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Quick answer: Supplements play a small part in menopause care. For your bones, aim for 1,200 mg of calcium a day after age 50, mostly from food, and 600 IU of vitamin D a day (800 IU after 70); for hot flashes, The Menopause Society does not recommend herbs or supplements. Sleep problems, low mood and vaginal dryness have effective options to discuss with your doctor.
In This Article
This guide looks at menopause as a whole: bones, hot flashes, sleep, mood and vaginal symptoms, and where supplements fit. It is general information, not a substitute for advice from your doctor.
What Changes at Menopause and What Helps
Menopause is the point when periods stop for good, at an average age of 51. In the years around it, some women have hot flashes, night sweats, trouble sleeping or other symptoms (NCCIH). Falling estrogen also reduces calcium absorption and increases calcium loss in urine, which speeds bone loss (NIH ODS).
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| Concern | What has the best evidence | Where supplements fit |
|---|---|---|
| Bone loss | Enough calcium and vitamin D, bone density screening at the right age, and medical options your doctor may offer | Calcium and vitamin D to fill gaps in your diet |
| Hot flashes | Hormone therapy; nonhormone options such as CBT, clinical hypnosis and some prescription medicines | Not recommended by The Menopause Society |
| Trouble sleeping | Cognitive behavioral therapy for insomnia (CBT-I) | Ask your doctor before trying sleep aids |
| Low mood | Screening and support from your doctor, especially in perimenopause | Not a substitute for care |
| Vaginal dryness | Lubricants and moisturizers; low-dose vaginal estrogen or other prescription options | Not among the recommended options |
Each row is explained, with its sources, in the sections below.
Bone Health: Calcium and Vitamin D
About 30% of postmenopausal women in the United States and Europe have osteoporosis (NIH ODS).
Women aged 51 and older need 1,200 mg of calcium a day, and the upper limit at that age is 2,000 mg a day from food and supplements combined. The body absorbs calcium best in doses of 500 mg or less: about 36% of a 300 mg dose versus 28% of a 1,000 mg dose (NIH ODS). Count what you get from food first and use a supplement only to fill the gap.
Adults need 600 IU of vitamin D a day up to age 70 and 800 IU after that, and the upper limit is 4,000 IU a day. Vitamin D and calcium taken together may increase bone density in some postmenopausal women, but it is not clear that they reduce falls or fractures (NIH ODS).
In 2018, the US Preventive Services Task Force found that daily supplements of 400 IU or less of vitamin D and 1,000 mg or less of calcium do not lower fracture risk in postmenopausal women living at home, and that vitamin D taken with calcium increases kidney stones. It found too little evidence to judge higher doses. These findings do not apply to women with osteoporosis, a past fracture, a high risk of falls or vitamin D deficiency (Grossman et al., 2018).
The Task Force recommends bone density screening for all women 65 and older and for younger postmenopausal women at higher risk of fracture (Nicholson et al., 2025). Hormone therapy also reduces bone loss and fractures; whether it suits you is a decision to make with your doctor (The Menopause Society, 2022).
Hot Flashes: Where Herbs and Supplements Stand
Hot flashes are the symptom most supplements target. In its 2023 review of nonhormone options, The Menopause Society recommended cognitive behavioral therapy, clinical hypnosis, certain antidepressants (SSRIs and SNRIs), gabapentin, fezolinetant and oxybutynin. It did not recommend supplements or herbal remedies, soy foods and soy extracts, or equol for hot flashes. It called hormone therapy the most effective treatment and said it should be considered for women within 10 years of their last period (The Menopause Society, 2023).
Black cohosh is the herb studied most. A Cochrane review of 16 trials (2,027 women) found no significant difference from placebo in how often hot flashes happened (Leach and Moore, 2012), while NCCIH notes that a 2023 review of 22 studies found possible benefits for overall menopause symptoms and hot flashes (NCCIH). The results are mixed.
NCCIH says soy isoflavone supplements may reduce how often hot flashes happen and how bad they are, but the effect may be small and the results have not been fully consistent (NCCIH). For doses, the trial results for each option and how to choose a product, see our guide to supplements for hot flashes.
Ashwagandha, magnesium and evening primrose oil
- Ashwagandha: three small trials from India (60 to 100 women, 8 to 12 weeks) reported lower menopause symptom scores (Gopal et al., 2021; Vani et al., 2025; Obhrai et al., 2026). It should be avoided in pregnancy, has been linked to rare liver injury and is not recommended for people with thyroid disorders (NCCIH). More in our ashwagandha guide for women.
- Magnesium: in 289 women with a history of breast cancer, magnesium oxide at 800 or 1,200 mg a day did no better than placebo for hot flashes and caused more diarrhea (Park et al., 2015). Those were study doses: the upper limit for magnesium from supplements is 350 mg a day (NIH ODS).
- Evening primrose oil: it is an herbal supplement, and The Menopause Society does not recommend supplements or herbal remedies for hot flashes (The Menopause Society, 2023).
Sleep, Mood and Vaginal Dryness
Sleep
For chronic insomnia, the American College of Physicians recommends cognitive behavioral therapy for insomnia (CBT-I) as the first treatment for all adults (Qaseem et al., 2016). In NCCIH-funded studies in menopausal women, clinical hypnosis reduced hot flashes and helped women sleep better, and mindfulness training improved self-reported sleep quality (NCCIH).
