Supplements during menopause: what is worth taking?

What happens in the body when oestrogen falls?

Oestrogen does much more than govern the menstrual cycle. The hormone affects bones, skin, blood vessels, brain and mucous membranes. When levels fall during menopause, it is therefore noticeable in several places at once.

Bone mass decreases by around 1–2 percent per year during the first years after menopause. The skin's collagen decreases by up to 30 percent during the first five years. Many women also sleep worse, sweat at night and feel more tired than before.

The changes often begin as early as perimenopause, the years before the final period. That is why it is wise to review your diet – and any supplements – in good time.

Which menopause supplements have the best support?

Calcium, vitamin D and omega-3 come out on top, followed by magnesium and collagen. Here is an overview before we go through them one by one.

Calcium and vitamin D – the foundation for your bones

Bone health is the clearest reason to think about supplements during menopause. When oestrogen falls, bone is broken down faster than it is built up, and the risk of osteoporosis increases with the years.

Calcium and vitamin D are both needed for the maintenance of normal bones, and vitamin D also contributes to normal absorption of calcium. The reference intake according to NNR 2023 is 950 mg of calcium and 10 micrograms of vitamin D per day for adults, 20 micrograms from age 75.

Food comes first: dairy products, fortified plant drinks, green leafy vegetables and oily fish cover a lot. Vitamin D, however, is hard to get enough of during the winter months at northern latitudes, when the sun is not strong enough for the skin's own production. Food authorities highlight vitamin D as one of the few supplements that several groups may need.

Magnesium – for sleep, muscles and mood

Sleep problems are among the most common complaints during menopause – an estimated half of all women are affected to some degree. Magnesium contributes to normal functioning of the nervous system, normal muscle function and to a reduction of tiredness and fatigue.

The reference intake is around 300 mg per day for women. Whole grains, nuts, seeds and pulses are good sources, but many people fall below the recommendation. A supplement of 250–350 mg is then a simple way to get up to the right level.

We have written more about how the mineral relates to a good night's sleep in the article on magnesium and sleep.

Omega-3 – for the heart after menopause

After menopause, the risk of cardiovascular disease increases, partly because oestrogen's protective effect on the blood vessels wanes. This is where the fatty acids EPA and DHA come in: 250 mg per day contributes to normal function of the heart according to EFSA.

If you eat oily fish such as salmon, mackerel or herring two to three times a week, you get there through food. If you don't, an omega-3 supplement is a reasonable alternative. Choose one with clearly stated amounts of EPA and DHA per capsule.

Note that plant-based omega-3 from flaxseed and rapeseed oil consists of ALA, which the body only converts to EPA and DHA to a small degree. If it's EPA and DHA you're after, fish or algae oil are the reliable routes.

Collagen – for skin and joints

Collagen is the supplement most people ask about for the sake of their skin, and the research actually has something to say. In a randomised study from 2019, researchers saw better skin elasticity and skin moisture after twelve weeks of 2.5 g of collagen peptides per day compared with placebo.

Doses in studies usually range between 2.5 and 10 g per day, and the effect typically only shows after 8–12 weeks. Vitamin C is a smart companion since it contributes to normal collagen formation.

We have covered the topic in depth in the article on collagen during menopause, and in our comparison of collagen supplements you can see what sets different products apart.

Do I need iron during menopause?

It depends on where you are in the transition. During perimenopause, many women bleed more heavily than before, and iron stores can drop. Tiredness, paleness and palpitations are typical signs – a simple blood test at your doctor's surgery gives you the answer.

After menopause it is the opposite. When the bleeding stops, iron requirements fall from 15 to around 9 mg per day, and most women manage that with ordinary food. So don't take iron supplements routinely after your final period – only if a deficiency has been confirmed.

Phytoestrogens and herbs – what does the research say?

Soy isoflavones, red clover and black cohosh are often marketed for hot flushes. In a 2012 meta-analysis, researchers found that soy isoflavones reduced the frequency of hot flushes somewhat, but the effect was moderate and the studies varied in quality.

For black cohosh, the results are mixed. In short: the herbs are not worthless, but the evidence is clearly weaker than for the nutrients above.

Taking medication or hormone therapy? Check with your doctor or pharmacist before adding herbal preparations – some can affect how medicines work.

How to choose – and what you can skip

A few simple guidelines go a long way:

• Choose third-party tested products manufactured to GMP standards.
• Stay close to the reference intakes – more is not better.
• Start with one thing at a time, so you know what actually makes a difference.
• Skip expensive "miracle blends" with twenty ingredients in low doses.

If you want a broader review by life stage, see our guide on vitamins for women, and you'll find our full range for this life stage in the menopause collection.

Frequently asked questions

Which supplement is most important during menopause?

It depends on your symptoms. For your bones, calcium and vitamin D are the foundation, especially in winter. If you sleep badly or feel tired, magnesium is a reasonable first choice. For skin and joints, collagen is the most studied option. Start with what bothers you most and evaluate after two to three months.

Can supplements replace hormone therapy?

No. Hormone therapy is the most effective measure against pronounced symptoms such as severe hot flushes, and it is prescribed by a doctor after individual assessment. Supplements can cover nutritional gaps and support normal bodily functions, but they do not treat menopausal symptoms. See them as a complement to good food, exercise and sleep – not as an alternative to medical care.

When should I start taking supplements – before or after menopause?

Preferably early. Bone mass starts to decline as early as perimenopause, and the skin's collagen production wanes from around age 25. Securing calcium, vitamin D and omega-3 during the years before your final period gives your body a better starting point. There is no deadline, though – bones and heart benefit from good nutrition at any age.

Can I take several supplements at the same time?

Yes, the nutrients above combine well in normal doses. A practical routine is calcium and vitamin D at breakfast, omega-3 with a meal containing fat and magnesium in the evening. Avoid doubling up on products with the same ingredient so the total dose doesn't become unnecessarily high, and consult a pharmacist if you take medication.

Sources

1. 1177 (Swedish health service guide) – Menopausal symptoms
2. Swedish Food Agency (Livsmedelsverket) – Vitamin D
3. Swedish Food Agency (Livsmedelsverket) – Calcium
4. Avis et al. 2015 – Duration of menopausal vasomotor symptoms (SWAN), JAMA Internal Medicine
5. Bolke et al. 2019 – Collagen supplement and skin, randomized placebo-controlled study
6. Taku et al. 2012 – Soy isoflavones and menopausal hot flashes, meta-analysis
7. EU register of authorised health claims (EFSA)