Are perimenopause supplements effective and safe?

The perimenopause (or premenopause) refers to the transition phase that precedes menopause. It generally begins between the ages of 40 and 50 and can last from a few months to several years (on average 4 years, sometimes up to 10). During this period, oestrogen and progesterone production fluctuates and then gradually declines, leading to the appearance of the first signs (1).

The menopause is reached when periods have been absent for 12 consecutive months. At this stage, the hormonal decline is permanent and the ovaries almost completely cease to function (2).

Symptoms vary considerably from woman to woman, but the most common ones include (3):

• Hot flushes (affecting 70 to 80% of women)
• Night sweats
• Irregular menstrual cycles (shorter, longer, heavier or lighter flow)
• Chronic fatigue
• Emotional disturbances: irritability, anxiety, mood swings, and even mild depressive symptoms
• mild incontinence or urinary leaks
• Changes in sleep: difficulty falling asleep, frequent night-time waking
• Weight gain, especially around the abdomen
• On an intimate level: vaginal dryness, intimate discomfort, reduced libido. Daily hydration and appropriate intimate care can help preserve comfort.
• Joint pain
• Brain fog: difficulty concentrating, forgetfulness, short-term memory problems

These symptoms can significantly impact quality of life, both professionally and personally.

Food supplements can be grouped into two main categories according to their composition: those based on plants (herbal medicine), and those based on micronutrients (vitamins, minerals). Which is best? For each category, we will examine proven efficacy, potential risks and the available scientific data.

Herbal supplements

This category includes classical phytoestrogens, black cohosh, adaptogens (maca, ashwagandha, shatavari) and others used traditionally. It is essential to distinguish those with solid evidence and a high safety profile from those that are controversial, ineffective or risky.

a) Classical phytoestrogens and black cohosh: limited efficacy and hormonal risks

Classical phytoestrogens or phytohormones, notably the isoflavones of soy, of red clover and of hops, have a chemical structure close to human oestrogens. A meta-analysis of 17 studies showed that soy isoflavones (54 mg/day) reduce hot flushes by 20% in frequency and 26% in severity after a minimum of 3 months. However, the placebo effect is strong (29%), the studies vary considerably, and this modest impact has not been clinically proven to be particularly useful on a day-to-day basis. For this reason, ANSES and EFSA prohibit food supplements containing soy isoflavones from claiming to relieve hot flushes, due to insufficient evidence (5).

Theblack cohosh (Cimicifuga racemosa), often sold as a natural alternative, does not contain isoflavones and has no direct oestrogenic action. Its active constituents are triterpenes, not phytohormones. It appears to work in some women to reduce hot flushes, with variable results. It would only relieve around 30% of them compared with 70% for synthetic oestrogens, and its effects are thought to be primarily psychological (reduction of stress and anxiety) rather than hormonal. Furthermore, 3 out of 11 products tested did not contain the declared active ingredient, which raises a major quality concern. Its exact mechanism remains debated (possible action on serotonin), but it does not bind to oestrogen receptors (6).

The risks differ :

• Phytoestrogens: contraindicated in cases ofpersonal history of breast cancer or hormone-dependent uterine cancers. Risk of overdose (ANSES: max 1 mg/kg/day of isoflavones). Side effects: nausea, bloating, uterine bleeding.
• Black cohosh: no oestrogenic risk but rare risk of hepatic toxicity (7 cases in 10 reports). It is also contraindicated in cases of hormone-dependent cancer. Side effects: headaches, digestive discomfort.

Whether in France or abroad, no study has validated the long-term safety of these products. Phytoestrogens can stimulate hormone-sensitive tissues (cancer risk). Black cohosh, although without an oestrogenic mechanism, should be used with caution (use limited to a few months, prolonged use under medical supervision).

b) Adaptogens: maca, ashwagandha, shatavari

Adaptogens are plants thought to help the body adapt to stress and restoring overall hormonal balance. The maca (Lepidium meyenii) shows mainly anecdotal data for the menopause: some studies indicate a mild reduction in fatigue, libido and psychological symptoms (anxiety, mild depression), but evidence on hot flushes remains insufficient (7). It is generally well tolerated, but may cause digestive issues, headaches andinsomnia if taken in the evening.

