As I mentioned at the start of this guide, I am not a doctor, nor do I play one on TV. But I have been very interested in holistic health and wellness for the past 25+ years. That includes an interest in supplements and herbs. I am not making any individual recommendations here. I’m just going to discuss the supplements and herbs I experimented with for perimenopause specifically (and why), and how they worked for me. There are a lot of them out there and, honestly, with most of them you can’t really be sure if they’re working or not, so do your own homework (including discussing them with your health-care practitioner as they may interact with medications you take) and know that not every supplement and herb is going to work the same for everybody. And better than supplements, just try to get these vitamins and nutrients from whole foods and lifestyle changes first!
Melatonin I discussed melatonin earlier in the section on hormones. Our brain produces it in response to darkness. Being a Highly Sensitive Person (HSP) with a nervous system that is harder to regulate means that I often have a hard time falling or staying asleep at night anyway, but the hormonal shifts of perimenopause made it that much harder. Therefore, melatonin is a staple in my personal apothecary. Even if you’re not an HSP, if you look at screens before bed or have bright lighting on, your melatonin levels may be below what is ideal for sleep. While many people are under the assumption that melatonin is just for jet lag, I’ve been assured by my integrative doctor at University of Michigan Medicine that it is fine to use on a regular basis.
GABA According to the National Institute of Health’s website, “Gamma-aminobutyric acid (GABA) is an amino acid that functions as the primary inhibitory neurotransmitter for the central nervous system (CNS). It functions to reduce neuronal excitability by inhibiting nerve transmission." Translation: it helps ease physical tension and anxiety. It is related to progesterone in the body which, as you may recall, also has a calming effect. I occasionally take this supplement on its own and also with magnesium before bed to help me feel calmer and more relaxed, and I do feel like it works for me.
Magnesium I mentioned magnesium above, so I’ll say more about it here. Magnesium is a mineral that has a relaxing effect on the body, especially your muscles. A deficiency can cause hormone disruption, endocrine disorders, headaches, anxiety, fatigue, insomnia, muscle cramping, nervousness, and high blood pressure. Magnesium glycinate and magnesium citrate are two highly absorbable forms. Because of my nervous system dysregulation issues I’ve taken magnesium as part of my supplement routine for years. Another nice way to get magnesium is to take a bath with Epsom salts, which are mainly composed of magnesium sulfate. The magnesium will absorb into your bloodstream through your skin while you enjoy the peaceful effects of a quiet soak in a warm tub. Foods that are particularly high in magnesium include dark, leafy greens like spinach, pumpkin seeds, brown rice, and even dark chocolate.
Vitamin B6 Vitamin B6 is essential for the production of progesterone. (And by now you know its association with progesterone means it has a calming effect on your body, which is why it’s been part of my supplement regimen for years.) It also helps your liver break down estrogen. Therefore, it could be a good supplement to take if you have estrogen dominance. Besides supplement form, B6 can be found in foods such as walnuts, bananas, leafy greens and beans.
Iron Speaking of estrogen dominance above, you may consider adding additional iron to your daily supplement regimen if you experience heavy bleeding due to estrogen dominance (and are therefore losing a lot of iron). While I did not have issues with estrogen dominance, I took iron for a number of years in my 30s and 40s while I was still menstruating because I was a vegetarian and then a vegan, and did not get iron from meat. Check with your doctor about whether or not you need an iron supplement.
Chaste Berry (also known as Vitex or Chaste Tree) This is a well-recognized herbal supplement used to treat menstrual issues and PMS. It can increase the progesterone levels in your body to help you combat symptoms of estrogen dominance and regulate your bleeding. I took it as a tincture early in perimenopause, which did seem to help me feel calmer but, by later perimenopause, it didn’t seem to be as up for the job anymore.
Nettle This herb may help to increase the health of the adrenal glands. I like to buy it at the farmers market in the spring and steep if for an infusion tea. Bonus: it’s also high in iron which is great if you’re dealing with estrogen dominance. One of my friends buys the herb for this purpose. You’d probably need to use it quite regularly to notice any effects.
Motherwort I talked to a fellow gardener a couple years back who said that plants come into your life for a reason. Shortly before that, I had started noticing a very interesting-looking wildflower growing in my yard. I learned it was motherwort, and one of my plant books said it is used for the heart as well as the uterus. Sure enough, another book mentioned it being a phytoestrogen, and good for heart palpitations associated with (peri)menopause. It also claims to help with hot flashes, vaginal lubrication, cramps PMS, mood swings, stress and anxiety. I take the tincture before I go to bed at night for heart palpitations and hot flashes, and I do think it helps. Thanks for coming into my life—and my yard—motherwort!
Ashwagandha This is an adaptogenic herb, meaning it helps the body’s resilience in dealing with physical and emotional stresses. According to the Cleveland Clinic’s website, “ashwagandha can help normalize cortisol levels, thus reducing the stress response. In addition, ashwagandha has also been associated with reduced inflammation, reduced cancer risks, improved memory, improved immune function and anti-aging properties.” As I will get into more in the Stress + Self-Care section, perimenopause tends to correspond with a stressful period in a woman’s life, not to mention the fact that we just live in a very stressful world. I took ashwagandha tincture for several months while recovering from the aforementioned super-stressful period of my life and I do think it helped in my recovery process.
Valerian Valerian is a fairly well-researched herb that is often used for insomnia. I have used it for this purpose in a tincture form for years and usually have pretty good results with it making me feel sleepy. However, throughout my perimenopause research, I have seen it recommended for things like cramping, anxiety and heart palpitations as well.
Maca I have limited experience with taking maca in a powder form (mixing a little into my oatmeal and smoothies) but I can’t honestly make any claims as to how well it works. I just wanted to add it to this list so you are aware of it. You may decide to experiment with it for vaginal dryness and low libido and energy levels.
Progesterone cream Finally, if you want to ‘take the edge off’ and get some immediate relief while your body adjusts to the perimenopausal transition, you might try a bioidentical topical progesterone cream. It was one of my best finds going through perimenopause. Progesterone cream can be bought over the counter. I typically used it only at night for its calming effects, but there have been times when I used it during the day as well. You just need to be careful that you don’t use too much because then you might experience progesterone dominance (I might have just made up that term!)—too much progesterone in relation to estrogen, which can cause symptoms like vaginal dryness, itchiness and discomfort. It’s worth mentioning again here that every woman’s perimenopause is different. While I noticed improvements with the topical progesterone cream, when I started taking BHRT, the oral progesterone I was prescribed did not seem to give me the same benefits. You may need to experiment with both to see which one works better for you. (You can only get the oral progesterone through a prescription.)
*Given your current perimenopausal symptoms, which of the supplements and herbs I mentioned above will you consider researching further and possibly adding to your 'perimenopause apothecary?'
*Once you've chosen a supplement or herb to experiment with, be sure to use it for at least 3 months. (Some work right away; some take time to build up in your system.) After 3 months, if you don't notice any improvements, you may want to stop using it and try something else.