Many over-the-counter supplements are advertised for the treatment of menopause symptoms (which can begin in perimenopause) in what is being called ‘menowashing’, i.e. trying to convince menopausal women that relief is just a pill away.
The South African Menopause Society (SAMS) points out that complementary and alternative medicines are unregulated. It says plant oestrogens, mainly from soy and red clover, have been shown in most studies to have “a null effect or at most a minimal effect” on hot flushes and night sweats. Black cohosh appears to have “poor efficacy for menopausal symptoms”, and has been linked to liver toxicity in some cases.
“For this reason, complementary remedies like black cohosh should only be used under medical guidance,” says Stephanie Rouillard, a Cape Town-based registered dietitian with a special interest in menopause nutrition.
However, SAMS notes that supplementing with certain vitamins and minerals in menopause, such as vitamin D, may be helpful if you are deficient.
“Always check with your healthcare provider, who can test your levels if indicated and advise if a change in eating or a supplement is needed,” says Umhlanga-based GP Dr Megan Broughton. “They can give guidance on dosage of supplements, which can vary depending on your age, lifestyle and health conditions. Dietary micronutrients are preferable to supplements, but if you have gastrointestinal issues or food intolerances, you may not be able to get enough through your diet.”
Ask if you could benefit from the following supplements.
Vitamin D and calcium
Oestrogen levels drop with menopause, increasing your risk of osteoporosis. Calcium is critical for building and protecting bones, while vitamin D enhances calcium absorption, and many women in menopause may not get enough of either, Rouillard says.
“We generally recommend all menopausal women supplement with calcium and vitamin D,” says Dr Broughton.
Food sources: calcium can be found in dairy products, leafy greens, tofu, sardines and pilchards. Vitamin D is synthesised from sunlight through our skin, and occurs in fatty fish, egg yolks, liver, and fortified breakfast cereals and spreads, says Rouillard.
Magnesium
There is encouraging evidence that magnesium supports bone health: a 2022 study found that higher magnesium intake was associated with higher hip and femoral neck bone mineral density. This mineral plays an important role in many bodily functions, so it makes sense that adequate intake may relieve multiple symptoms. One study suggests magnesium supplementation may help reduce symptoms of anxiety and depression (which many women in menopause report), and may help with sleep difficulties by promoting relaxation and quieting a ‘busy brain’, according to the Mayo Clinic.
Food sources: magnesium is in nuts, seeds, dark green leafy vegetables, whole grains and legumes.
Vitamin B12
Ageing reduces the stomach’s ability to absorb B12 from food, and low levels can cause fatigue, memory loss and mood changes, symptoms that often overlap with and worsen those of menopause, Rouillard says.
A 2025 study in the Journal of Mid-life Health found postmenopausal women often have B12 deficiency, affecting their neurological health and contributing to falls, reduced mobility and decreased quality of life.
Food sources: meat, poultry, fish, eggs and dairy.
Creatine
Creatine is a compound produced naturally by the body, but is also obtained from animal products. The body converts creatine into phosphocreatine (PCr), used to generate ATP (adenosine triphosphate), the primary energy source for cells. This allows muscle to keep working at high intensity.
Loss of muscle mass begins to accelerate in perimenopausal women. There is some evidence that creatine supplementation – particularly alongside resistance exercise – may help preserve muscle mass, says Rouillard. It may also improve mood and cognition.
Creatine has been studied more extensively than many supplements, and is generally considered safe. “It is not yet known exactly how it works in menopausal women, but the research coming through is looking promising,” says Dr Broughton.
Food sources: red meat and seafood. Eggs and animal milk have trace amounts.
Omega-3
Omega-3 fatty acids are essential nutrients, meaning the body cannot produce them, so they must be obtained from your diet, says Rouillard. They are especially critical in menopause, when oestrogen (a natural anti-inflammatory) declines, and omega-3’s anti-inflammatory properties may help protect heart health, stabilise mood and combat joint stiffness.
Food sources: fatty fish like sardines, pilchards, mackerel and salmon, and fish oils. Also rapeseed, soybean and flaxseed oils, walnuts and some other nuts and seeds, soybeans and green leafy vegetables.
Take care
Supplements may not provide the total recommended daily requirement of vitamins and minerals; and while your body excretes excess water-soluble vitamins, it stores fat-soluble ones in the liver and fatty tissue, and too much can be toxic, says Rouillard. “Take them only as directed.”