to the protection of cells from oxidative stress, contributes to normal collagen formation for the normal function of skin, and contributes to the reduction of tiredness and fatigue - all relevant given the skin, energy, and oxidative changes that accompany perimenopause.

Algal DHA: Most omega-3 trials in menopausal women used 1-2g EPA+DHA combined. The evidence for DHA specifically on cognitive function and mood in this population is promising but not conclusive - a meta-analysis by Shim et al. (2019) found modest positive effects on depressive symptoms (standardised mean difference ?0.34, 95% CI ?0.57 to ?0.11) in women supplementing omega-3s, though effect sizes were small.

The polyphenol question: promising but cautious

A significant portion of the perimenopause supplement market is built around polyphenolic plant extracts. The mechanistic rationale is sound - they modulate oxidative stress, inflammation, and in some cases interact with oestrogen receptor pathways. The clinical evidence is considerably more mixed.

Grape seed extract

Grape seed extract contains oligomeric proanthocyanidins (OPCs) with demonstrated antioxidant activity in vitro and in small human trials. A pilot RCT by Terauchi et al. (2011) in 91 perimenopausal women found that grape seed extract may help reduce self-reported anxiety and fatigue scores over 8 weeks, though the trial was small and the effect sizes modest. Research is ongoing and large-scale human trials are limited - I wouldn't overstate this.

Pine bark extract

Pycnogenol (French maritime pine bark extract) has been studied more extensively than most botanical supplements in menopausal women. A double-blind RCT by Errichi et al. (2011) in 170 women found statistically significant reductions in menopausal symptom scores (Kupperman Index) with 100mg/day Pycnogenol versus placebo (p<0.001). Vasomotor symptoms, sleep quality, and mood all improved. This is one of the stronger datasets in the botanical category. That said, most trials use proprietary Pycnogenol specifically - whether generic pine bark extracts perform equivalently isn't established.

Olive leaf extract

Olive leaf extract contains oleuropein, which has antioxidant and anti-inflammatory properties in preclinical models. Some research suggests it may help support cardiovascular markers, including blood pressure, though the evidence in perimenopausal women specifically is limited and large-scale human trials are lacking. I'd treat it as a reasonable antioxidant inclusion rather than a targeted perimenopause intervention.

Bone density: what actually moves the needle

Bone loss accelerates sharply around perimenopause - women can lose up to 20% of bone density in the 5-7 years following menopause, per Recker et al. (2000). The supplement evidence here is more established than in most other areas.

Calcium and vitamin D3 remain the foundation. A Cochrane review by Avenell et al. (2014) covering over 50,000 participants found that combined calcium and vitamin D supplementation reduced fracture risk in older women, though the effect was more pronounced in institutionalised populations than community-dwelling ones. For women who are deficient - which is common in the UK given our latitude and diet - supplementation is sensible.

Creatine's effect on bone is worth noting again. The Chilibeck (2021) trial found that creatine plus resistance training improved femoral neck bone mineral density versus resistance training alone. The mechanism likely involves creatine's role in cellular energy availability for osteoblast function. This is a secondary benefit that most people don't associate with creatine.

For broader context on nutritional needs during this life stage, my piece on supplements for women covers the full evidence picture across the female lifespan.

Cognitive symptoms: the overlooked part of perimenopause

Brain fog, word-finding difficulties, and memory lapses are among the most distressing - and least discussed - perimenopause symptoms. They're also among the hardest to study because cognition is difficult to measure objectively in free-living populations.

The evidence for creatine's cognitive effects is more developed than most people realise. A meta-analysis by Avgerinos et al. (2022) covering 281 participants found that creatine supplementation significantly improved memory performance (standardised mean difference 0.58, 95% CI 0.24-0.91, p=0.001), with effects strongest in older adults and vegetarians - two groups with lower baseline creatine stores. Menopausal women often fall into the older adult category and frequently have lower dietary creatine intake if they're reducing red meat consumption.

Algal DHA is also worth considering here. DHA is the primary structural fatty acid in neuronal membranes, and its incorporation into brain tissue is influenced by dietary supply. The evidence for DHA specifically on cognitive function in midlife women is preliminary but biologically plausible.

Anxiety and mood changes are closely linked to the same hormonal shifts. If that's a primary concern, my piece on supplements for stress and anxiety covers the evidence on ashwagandha, magnesium, and L-theanine in more detail.

Aged garlic extract and cardiovascular risk

Perimenopause marks a meaningful inflection point in cardiovascular risk. Before menopause, women have lower rates of cardiovascular disease than men of the same age. After menopause, that gap closes substantially. Oestrogen's cardioprotective effects - modulating lipid profiles, endothelial function, and inflammatory markers - diminish.

Aged garlic extract (AGE) has been studied for cardiovascular endpoints more rigorously than most botanical supplements. A meta-analysis by Ried et al. (2016) covering 12 trials found that AGE supplementation was associated with meaningful reductions in systolic blood pressure in hypertensive individuals (mean reduction ~5mmHg). Research suggests AGE may help support healthy blood pressure, though I'd note that most trials used doses of 600-1200mg AGE daily, and the evidence is stronger in people with elevated baseline blood pressure than in normotensive individuals. Large-scale trials specifically in perimenopausal women are limited.

What to actually look for on a UK label

The UK supplement market is regulated under the Food Supplements (England) Regulations 2003, with health claims governed by the Nutrition and Health Claims Regulation (NHCR). This means any product making a health claim must use authorised wording - which is actually useful for consumers, because it creates a floor below which claims can't fall without being illegal.