Theashwagandha (Withania somnifera) has demonstrated in several studies a significant reduction in stress (up to 44%) and anxiety, with a beneficial impact on wellbeing and sleep by reducing cortisol (8). It may also have a broader beneficial effect on the body: skin, hair, muscles, etc. However, it can increase thyroid hormones and is not recommended in cases ofhyperthyroidism, to people with endocrine disorders (particularly thyroid dysfunction and hyperandrogenaemia), autoimmune conditions, pregnancy or breastfeeding. It may also interact with sedative, thyroid or immunosuppressant medications. Choose an organic form and opt for the KSM-66® variety. 

The shatavari (Asparagus racemosus), an Ayurvedic plant rich in steroidal saponins (and not as isoflavones), acts as a gentle modulator of oestrogen receptors, preferentially on ERβ receptors (protective). It is traditionally used for female wellbeing, stress, energy and cycle regulation. In one study, after 60 days, hot flushes were notably reduced by 93% (compared with 41% under placebo), with only 12% of women still affected (vs 58%), while night sweats almost completely disappeared (2 out of 35 affected), with a reduction three times greater than placebo (-92% vs -30%). Its action is moderating rather than a crude stimulant, which gives it a safety profile higher than that of soy, even in certain situations of hormonal imbalance (9). 

c) Other plants: sage, saffron, milk thistle

Unlike the previous ones, these act through different mechanisms, often with a superior safety profile and more reliable evidence for targeted symptoms.

The sage (Salvia officinalis) is recognised for significantly reducing frequency and intensity of hot flushes and night sweats. An 8-week double-blind study of 71 menopausal women showed a 46% reduction in mild hot flushes, and an overall reduction of up to 81% after 2 months (10). It acts on heat regulation and reduces perspiration, with no oestrogenic effect. Very well tolerated and with no hormonal risk.

The saffron (Crocus sativus) has demonstrated its efficacy on wellbeing, the reduction of anxiety and irritability, with results comparable to certain mild antidepressants. A study of 160 menopausal women found a significant reduction in symptoms such as hot flushes, irritability, sleep disturbances and mood swings (11). Another 12-week study of 86 perimenopausal women confirmed a reduction in symptoms with 14 mg of extract twice daily (12). Saffron modulates serotonin, dopamine and noradrenaline, with no direct effect on oestrogen receptors in sensitive tissues. It is very well tolerated at standard doses (≤30 mg/day).

The milk thistle (Silybum marianum) does not act directly on hot flushes but supports the liver and the digestion, essential during perimenopause when hormonal metabolism is less efficient. Rich in silymarin, it protects and regenerates liver cells, supports detoxification and the elimination of excess oestrogens, and helps ease digestive discomfort after meals. It is very well tolerated and presents no hormonal risk (13).

Péri Support by Jolly Mama

Among the existing formulas, Péri Support by Jolly Mama stands out with a targeted combination of 4 ingredients: sage (menopausal comfort, night sweats), shatavari (stress, energy, comfort and cycle regulation), saffron (wellbeing, relaxation) and milk thistle (liver support and digestion).

This formula is hormone-free, 100% plant-based, suitable from age 35, including in cases of personal history of breast cancer or thyroid disorders. At 2 capsules per day, Péri Support can be taken alone or as a duo with Péri Essentials, whose complementary composition of vitamins and minerals reinforces the relief. The selection of these ingredients is based on a favourable level of evidence and a high safety profile.

