Building a Smart Supplement Strategy in Perimenopause

Are supplements overwhelming you? It seems like each week there's a new one being marketed that's the be-all-end-all for women in perimenopause and menopause. 

Honestly, it’s enough to make anyone’s head spin, and it’s easy to feel like you’re missing something crucial, or worse, wasting money on things you don’t need.

Now here's the truth: you don’t need a cabinet full of supplements and powders. In fact, you might not need any supplements at all. And if you’re already taking multiple, it might be time to take a hard look at each one and ask whether it’s actually benefiting you.

What you do need is a clear strategy that supports your gut, hormones, energy, and overall wellbeing: one that’s tailored to you, not the latest marketing hype.

Keep in mind that a smart approach means starting one new supplement at a time, giving it 4-6 weeks to see if it truly makes a difference. That way, you’ll know what’s actually working (and what’s just taking up space on your shelf and emptying your bank balance!).

Let’s walk through how to build a supplement strategy that keeps it simple, effective, and grounded in real science. (Note: Please advise your GP of anything you are planning to take. Some supplements interact with medications).

First Thing's First: Start With Your Foundation

Think of your supplement strategy like a cake or a pyramid. At the base lies nutrition, the foundation of your health. In the middle is lifestyle, like movement and sleep. At the top (the cherry on the top) is medications and supplements. Supplements should support a balanced diet, not replace it! 

• Focus on gut-loving foods first: fibre-rich vegetables, fermented foods (like kefir, sauerkraut, yoghurt), prebiotics (onion, garlic, asparagus), and hydration.
• Stabilise blood sugar: include protein, complex carbs, adequate fibre, and healthy fats with every meal to reduce energy crashes and mood swings.
• Support your microbiome: a healthy gut helps regulate oestrogen metabolism, impacting symptoms like bloating, mood changes, weight management and even hot flushes.

Once your foundation is solid, then consider targeted supplements.

Step 1: Know Your Blood Work

Now this is a very important first step. Before adding anything new to your daily routine, check your baseline levels. Ask your doctor for comprehensive blood work that includes:

• Iron and ferritin (low iron is common and can mimic fatigue or brain fog)
• Vitamin D and calcium levels (essential for bone and hormone health)
• B12, thyroid function, and inflammatory markers
• Lipid profile (as heart health risk increases in midlife)

Start by correcting any clear deficiencies. If your iron or vitamin D is low, that’s your first supplement priority.

Step 2: Target Specific Symptoms, Your Smart Supplement Layer

Once you’ve built a strong foundation with whole foods and checked your blood work, it’s time to look at targeted support. Perimenopause affects everyone differently, so this is about tuning into your body, not throwing everything at once and hoping something sticks.

Below is a breakdown of the most common concerns and the evidence-based supplements that can help to support you. 

Gut Health & Hormone Metabolism

Your gut does far more than digest food, it’s deeply involved in oestrogen regulation, supporting immunity, metabolism, even supporting your mood. We want to take a moment to highlight that the best way to support your gut is through your food (plant diversity, fibre, etc.) but there are key supplements that can help to support you IF there are any gaps.

Key supplements to consider:

• Probiotics:
  Not all probiotics are created equal, and not everyone needs a probiotic. There are certain strains that CAN support specific conditions, such as managing IBS symptoms or supporting vaginal health. Depending on your needs, a specific probiotic strain may be able to help you.
• Prebiotic Fibre (Inulin, Partially Hydrolysed Guar Gum):
  Not everyone needs a fibre supplement. As we discussed in our latest blog on psyllium husk, it may even contribute to unwanted symptoms if you’ve already got plenty of fibre in your diet. However, if you struggle to get enough fibre consistently then a fibre supplement may help. It feeds beneficial gut bacteria and helps keep bowel movements regular. Remember to start slow and increase slowly to avoid gas or discomfort. Check with your health practitioner.
• Digestive Enzymes:                                                                                                             For most people, broad “digestive enzyme” blends (a bit of protease, lipase, amylase all thrown together) aren’t well supported by evidence and usually aren’t needed if your pancreas is working normally (despite their popularity!). Enzymes are most helpful when they’re targeted to a specific problem – for example:

• Lactase for lactose intolerance

• Pancreatic enzyme replacement for diagnosed pancreatic insufficiency

• Other specialist enzymes for confirmed carbohydrate intolerances (prescribed/guided by a gastroenterologist or dietitian)

If you’re getting regular bloating or discomfort after meals, it’s far better to look at what and how you’re eating (and rule out medical issues) rather than relying on a catch-all enzyme blend.