Practically speaking, look for:

Actual doses, not proprietary blends. If a label lists a "botanical complex" without individual doses, the manufacturer is hiding something - usually the fact that active ingredients are present in sub-therapeutic amounts.

Form matters. Magnesium oxide is cheap and poorly absorbed. Creatine monohydrate is the form with the evidence base - not creatine HCl, not buffered creatine. Algal DHA is the sustainable, bioavailable form of omega-3 DHA.

Realistic claims. No supplement treats perimenopause. The honest framing is that certain nutrients support specific physiological functions that are under stress during this transition.

If you want a broader framework for evaluating supplement quality in the UK context, my piece on best greens powders UK 2026 walks through the same principles applied to a different category.

Frequently asked questions

Is creatine safe for perimenopausal women?

Yes, based on the available evidence. The Chilibeck et al. (2021) RCT ran for 12 months in 220 postmenopausal women with no significant adverse events reported. Creatine is one of the most studied supplements in existence. The main side effect at standard doses is mild water retention in muscle tissue, which is physiologically benign. Chilibeck et al. (2021)

Do phytoestrogens (soy isoflavones, red clover) work for hot flushes?

The evidence is mixed. A Cochrane review by Lethaby et al. (2007) found modest reductions in hot flush frequency with isoflavones versus placebo, but effect sizes were small and inconsistent across trials. They may help some women and do little for others. The safety profile appears acceptable for most women without hormone-sensitive conditions.

What about black cohosh?

A systematic review by Shams et al. (2010) found some evidence of benefit for vasomotor symptoms, but trial quality was generally poor. There are also rare case reports of hepatotoxicity associated with black cohosh, which warrants caution. I'd want to see better-quality trials before recommending it confidently.

Should I take vitamin D during perimenopause?

If you live in the UK and aren't supplementing, there's a reasonable chance you're deficient - particularly October through March. The NHS recommends 10mcg (400 IU) daily for the general population. For bone health specifically, most trials showing benefit used 800-1000 IU combined with calcium. Avenell et al. (2014)

Can supplements replace HRT?

No. Hormone replacement therapy has a substantially larger evidence base for managing moderate-to-severe vasomotor symptoms than any supplement. For women who can take HRT, it remains the most effective intervention for symptom management. Supplements address specific nutritional gaps and physiological functions - they're not hormonal interventions. Discuss HRT with your GP.

How long before I'd expect to notice any difference from creatine?

Muscle creatine stores take approximately 4 weeks to saturate at 3-5g/day without a loading phase. Cognitive effects in trials have typically been assessed at 4-8 weeks. Don't expect anything dramatic in week one. Avgerinos et al. (2022)

My honest take

I came to this topic because several women who use Kojo asked me directly what the evidence said about perimenopause supplementation. I spent longer than I expected in the literature, partly because the research is genuinely patchy and partly because the marketing around this topic is particularly egregious - lots of "hormone balance" language attached to products with no plausible mechanism and doses too low to do anything.

What I came away with: creatine has the strongest and most consistent evidence in this population, and it's still underused. The cognitive and musculoskeletal data are both credible. Pine bark extract has better RCT data than I expected. Most of the rest - the adaptogens, the "hormone support" blends - ranges from plausible-but-unproven to frankly speculative.

I'm also aware that supplements are not the primary intervention here. Sleep hygiene, resistance training, dietary protein adequacy, and - for many women - a proper conversation with a GP about HRT will do more than any combination of capsules. Supplements fill specific gaps; they don't replace fundamentals.

The women I've spoken to who are navigating perimenopause are not looking for miracles. They want to know what's actually worth their money and what isn't. I hope this is useful for that.

References (11 studies)

1. Chilibeck et al. (2021) - Creatine supplementation and resistance training in postmenopausal women: 12-month RCT, n=220. Lean mass and bone mineral density outcomes.

2. Smith-Ryan et al. (2021) - Creatine supplementation in women: meta-analysis, n=405. Upper body strength and lean mass outcomes.

3. Arab et al. (2023) - Magnesium supplementation and insomnia: systematic review. Sleep quality outcomes in adults with suboptimal magnesium status.

4. Maltais et al. (2018) - Muscle mass loss and the menopausal transition: accelerated sarcopenia in perimenopausal women.

5. Shim et al. (2019) - Omega-3 supplementation and depressive symptoms in menopausal women: meta-analysis. SMD ?0.34 (95% CI ?0.57 to ?0.11).

6. Terauchi et al. (2011) - Grape seed extract in perimenopausal women: pilot RCT, n=91. Anxiety and fatigue scores over 8 weeks.

7. Errichi et al. (2011) - Pycnogenol in menopausal women: double-blind RCT, n=170. Kupperman Index scores, p<0.001.

8. Recker et al. (2000) - Bone density loss in women around menopause: up to 20% loss in 5-7 years post-menopause.

9. Avenell et al. (2014) - Cochrane review: calcium and vitamin D supplementation and fracture risk, n>50,000.

10. Avgerinos et al. (2022) - Creatine supplementation and cognitive function: meta-analysis, n=281. SMD 0.58 (95% CI 0.24-0.91, p=0.001).

11. Ried et al. (2016) - Aged garlic extract and blood pressure: meta-analysis, 12 trials. Mean systolic reduction ~5mmHg in hypertensive individuals.