Micronutrient-based supplements 

This category covers vitamins (B6, B9, B12, D, E, C, K2) and minerals (calcium, magnesium, zinc, selenium), essential for compensating increased deficiencies and relieving perimenopausal symptoms. During this period, the decline in oestrogen leads to accelerated bone loss, increased oxidative stress and nervous irritability. Here are the most useful micronutrients and their practical effects:

• Calcium (1200 mg/day from all sources combined) + Vitamin D: reduce bone density loss in women aged 50 and over (14)
• Vitamin K2: directs calcium towards the bones and prevents its deposit in the arteries.
• Magnesium: reduces fatigue, stress and improves sleep quality by calming the nervous system.
• Vitamins B6, B9, B12: regulate the nervous system and reduce fatigue via the synthesis of serotonin and dopamine (15).
• Vitamins C and E + Zinc + Selenium: protect cells against increased oxidative stress associated with declining oestrogen levels.

The calcium should not exceed 2,000 mg/day from all sources combined, to avoid kidney stones and cardiovascular risks. The vitamin D can lead to hypervitaminosis (rare) at very high doses (>10,000 IU/day over the long term). The magnesium causes diarrhoea at high doses (>350 mg/day of elemental magnesium) and when supplied in forms such as oxide or marine magnesium. The B vitamins are generally safe as they are water-soluble, but excessive doses of B6 (>100 mg/day over the long term) can cause peripheral neuropathies. It is important not to combine multiple sources of micronutrients in order to avoid overdosing.

Péri Essentials by Jolly Mama

Péri Essentials is a comprehensive formula designed specifically for the needs of the perimenopause. It combines:

Vitamins B6, B9, B12: hormonal regulation and nervous system balance

Vitamins D + K2: bone preparation and calcium absorption

Vitamins E, C, zinc, selenium: overall antioxidant action

Patented Bacopa extract: support for cognitive function, concentration, and memory

There are several pitfalls to avoid when choosing a supplement. The hidden phytoestrogens (soya, red clover, hops - undeclared) can appear in products labelled "Natural". The isoflavone overdose is possible if several products are combined; do not exceed 1 mg/kg/day. The drug interactions serious interactions exist, in particular with St John's wort (antidepressants, anticoagulants, contraceptives) (16). Prefer brands that are transparent on dosages (mg per capsule indicated) and prices, and be wary of false claims such as "Relieves 100% of hot flushes". Finally, choose products that are quality-certified, as the absence of testing may mean that the product does not contain the declared ingredient.

The most common side effects include: nausea, bloating and uterine bleeding for phytoestrogens ; headaches, digestive discomfort and rare hepatotoxicity forblack cohosh ; insomnia, agitation and digestive problems for maca ; drowsiness and thyroid interactions forashwagandha ; diarrhoea at high doses for magnesium ; serious interactions for St John's wort ; long-term neuropathy for vitamin B6 high dose (>100 mg/day); and kidney stones or cardiovascular risk for calcium in overdose (>2000 mg/day).

Supplements to avoid in pre-menopause / perimenopause

Some molecules or supplements may further disrupt the fragile hormonal balance of this period and are not suitable without medical advice.
It is generally recommended to limit or avoid :

• Wild yam (or yam), often used as a "phyto-oestrogen", as its effects on cycles and hormonal risk are not well evaluated, particularly in cases where hormonal imbalances are already present.
• Royal jelly. One study suggests that royal jelly may alleviate certain menopausal symptoms through its oestrogen-like activity, but the data remain limited and do not guarantee either its safety or its efficacy for self-medication (17).
• DHEA, a pro-androgenic hormone that may cause acne, increased hair growth, mood disturbances, a reduction in HDL cholesterol and a theoretical increase in the risk of hormone-dependent cancers. It is not authorised as a food supplement.
• Iron without medical need: A blood test (ferritin, haemoglobin) is always necessary before considering iron supplementation.  
• Vitamin E at high doses, often sold for "skin" or "fatigue", which has not been shown to provide any clear benefit for pre-menopause.