Creatine, magnesium, omega-3 fatty acids, and vitamin D show moderate evidence for reducing menopausal symptoms such as muscle loss, mood problems, and depression, but their clinical significance is often unclear. Black cohosh and red clover are popular but their efficacy and safety have not been conclusively proven. Calcium combined with vitamin D is not routinely recommended for fracture prevention in all postmenopausal women.
Menopause brings many women symptoms such as hot flushes, mood swings, sleep problems, bone loss and muscle loss. Various supplements and herbs are used to address these complaints, but the scientific evidence varies considerably from one product to another.
Creatine (high dose, approximately 0.3 grams per kilogram of body weight per day) shows moderate evidence of improving muscle mass and muscle function in postmenopausal women. Effects on bone health are found only in combination with strength training. There are also early indications that creatine may improve mood and cognition, but that evidence is still limited and uncertain. For women who are in the middle of the transition (perimenopause), hardly any specific research has been done, so no conclusions can yet be drawn for them.
Magnesium supplementation appears to help reduce menopausal symptoms. The evidence exists but is not yet strong enough for firm recommendations. Dietary supplements as a group, including omega-3 fatty acids and vitamin D, appear to moderately reduce depression and anxiety symptoms during menopause compared with placebo (with an average measurable difference, though the clinical significance is unclear). Results vary considerably between studies and it is unclear which specific product is actually responsible.
After menopause, women are at greater risk of deficiencies in vitamin B6, B12, vitamin D, omega-3 fatty acids, iron and lycopene (a compound found in, among other things, tomatoes). These deficiencies are associated with a higher risk of cardiovascular disease, osteoporosis and cognitive decline. Targeted supplementation or a good diet can then be worthwhile, but no firm dosage recommendations based on the available research exist yet. Calcium combined with vitamin D is actually NOT routinely recommended to all postmenopausal women for fracture prevention. Only women who take in too little through their diet benefit from it.
Black cohosh and red clover (phytoestrogens, plant-based compounds that resemble oestrogen) are the most commonly used herbs for menopausal symptoms. Their efficacy and safety are, however, disputed and not conclusively proven. Women who are considering these products would do well to consult their doctor, especially when using other medications. Finally, hormone therapy (oestrogen with or without progesterone) is not a supplement but a medicine, and is scientifically proven to be effective against severe hot flushes and night sweats, particularly when started before the age of 60. It is not recommended, however, for the prevention of cardiovascular disease or dementia.
Based on PMID 33800439, 40371844 (creatine), 28392498 (magnesium), 36576445 (dietary supplements and depression/anxiety), 38935105 (vitamins and minerals postmenopause), 38691368 (calcium/vitamin D and hormone therapy) and 39477563 (black cohosh/red clover). The level of evidence ranges from strong (hormone therapy, calcium + vitamin D) to limited or insufficient (creatine in perimenopause, herbs).