Menopause Supplements & Vitamins: Which Do You Really Need?

During perimenopause and menopause, many women turn to supplements to ease their symptoms or protect their long-term health. And if you’ve moved to the UK from somewhere sunnier (like me!), your needs may be different too: less sunshine, different foods, different products on the shelves. The choices are endless, and the claims often go well beyond what the science supports. So let’s look at which menopause supplements have a real place before and after menopause, and which don’t.

First things first: what is a supplement?

A supplement is exactly what the name suggests: something that supplements your diet where it isn’t meeting your needs. It doesn’t replace it. That’s why there’s no magic combination of supplements that works for everyone. What you need depends on your diet, your sun exposure, your blood test results, any medication you take, your bone health and how active you are.

Important: If any of the supplements below have been prescribed for you, such as iron, vitamin D, calcium or B12, always follow your doctor’s advice on dose and how to take them.

Vitamin D

Why you may need it: Vitamin D is best known for helping us absorb calcium and keeping bones healthy, but its role goes much further. It supports normal muscle and immune function, and there are vitamin D receptors in almost every tissue in the body, including the brain. Research has also linked low vitamin D levels with low mood. In the UK, between October and March, the sun simply isn’t strong enough for your body to make the vitamin D it needs.

What the evidence says: The official recommendation is 10 µg (400 IU) a day during autumn and winter, and all year round if you don’t get much sun. This is a minimum reference point, though, and it isn’t always enough. On the other hand, high doses without a deficiency haven’t shown any extra benefit and can push vitamin D levels too high.

In practice:

• There are few good food sources of vitamin D: egg yolks, oily fish and fortified foods. Our bodies rely mainly on sunlight to make it.
• People at higher risk of deficiency include those who get little sun, have darker skin or cover their skin, and those with osteopenia or osteoporosis.
• If you need a supplement, ideally your dose should be guided by a blood test.
• Take vitamin D supplements with a meal that contains some fat, for better absorption.

Vitamin K: emerging evidence

New research suggests that vitamin K, especially K2 (menaquinone), helps direct calcium into the bones rather than the blood vessels. That’s why some newer supplements combine vitamin D with K2. Early studies on both bone health and arterial calcification are encouraging, but not yet strong enough for a general recommendation.

Importantly, vitamin K interacts with blood thinners such as warfarin. If you take this type of medication, talk to your doctor before taking a supplement. Vitamin K1 is found in green leafy vegetables, while K2 is found in chicken, beef, eggs, fermented foods and some cheeses.

Calcium

Why you may need it: After menopause, falling oestrogen levels speed up bone loss.

What the evidence says: In the UK, adults need 700 mg of calcium a day. For women with osteoporosis, at higher risk, or taking osteoporosis medication, your doctor may recommend around 1,000 mg. Ideally, aim to meet your needs through food: yoghurt, milk, cheese, sardines with bones, tahini, almonds, calcium-set tofu, and fortified plant-based drinks, yoghurt alternatives or juices.

In practice:

• You may need a supplement if your diet falls short, or if you have osteopenia or osteoporosis. Calcium supplements can cause side effects (such as constipation, or kidney stones in people who are prone to them) and can interact with medication. So the type and dose are best decided with a healthcare professional.
• The most common supplements are calcium carbonate and calcium citrate.
  • Carbonate is cheaper and comes in smaller tablets, but needs to be taken with food.
  • Citrate is more expensive and the tablets are larger. However, it can be taken on an empty stomach and may cause fewer digestive side effects for some people. It may also be a better choice if you take stomach medication such as omeprazole.
• Calcium from supplements is absorbed best in small doses (up to 500 mg at a time). If you’ve been prescribed a particular product, don’t switch without talking to your doctor.
• Leave a gap between calcium and iron supplements, thyroxine or osteoporosis medication.

Iron

Why you may need it: Iron deficiency can develop during perimenopause, especially if your periods become more frequent, heavier or longer. After menopause, your iron needs drop significantly.

What the evidence says: Iron supplements are recommended when a deficiency has been confirmed by a blood test. According to the National Institute for Health and Care Excellence (NICE), a ferritin level below 30 µg/L confirms iron deficiency. This means your iron stores are low, even if you’re not anaemic.

