Best Supplements for Perimenopause

Black cohosh has more research behind it for hot flashes and night sweats than the other supplements on this page. Those results come from specific extracts, mainly an isopropanolic black cohosh extract studied in more than 11,000 patients. A bottle that doesn't name its extract can't promise the same results. Pick a supplement by your main symptom and read the extract on the label. If it doesn't help, ask your clinical team about prescription options.

Which supplement for perimenopause has the most research?

Black cohosh is a plant. Its root, or rhizome (an underground stem), is sold as a dietary supplement for menopause symptoms such as hot flashes and night sweats.

The strongest evidence is for one type of black cohosh, the isopropanolic extract. A 2013 review of black cohosh extracts found it had the best evidence. Studies of it included more than 11,000 patients and gave consistent results for menopause complaints.

A second extract, an ethanolic one called BNO 1055, has been studied in more than 500 patients. That research is earlier and less certain.

The same review found that only black cohosh products registered as medicines proved they worked. Its positive verdict on benefits versus risks covers only those products. Good results for one extract don't mean every black cohosh bottle on the shelf will work.

How do I pick a black cohosh supplement that works?

• Look for the extract type on the label. "Isopropanolic extract" matches the research with the most patients. A label that says only "black cohosh root" or "proprietary blend" doesn't tell you which one you're getting. In the review, only registered medicines proved they worked. So a supplement that names the same extract still isn't one of those products, but it's the closest match you can read on a label.
• Check the dose. WebMD lists a usual recommended dose of 20 to 80 mg a day, about two capsules or tablets. Studies of menopause symptoms have used anywhere from 6.5 to 160 mg.
• Buy it as a supplement, never as the raw plant. Parts of the plant, including the roots and berries, are poisonous. Black cohosh is only safe to take in supplement form.
• Expect the standard disclaimer, and read reviews as one woman's story. Kindra's MenoRelief blend says on its own product page that "These statements have not been evaluated by the Food and Drug Administration." The same page shows a customer saying, "Within two days, hot flashes and night sweats went away." That was her experience. It doesn't tell you what the bottle will do for you.

Is black cohosh safe for your liver?

A large review rates its safety well, but there is a liver caution you should know about.

There have been reports of liver damage in people taking black cohosh. A US Pharmacopeia expert committee reviewed 30 of these reports. It rated every case a "possible" link to black cohosh, and it rated none probable or certain.

Even so, the committee decided that black cohosh products should carry a cautionary label about the liver. In 2002 it had decided they needed no warning.

The 2013 review rated black cohosh extracts as having good to very good safety overall. That rating included the liver and estrogen-sensitive organs such as the breast and uterus.

Tell your clinical team about any supplement you take, including black cohosh, so they can see the whole picture.

Which perimenopause supplement fits your main symptom?

Low sex drive is where the supplement shelf has the least to offer. It's also where a prescription plan comes in.

What if supplements don't fix your hot flashes or sex drive?

Then the next step is a prescription plan with your clinical team.

Set yourself a checkpoint. If a clearly labeled, properly dosed supplement isn't making a difference you can feel, stop buying it and ask your clinical team what else fits.

The same goes for your sex drive. Wanting to enjoy sex again is reason enough to ask for help. You don't need any other reason.

Our clinical team can prescribe bioidentical estrogen if it fits your goal and your health history. For sex drive, they can also prescribe PT-141 or kisspeptin if either fits your goal. Your clinical team looks at your symptoms and history and decides which option suits you.

If hot flashes, broken sleep or a flat sex drive are still running your week, take the quiz to see which plan with our clinical team fits your symptoms.