Supplements
Food first, test the gap, then supplement the gap. A mega-dose of calcium isn't better and may have downsides. Nila doesn't sell a supplement, a drug or a clinic, so we can tell you the truth about supplements and the wellness grift. No affiliate links, ever. Sponsorship never shapes what lands where on this page.
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The graded list
Name, grade, sample size, who funded it, the plain takeaway, and the interaction to flag with a pharmacist. Nothing on this list is locked.
Worth it if there's a gap
Reasonable if your intake or tested level is low, especially paired with calcium for bone. Testing first beats guessing.
Interaction flag: High doses can raise calcium too far; flag if you have kidney stones.
SOGC guideline 422a (2024)Food first. Supplement only the gap between what you eat and what you need. Mega-doses aren't better and may carry downsides.
Interaction flag: Can block thyroid medication absorption; take hours apart.
SOGC guideline 422a (2024)Monohydrate plus resistance training gave small gains in muscle and leg strength at trial doses of 5 g a day or more. Without training, no measurable effect, and bone density didn't change. A muscle finding, not a bone, sleep or brain-fog one.
Interaction flag: Kidney indices didn't change in trials, which excluded kidney disease; flag it if that's you.
JISSN meta-analysis (2026)Mixed or thin evidence
May help you fall asleep a little faster if you're low. Low to very low certainty, and no form is proven superior. Not a hot-flash, weight or brain-fog treatment.
Interaction flag: Can loosen stools at higher doses; separate from thyroid medication.
Mah and Pitre, systematic review (2021)Some signal for mood in pooled trials, but studies differ wildly in dose and quality. Food sources first is the safer bet.
Interaction flag: High doses can thin blood, and high doses in people with heart disease carry a modest heart-rhythm signal; flag either with your prescriber.
NAMS nonhormone position (2023)A small average lift in depression scores, below what usually counts as clinically meaningful, with very low certainty. Studied mainly as an add-on to prescribed care, and not in menopause. In older adults, strength training moved mood; creatine alone didn't.
Interaction flag: If you take an antidepressant, raise it with your prescriber first; flag kidney disease.
Br J Nutr meta-analysis (2025)Trials are inconsistent and products vary a lot. NAMS doesn't recommend it over placebo for hot flashes.
Interaction flag: Rare liver injury reports; avoid with liver conditions.
NAMS nonhormone position (2023)Small trials hint at modest cholesterol and blood sugar changes, but NCCIH finds too little evidence for any condition. On top of a multi it adds little, and its B12 is mostly a form the body can't use.
Interaction flag: Can carry liver toxins (microcystins) or heavy metals, so pick third-party-tested products. May stimulate the immune system: check first with autoimmune conditions or immune-suppressing medicines.
NCCIH: Blue-green algaeEven less human research than spirulina. Nothing shows a benefit beyond what a multivitamin and a varied diet already give you.
Interaction flag: Can be high in vitamin K (raise it if you take warfarin) and iodine (raise it if you have a thyroid condition).
NIH ODS: Vitamin K fact sheetMarketing only
Proprietary blends with a dozen ingredients at untested doses. You're paying for the label, not the evidence.
Interaction flag: Unknown, because the doses are undisclosed. That's the problem.
NAMS nonhormone position (2023)Your liver and kidneys already detox you. No trial has ever shown a cleanse does anything a healthy body doesn't.
Interaction flag: Some laxative-based products interfere with medication absorption.
NAMS nonhormone position (2023)Pooled trials looked positive, but studies without industry funding, and the high-quality ones, showed no significant effect on skin. Unproven for hair, and not a bone treatment.
Interaction flag: Low risk, low reward.
Am J Med meta-analysis (2025)Interaction checker
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Read the fuller supplements and treatment guideBefore you buy a "menopause" blend
In 2026, the UK consumer group Which? reviewed 26 supplements sold for perimenopause and menopause. None had the right nutrients at doses worth taking, so none earned its top rating.
A basic multi is a reasonable way to cover gaps. It won't prevent heart disease or cancer, according to the US Preventive Services Task Force. What to look for:
Fewer bottles, fewer missed doses. A weekly pill organizer with morning and evening slots, filled once on a Sunday, means you only open one thing each day. Bring the bottles, not the organizer, to a pharmacist when you want everything checked for overlaps.
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The evidence
The reference point for what actually has evidence for hot flashes beyond hormones, and what doesn't.
Read the sourceCanadian guideline covering calcium, vitamin D and bone protection through the transition.
Read the sourceFrames the transition as a window where nutrition and movement choices compound, for heart and bone.
Read the sourceWhere a trial was funded by the company selling the product, we say so on the row and grade accordingly.
Read the sourceOne more time, gently.
We're an older sister with reading glasses on, not your doctor. Supplements bump into medication, conditions, and each other in ways that aren't always obvious. Anything here is a starting point for a conversation with your doctor or pharmacist, not a replacement for what they've already prescribed you.
Sources
Including the places where the honest answer is “the evidence is thin”. See how we grade evidence.
Creatine and cognition: promising, still being studied
2 sources
Evidence for strength alongside resistance training doesn't automatically establish a benefit for menopause brain fog.
Creatine and cognitive function in adults: systematic review and meta-analysis
Sixteen randomized trials involving 492 adults found modest memory benefits and improvements on some timed tasks, but no significant improvement in overall cognition or executive function. These weren't menopause-specific trials. All used creatine monohydrate; certainty was moderate for memory and low for other outcomes.
Read the sourceCONCRET-MENOPA: an eight-week creatine trial in perimenopause and menopause
A small trial of 36 participants found improved reaction time and increased frontal brain creatine with the medium-dose hydrochloride group compared with placebo. It lasted eight weeks and tested creatine hydrochloride and ethyl ester, not standard monohydrate. Partly industry-funded by Vireo Systems, which supplied the products. It doesn't establish a treatment for everyday menopause brain fog or superiority over monohydrate.
Read the sourceThe position statements behind every grade on this page
4 sources
We don't sell supplements, so we can be blunt: most of this category is under-evidenced, and these are the documents that say so.
Cognitive behavioural therapy and clinical hypnosis are the non-hormone approaches with enough evidence to be recommended for vasomotor symptoms. Most supplements, and several popular practices, aren't.
The single most useful document for separating 'has trials' from 'has marketing'.
Read the sourceThe UK's national guideline sets out what's and isn't supported for menopause symptoms, including its position on complementary therapies and unregulated preparations.
Nutrition, activity, alcohol, smoking and weight are addressed as first-line levers for vasomotor symptoms in Canada's national menopause guideline — with realistic expectations of how much they move the needle.
Weight-bearing and resistance exercise sit inside the standard framework for postmenopausal bone health — alongside calcium, vitamin D and, where fracture risk is high, medication.
Also the honest source on what exercise alone can't do once bone loss is established.
Read the sourceHow thin the evidence base actually is
1 sources
Someone finally counted. Twenty-five years of US supplement research on menopause, mapped ingredient by ingredient — and perimenopause is barely in it.
Two decades of US dietary-supplement research on menopause adds up to only 253 experimental studies, spread across more than 80 different ingredients — and almost all of it (n = 234) looks at postmenopause, not perimenopause.
Annual growth in this literature is 3.89%. Calcium, vitamin D and isoflavones are the only ingredients studied often enough to replicate — which is why most of the shelf below grades low.
Read the source