Are perimenopause supplements effective and safe?

The perimenopause (or premenopause) refers to the transitional 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 time, the production of oestrogen and progesterone fluctuates and then gradually decreases, leading to the onset of premenopause symptoms (1).

The menopause is reached when periods have stopped 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 urinary incontinence or leaks
• Sleep changes: 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 issues

These symptoms can significantly impact quality of life, both professionally and personally. The good news is that a food supplement menopause can help.

Food supplements can be grouped into two broad 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 the proven efficacy, potential risks and available scientific evidence.

Plant-based supplements

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

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

Classic phytoestrogens or phytohormones, particularly isoflavones from soya, red clover and of hops, have a chemical structure close to human oestrogens. A meta-analysis of 17 studies showed that soya 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 high (29%), the studies vary widely, and this modest impact is not clinically proven to be genuinely useful day to day. As a result, ANSES and the EFSA prohibit food supplements containing soya 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 compounds are triterpenes, not phytohormones. It appears to work in some women to reduce hot flushes, with variable results. It is thought to provide relief for only 30% of women compared to 70% for synthetic oestrogens, and its effects are believed to be primarily psychological (stress and anxiety reduction) rather than hormonal. In addition, 3 out of 11 products tested did not contain the declared active ingredient, which poses a major quality concern. Its exact mechanism remains debated (possible action on serotonin), but it does not bind to oestrogen receptors (6).

Risks differ :

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

In France or abroad, no studies have validated the long-term safety of these products. Phytoestrogens can stimulate hormone-sensitive tissues (cancer risk). Black cohosh, although lacking an oestrogenic mechanism, should be used with caution (durations limited to a few months, prolonged use under medical supervision).

b) Adaptogens: maca, ashwagandha, shatavari

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

TheKSM-66 ashwagandha (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 is also reported to have wider benefits across the body: skin, hair, muscles, etc. However, it can increase thyroid hormone levels and is not recommended in case ofhyperthyroidism, for people with endocrine disorders (particularly thyroid dysfunction and hyperandrogenism), autoimmune diseases, during pregnancy or breastfeeding. It may also interact with sedatives, thyroid medication or immunosuppressive treatments. Choose organic and in the KSM-66® form. 

The shatavari (Asparagus racemosus), an Ayurvedic plant rich in steroidal saponins (and not 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, it notably showed after 60 days that hot flushes were reduced by 93% (versus 41% with 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 crudely stimulating, which gives it a safety profile higher than that of soya, even in certain situations of hormonal imbalance (9). 

c) Other botanicals: sage, saffron, milk thistle

Unlike the former, these work through different mechanisms, often with a superior safety profile and more reliable evidence for targeted concerns.

The sage (Salvia officinalis) is recognised for significantly reducing the frequency and intensity of hot flushes and night sweats. An 8-week double-blind study on 71 postmenopausal women showed a 46% reduction in mild hot flushes, and an overall reduction of up to 81% after 2 months (10). It acts on temperature regulation and reduces perspiration, without any oestrogenic effect. Very well tolerated with no hormonal risk.

The saffron (Crocus sativus) has demonstrated efficacy on wellbeing, reducing anxiety and irritability, with results comparable to certain mild antidepressants. A study on 160 postmenopausal women demonstrated a significant decrease in concerns such as hot flushes, irritability, sleep changes and mood swings (11). Another 12-week study on 86 perimenopausal women confirmed symptom reduction with 14 mg of extract twice daily (12). Saffron modulates serotonin, dopamine and noradrenaline, without any direct effect on the oestrogen receptors of sensitive tissues. It is very well tolerated at standard dosages (≤30 mg/day).

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

Péri Support by Jolly Mama

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

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

Micronutrient supplements 

This category includes vitamins (B6, B9, B12, D, E, C, K2) and minerals (calcium, magnesium, zinc, selenium), essential to compensate for increased deficiencies and ease the signs of perimenopause. During this time, declining oestrogen leads to accelerated bone loss, greater oxidative stress and nervous irritability. Here are the most useful micronutrients and their concrete benefits:

• Calcium (1,200 mg/day from all sources combined) + Vitamin D : reduce bone mineral density loss in women aged 50 and over (14)
• Vitamin K2 : directs calcium to the bones and prevents it from being deposited 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 linked to falling 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.