In practice:

• Take iron under medical supervision.
• Iron is absorbed best on an empty stomach. If it upsets your stomach, you can take it with a little food.
• A source of vitamin C, such as a small glass of orange juice, may help absorption.
• Avoid coffee, tea, dairy and calcium supplements around the time you take it.

Magnesium

Why you may need it: Magnesium is involved in hundreds of processes in the body, including muscle and nerve function, energy production, glucose metabolism and bone health. It’s also needed to activate vitamin D. Many women don’t get enough from their diet. Good sources include nuts, seeds, pulses, wholegrains and green leafy vegetables.

What the evidence says: For sleep and hot flushes, the evidence is limited and comes from a small number of small studies.

In practice:

• If you think your intake may be low, start with a low dose (e.g. 150–200 mg elemental magnesium) and don’t exceed 400 mg a day from supplements.
• Magnesium citrate and glycinate are better absorbed and tolerated than magnesium oxide, which mainly acts as a laxative.
• It’s usually taken in the evening, leaving a gap from thyroxine and osteoporosis medication.
• If you have kidney disease, only take magnesium on medical advice.

Omega-3

Why you may need it: Omega-3 fatty acids (EPA and DHA) are building blocks of our cells, especially in the brain and eyes, and they support cardiovascular health. This matters even more after menopause, when cardiovascular risk rises. Our bodies can’t make omega-3, and converting plant omega-3s (from walnuts or flaxseed) into EPA and DHA is limited.

What the evidence says: Eating fish is linked to a lower risk of heart disease. The UK recommendation is at least two portions of fish a week, one of them oily (sardines, mackerel, salmon). This fits perfectly with the Mediterranean diet. Food should always come first. If you don’t eat fish, though, a supplement is a good way to cover your needs. Supplements haven’t shown benefits for hot flushes or sleep, or protection against heart attacks and strokes in healthy adults. Their role is to fill a gap in your diet, not to act as treatment.

In practice:

• A typical dose is 250–500 mg of EPA and DHA a day. Check the label: what counts is the amount of EPA and DHA, not the total amount of fish oil.
• If you’re vegan or vegetarian, algae oil supplements provide EPA and DHA directly.
• Take them with a meal, for better absorption and fewer side effects.
• If you take blood thinners, talk to your doctor first.

Vitamin B12

Why you may need it: Vitamin B12 is essential for a healthy nervous system, red blood cell production and energy. It’s found naturally only in animal foods (meat, fish, eggs and dairy), but it’s also added to some fortified foods. As we get older, we absorb less B12, mainly because we produce less stomach acid, which is needed to release it from food. You’re at higher risk of deficiency if you:

• follow a vegan or mainly plant-based diet
• take metformin or stomach medication such as omeprazole long term
• have had stomach surgery or have a digestive condition (such as coeliac disease)
• have an autoimmune condition such as Hashimoto’s thyroiditis, as it’s linked to pernicious anaemia: an autoimmune form of anaemia in which the body lacks intrinsic factor, a protein needed to absorb B12

What the evidence says: Tiredness, numbness or tingling, and difficulty concentrating can easily be put down to menopause, when they may actually be signs of B12 deficiency.

In practice:

• If you’re in a higher-risk group, ask your GP for a blood test.
• If you’ve been prescribed B12, as tablets or injections, follow your doctor’s advice.

Creatine

Why you may need it: Creatine is a substance our bodies make naturally from amino acids. We also get it from food, mainly meat and fish. It’s stored mostly in our muscles, where it acts as a “quick energy source” for short, intense movements such as strength training. Smaller amounts are found in the brain. Women generally have lower creatine stores than men, and even lower if they eat little or no meat or fish.

What the evidence says:

• It may help improve muscle strength when combined with resistance training.
• It hasn’t been shown to benefit bone health.
• Evidence for brain health and mood is encouraging but still at an early stage.