For Energy, Fatigue & Brain Fog

The hormonal fluctuations of perimenopause (along with everything else that you may have going on in your life) can certainly lead to feeling run down and chronically fatigued. If you've got your bases covered - eating regular balanced meals, having a set bed routine, limiting caffeine - there are several supplements which may help. 

Helpful additions:

• Magnesium (Glycinate or Threonate):
  Calms the nervous system, supports deep sleep, and reduces PMS-style mood shifts. Glycinate is best for relaxation and sleep; threonate is ideal for cognitive clarity and focus.
• Iron (If Deficient):
  Many women experience low iron in their 30s and 40s due to lighter but irregular cycles. Supplementing can dramatically improve fatigue, but only if blood work confirms deficiency.
• CoQ10:
  A potent antioxidant that supports energy, cardiovascular health, and cognitive sharpness. Levels naturally decline with age and stress.

For Mood, Stress & Sleep

As oestrogen levels decline, cortisol and serotonin balance can change, often showing up as anxiety, irritability, or disrupted sleep.

Consider:

• Magnesium (again!), especially glycinate or citrate for calming before bed.
• Ashwagandha: An adaptogenic herb shown to reduce cortisol, improve resilience to stress, and enhance sleep quality. Look for standardised extracts such as KSM-66 or Sensoril. 
• L-Theanine:
  Found naturally in green tea, it promotes calm alertness, ideal if you’re feeling overstimulated but tired.
• Omega-3s (EPA + DHA):
  Support mood regulation, brain health, and inflammation control. Choose a high-quality, IFOS-certified fish oil or algal-based supplement.

 For Skin, Hair & Joint Support

Collagen loss accelerates once oestrogen drops, leading to drier skin, thinning hair, and reduced elasticity.

Supportive options:

• Marine Collagen Peptides:
  The most bioavailable form, clinically shown to improve skin hydration, elasticity, and nail strength.Combine with Vitamin C to support natural collagen synthesis.
• Hyaluronic Acid (Oral):
  Emerging research suggests it supports skin moisture and joint health from within.

For Hot Flushes, PMS-like Symptoms & Hormonal Balance

These are often the most uncomfortable signs of perimenopause. Some botanicals can offer gentle, natural support, but they should always be used mindfully.

Options to discuss with your practitioner:

• Black Cohosh:
  One of the most researched herbs for hot flushes and night sweats, although research is limited.
• Red Clover:
  Contains isoflavones (plant oestrogens) that has limited evidence that it may relieve mild menopausal symptoms. Works best for women who still have some natural oestrogen activity.
• Vitex (Chaste Tree Berry):
  Potentially helpful for cycle irregularities, PMS-type symptoms, and breast tenderness, but research is limited.

Note: Herbal supplements can interact with hormonal therapies or medications. Always seek professional guidance before starting them, especially if you have hormone-sensitive conditions.

Step 3: Long-Term Support & Prevention

Perimenopause isn’t just about symptom relief, it’s also about protecting your long-term health. Once your foundation and symptoms are addressed, supplements may have their place to help support you long-term:

• Calcium + Vitamin D + K2: the trio for strong bones and heart health. Safe sun exposure and including dairy products regularly can help you meet your increased needs. Only if gaps in your diet are identified or a deficiency is confirmed then a supplement can help.
• Creatine: supports muscle tone, strength, and cognition, especially important as oestrogen drops. Check out our latest blog on creatine for a deep dive into the latest evidence!
• Ashwagandha or magnesium glycinate: may help to calm stress and support restorative sleep.

Safety First

Just because a supplement is “natural” doesn’t mean it’s automatically safe. Some can interact with medications or medical conditions, and not all are meant for long-term use. Always speak to your doctor or a qualified health professional before starting anything new.

A Final Word

Remember, supplements are just one tool in your perimenopause toolkit. The best approach to supporting your health comes from building a strong foundation with whole foods fist. When you do choose to use supplements, approach them thoughtfully, one at a time, and always in consultation with a healthcare professional. With a clear strategy, you can feel confident that each choice supports your energy, hormones, and overall wellbeing, helping you navigate this transition with more ease, balance, and vitality.

Reference:

Gray, S. (2024). It’s not you, it’s perimenopause: How to navigate the physical and emotional changes with confidence. Hachette Australia.