Menopause Supplements: Start With What You're Actually Low In

A woman sits down for her consultation and gets out her phone. On it is a photo of her kitchen shelf: 8 tubs and boxes. Something for her energy, something for her bones, a menopause blend a friend swore by, collagen, magnesium, and 2 she can't remember starting.

I hear some version of this a lot. And when I ask which of them has helped, the answer is usually "I don't know". That isn't her fault. When you start 8 things at once, there's no way to tell.

So this post goes the other way round. Start with what you're actually low in, fix that first, and then decide whether you need anything else.

Start with a blood test

Low iron, low vitamin D and low B12 can all make you tired, foggy and flat, which is exactly how perimenopause can feel. Correcting a real deficiency is one of the most useful things a supplement can do. Taking something you're not low in usually isn't.

The clinic works in this order: talk, start, test, review. Treatment for your symptoms doesn't wait for a blood test. But iron does, and vitamin D above the everyday dose does, because you need to know the number before you decide the dose. The Wellbeing Profile Blood Test checks your iron stores (ferritin), vitamin B12, vitamin D, cholesterol and inflammation. Ask for the numbers, not just "normal".

Vitamin D: the one most of us need in winter

From October to March, the UK sun is too weak for your skin to make enough vitamin D. UK advice is that everyone considers 10 micrograms (400 IU, international units) a day through autumn and winter. That's the floor, there so you don't run low. The clinic aims for levels in the optimal range, and a blood test tells you how far off you are and whether you need more.

Vitamin D contributes to the maintenance of normal bones and normal muscle function, to the normal absorption of calcium, and to the normal function of the immune system. Those are authorised health claims.

The Zooki vitamin D in the shop is a higher dose than the everyday 10 micrograms, so it's one to take once you know your level.

A few safety points. Don't take it on top of a multi that already contains vitamin D. Adults shouldn't go above 100 micrograms (4,000 IU) a day unless a clinician has advised it. The Zooki one also contains vitamin K2, so it isn't one for you if you take a blood thinner that works against vitamin K. If you're not sure which kind yours is, ask your pharmacist. And if you've had kidney stones, high calcium or sarcoidosis, ask about it before you start.

Iron: only if a blood test shows you need it

Heavy periods in perimenopause can drain your iron stores slowly. Ferritin, the stored iron, can be low while your haemoglobin still reads normal, so it's easy to miss. Iron contributes to the reduction of tiredness and fatigue, and to the normal formation of red blood cells and haemoglobin.

But don't take iron just in case. Too much iron isn't harmless. It often upsets your gut, and taking it without a test can delay finding out why you were low in the first place. Test first, take it for as long as your result says, then recheck, usually at around 3 months.

Keep it 2 hours away from tea, coffee, dairy and calcium, and 4 hours away from thyroid tablets. And keep iron out of reach of children. An iron overdose can be fatal for a child. If a child swallows any, call 999 or go to A&E straight away, even if they seem fine.

---

Magnesium: what it can and can't claim

You'll see magnesium recommended everywhere in menopause. Magnesium contributes to a reduction of tiredness and fatigue, to normal muscle function and to normal psychological function. Those are its authorised claims.

The trials in menopausal women specifically are thin, so it isn't something to rely on in place of treatment for your symptoms. At higher doses it can loosen your stools, and if you have kidney problems, ask about it before you start.

Creatine: for muscle, alongside strength training

From your 40s, holding on to muscle tends to get harder, and strength training is the thing that does the most for it. Creatine adds to that. Daily creatine consumption can enhance the effect of resistance training on muscle strength in adults over the age of 55, at 3g a day. Creatine also increases physical performance in successive bursts of short-term, high-intensity exercise.

The evidence is strong in adults generally and thinner in perimenopausal and postmenopausal women specifically. It only helps alongside the training, not instead of it. If you have kidney disease, ask about it first. Creatine can also make your kidney blood test read lower than it really is, so tell whoever checks your bloods that you take it. There's more in my post on creatine for women.

Collagen: what the evidence does and doesn't show

Collagen has no authorised health claim in the UK. The trials are mostly small and short, many are funded by the companies that sell it, and they measure skin hydration and elasticity on a machine rather than anything you'd see in the mirror.

If you enjoy taking it, that's your choice. The claim that exists sits with vitamin C, which contributes to normal collagen formation for the normal function of skin.

A women's multi: what it can and can't do

A multi can fill small gaps on the weeks your diet is patchy. It won't correct a real deficiency in iron or vitamin D, because the amounts are too small for that. Check the label for vitamin D and iron so you don't double up with anything else you take. I've written more about whether women over 35 need a multivitamin.

Where to start

Food and protein first. Then correct what a blood test shows you're low in. Then add 1 thing at a time and give it 8 to 12 weeks before you judge it. A free Symptom Tracker helps you see whether anything has changed. The Your Options guide goes through which supplements have evidence for each symptom, and which don't.

Food supplements should not replace a varied, balanced diet and a healthy lifestyle. If you take other medicines, check with your pharmacist or clinician before you start anything new, and tell anyone prescribing for you what you take.

You'll find the whole Zooki range in the shop.

If you'd like to go through your supplements, your symptoms and your bloods together, you can book a Menopause Consultation: 45 minutes, online, by video or voice call, wherever you are in the UK. Bring the photo of your shelf. If something other than menopause is going on, the Women's Health Consultation is the one for you.

Shop

Every Sunday morning I send out my newsletter, Beyond Prescriptions, with 1 women's health lesson and what to do with it. You can sign up here.

Debora Tentis, Women's Health Pharmacist.