In practice:

• Creatine monohydrate (3–5 g a day) is considered safe for most women. You can take it at any time of day, as long as you take it daily.
• In the first few weeks you may notice some weight gain, this is due to water retention.
• Make sure you stay well hydrated while taking it.
• If you have kidney disease, seek medical advice first.

Protein

Why you may need it: Getting enough protein, combined with resistance training, is one of the most effective ways to maintain muscle mass (and satiety!).

What the evidence says: A realistic target is around 1.2–1.6 g of protein per kg of body weight a day, especially if you do strength training.

In practice:

• Spread it across your meals, aiming for 25–30 g per main meal from foods such as yoghurt, eggs, pulses, soya, fish, chicken and cheese.
• Protein powder isn’t essential, but it can be a practical option when your diet falls short.
• If you have kidney disease, your protein intake should be personalised.

Collagen

• Skin: when only the most reliable studies are considered, the benefit isn’t confirmed.
• Bones: there’s very little evidence.
• Muscle: collagen isn’t a complete protein, so it can’t replace protein from food.

Collagen is considered safe, but the evidence doesn’t show any meaningful benefit.

Are there any vitamins for hot flushes?

So far, no supplement has been proven to work for hot flushes. That includes many popular products:

• Black cohosh: no clear benefit, and rare cases of liver damage have been reported.
• Soy isoflavones and red clover supplements: inconsistent results.
• Evening primrose oil: no strong evidence.
• Ashwagandha, maca: only a few small studies.
• “Hormone balance” blends: multiple ingredients in unknown doses, with no robust research behind them.

There are effective treatments for hot flushes, both hormonal and non-hormonal, and they’re worth discussing with your doctor.

Safety and interactions

“Natural” doesn’t necessarily mean safe. Many supplements interact with medication, including thyroxine, osteoporosis medication, blood thinners, antidepressants and HRT.

Food supplements are also regulated as foods, not medicines. This means they aren’t held to the same standards for content, purity or effectiveness. So:

• Choose products from reputable brands, ideally independently (third-party) tested.
• For herbal products in the UK, look for the THR (Traditional Herbal Registration) mark, which shows the product meets quality and safety standards.
• Be wary of products that promise “miracle” results.

Before starting any supplement, talk to your GP or pharmacist, especially if you take any medication.

In summary

• Vitamin D: a minimum of 400 IU in winter, ideally with your dose guided by a blood test.
• Calcium: food first. Consider a supplement if your intake is low or you have osteopenia or osteoporosis, with guidance from a healthcare professional.
• Iron and B12: only when a deficiency has been confirmed, and as prescribed by your doctor.
• Magnesium and omega-3: when your diet falls short.
• Protein and creatine: protein ideally from food. Creatine may be worth trying alongside strength training, if there’s no reason to avoid it.
• Collagen and “trendy” supplements: not enough evidence.

If you are Greek living in the UK

Moving to a new country can change your nutritional needs, often without you realising:

• Less sunshine: the sun in the UK is weaker and less available than in southern Europe, especially from October to March. Vitamin D you may not have needed back home becomes almost essential here.
• Tests through your GP: the NHS doesn’t always check vitamin D, B12 or ferritin in routine blood tests. If you have symptoms such as tiredness, heavy periods or numbness, or you’re in a higher-risk group, don’t hesitate to ask your GP.
• Different products: supplements in UK supermarkets and pharmacies may differ in dose and form from those you’re used to. Vitamin D, for example, is often listed in µg rather than IU (10 µg = 400 IU), so always read the label.
• Your pharmacist as an adviser: in England, you can get free advice from a pharmacist without an appointment.
• Fortified foods: plant-based drinks, breakfast cereals and some other foods are often fortified with calcium, vitamin D and B12, which can help you meet your needs through diet.

Personalised support

If you’d like to work out together what you need, based on your diet, blood tests and medication, find out more about my Perimenopause & Menopause Support Programme or read more about working with a menopause dietitian in the UK.

You can also book a free discovery call to talk about how I can help.

References

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This article is for educational purposes only and does not replace personalised medical or dietetic advice. Before starting any supplement, especially if you take medication or have a health condition, speak to your GP, pharmacist or dietitian.