Best Supplements to Start With in Perimenopause: A Practical Guide
Discover the best supplements to start with in perimenopause. Magnesium, vitamin D3, omega-3, B complex and creatine explained with dosing and quality tips.
Why Supplement Needs Change in Perimenopause
Perimenopause is not simply a hormonal event. It is a physiological shift that changes how your body absorbs, uses, and loses nutrients. Oestrogen decline affects bone mineral density, which increases calcium and vitamin D demands. Poor sleep drives up cortisol, which depletes magnesium. Inflammation increases, which raises the need for anti-inflammatory omega-3 fatty acids. At the same time, many women find their appetite and digestion change, making it harder to consistently get enough from food alone. Supplements do not replace a healthy diet or medical treatment, but the right ones, introduced carefully and one at a time, can meaningfully reduce symptoms and protect long-term health. The key is knowing which ones actually have evidence behind them for perimenopause and which are marketing noise.
Magnesium: The Foundation Supplement
Magnesium is involved in over 300 enzymatic processes including sleep regulation, muscle relaxation, mood, and blood sugar control. Studies suggest that 60 to 70 percent of adults in the UK and US are deficient, and perimenopause increases demand further because stress hormones deplete magnesium stores faster. For sleep and anxiety, magnesium glycinate is the best-tolerated form. For constipation and digestion, magnesium citrate works faster. For muscle soreness and fibromyalgia-type pain, magnesium malate is often preferred. Start with 200mg at bedtime. You can increase to 300 to 400mg over several weeks if tolerated. Avoid magnesium oxide: it is cheap and widely sold but has very low bioavailability. Look for third-party tested brands and avoid products with unnecessary fillers or artificial colourings.
Vitamin D3 and K2: Bone and Immune Support
Vitamin D3 is essential for calcium absorption, immune function, and mood regulation. Deficiency is extremely common in the UK and northern US states, particularly in winter. In perimenopause, falling oestrogen accelerates bone density loss, making adequate vitamin D non-negotiable. Most adults need at least 1,000 to 2,000 IU daily, and many perimenopause specialists recommend 2,000 to 4,000 IU based on blood test results. Vitamin K2 (specifically the MK-7 form) is important to take alongside D3 because it directs calcium into bones rather than arteries. A combined D3 and K2 capsule simplifies dosing. Get your vitamin D blood level tested before starting high doses: the optimal serum level is 100 to 150 nmol/L. Take both supplements with your largest meal of the day as they are fat-soluble.
Omega-3: Mood, Joints and Inflammation
Omega-3 fatty acids, specifically EPA and DHA, have strong evidence for reducing inflammation, supporting mood, protecting cardiovascular health, and easing joint pain. All four of these become more pressing in perimenopause. EPA is the more mood-relevant fraction and is the primary target for studies on depression and anxiety. DHA supports brain and retinal health. A combined supplement with at least 1,000mg of EPA plus DHA daily is a reasonable starting dose, with some studies supporting 2,000 to 3,000mg for mood benefits. Choose fish oil in triglyceride form rather than ethyl ester form for better absorption, or choose algae-based omega-3 if you are vegan. Keep fish oil refrigerated after opening and check the certificate of analysis for oxidation (TOTOX) values: fresh oil should have a TOTOX score below 26.
B Complex: Energy, Mood and Nerve Function
B vitamins work as a group and are involved in energy production, red blood cell formation, nerve function, and the methylation cycle that regulates mood and DNA repair. B6 has specific relevance to perimenopause because it supports serotonin and GABA synthesis, and deficiency is associated with depression, irritability, and sleep disruption. B12 absorption decreases with age. Folate (ideally as methylfolate, the active form) is important for women who carry the MTHFR gene variant, which is common and affects folate metabolism. A good B complex should contain methylfolate rather than folic acid, and methylcobalamin rather than cyanocobalamin for B12. Take B vitamins in the morning as they can be stimulating and disrupt sleep if taken in the evening.
Creatine: Muscle, Brain and Energy
Creatine monohydrate is one of the most extensively studied supplements in sports science and is now attracting growing interest specifically for perimenopausal women. It supports phosphocreatine regeneration in muscle, which improves strength training output and reduces post-exercise fatigue. More recently, research has suggested creatine also has neuroprotective properties and may support working memory and cognitive function, which is directly relevant to perimenopause brain fog. Women produce less creatine naturally than men, and oestrogen decline further reduces creatine storage. A dose of 3 to 5 grams of creatine monohydrate daily is well evidenced, with no loading phase necessary. Mix it into water or a smoothie; it is flavourless. Look for Creapure-certified creatine monohydrate for guaranteed purity.
How to Introduce Supplements Safely
Adding five new supplements at once is a recipe for not knowing what is helping, what is causing side effects, or how they are interacting. The better approach is to introduce one supplement at a time, starting with the one most relevant to your current symptoms, and waiting two to four weeks before adding the next. Start with magnesium if sleep or anxiety is your main issue. Start with vitamin D3 if you have not been tested or know you are deficient. Track how you feel each day using a symptom log: PeriPlan lets you log symptoms and track patterns over time, making it straightforward to see whether a new supplement is coinciding with improvement or causing new issues. Always inform your GP of any supplements you are taking, particularly if you are on any prescription medications, as some supplements interact with common drugs.
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