Mood
A meta-analysis of studies that followed women over time found higher odds of depressive symptoms or depression in perimenopause than before it (odds ratio 1.40), while the odds after menopause were not clearly higher (Badawy et al., 2024). If low mood or anxiety does not lift, talk to your doctor.
Vaginal dryness
Vaginal dryness and the related urinary and sexual symptoms, called the genitourinary syndrome of menopause, affect an estimated 27% to 84% of postmenopausal women. Over-the-counter vaginal lubricants and moisturizers give enough relief for most women with mild symptoms, and low-dose vaginal estrogen, vaginal DHEA and other prescription options work for moderate to severe symptoms. If you have had breast cancer, choose with your oncologist (The Menopause Society, 2020).
Safety: Liver, Hormone-Sensitive Cancers and Kidney Stones
- Black cohosh: at least 83 cases of liver damage have been reported worldwide, although it is uncertain whether black cohosh caused them. US Pharmacopeia advises stopping and seeing a doctor if you develop signs of liver trouble such as abdominal pain, dark urine or jaundice (NIH ODS). NCCIH says it may not be safe during pregnancy or while breastfeeding, and that its safety for women who have had breast or uterine cancer is uncertain (NCCIH).
- Soy and other phytoestrogens: they may act like estrogen, so they may not be safe for women who should not take estrogen, and an endocrinology guideline cited by NCCIH advises women with a personal or strong family history of blood clots, heart disease, or breast, uterine or ovarian cancer not to use soy-based treatments (NCCIH). NCCIH also notes that soy supplements have not been shown to lower breast cancer risk (NCCIH).
- Calcium: higher intakes of supplemental calcium might increase the risk of kidney stones; stay within 2,000 mg a day from all sources after age 50 (NIH ODS).
- Vitamin D: stay at or below 4,000 IU a day unless your doctor advises more (NIH ODS).
- Any supplement: dietary supplements may have side effects or interact with drugs, and little is known about their long-term safety (NCCIH).
Frequently Asked Questions
What is the best supplement for menopause?
There is no single best one. Calcium and vitamin D matter for bones if your diet falls short (NIH ODS), while The Menopause Society does not recommend supplements or herbal remedies for hot flashes (The Menopause Society, 2023).
How much calcium do I need after menopause?
Women 51 and older need 1,200 mg a day from food and supplements combined, and the upper limit is 2,000 mg a day. The body absorbs calcium best in doses of 500 mg or less at a time (NIH ODS).
Is black cohosh safe?
Cases of liver damage have been reported, although it is uncertain whether black cohosh caused them (NIH ODS). NCCIH says it may not be safe during pregnancy or while breastfeeding, and its safety after breast or uterine cancer is uncertain (NCCIH).
Can supplements help vaginal dryness?
The Menopause Society recommends vaginal lubricants and moisturizers for mild symptoms and prescription options such as low-dose vaginal estrogen for moderate to severe symptoms (The Menopause Society, 2020). Supplements are not on that list.
Can I take soy if I had breast cancer?
Ask your oncologist first. Phytoestrogen supplements may act like estrogen and may not be safe for women who should not take estrogen (NCCIH).
The Bottom Line
Menopause care rests on medical options with good evidence, not on supplements. Get the calcium and vitamin D you need, mostly from food and within the upper limits, ask about a bone density test at the right age, and talk to your doctor about hot flashes, sleep, mood and vaginal symptoms, which all have effective options.
Scientific References
- Grossman et al., 2018. Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: US Preventive Services Task Force Recommendation Statement. JAMA.
- Nicholson et al., 2025. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA.
- The Menopause Society, 2022. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause.
- The Menopause Society, 2023. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause.
- Leach and Moore, 2012. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev.
- Gopal et al., 2021. Effect of an ashwagandha (Withania Somnifera) root extract on climacteric symptoms in women during perimenopause: A randomized, double-blind, placebo-controlled study. J Obstet Gynaecol Res.
- Vani et al., 2025. A prospective, randomized, double-blind, placebo-controlled study on efficacy and safety of Ashwagandha root extract (Withania somnifera) for managing menopausal symptoms in women. Front Reprod Health.
- Obhrai et al., 2026. Effects of Withania somnifera root extract on sleep quality, body composition, and menopausal symptoms in postmenopausal women: a randomized, double-blind, placebo-controlled trial. Menopause.
- Park et al., 2015. North Central Cancer Treatment Group N10C2 (Alliance): a double-blind placebo-controlled study of magnesium supplements to reduce menopausal hot flashes. Menopause.
- Qaseem et al., 2016. Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med.
- Badawy et al., 2024. The risk of depression in the menopausal stages: A systematic review and meta-analysis. J Affect Disord.
- The Menopause Society, 2020. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause.
- NCCIH: Menopausal Symptoms and Complementary Health Approaches, In Depth (updated May 2017).
- NIH Office of Dietary Supplements: Calcium, Health Professional Fact Sheet (updated June 22, 2026).
- NIH Office of Dietary Supplements: Vitamin D, Health Professional Fact Sheet (updated June 27, 2025).
- NCCIH: Black Cohosh, Usefulness and Safety (updated November 2024).
- NCCIH: Soy, Usefulness and Safety (updated April 2025).
- NCCIH: Ashwagandha, Usefulness and Safety (updated March 2023).
- NIH Office of Dietary Supplements: Magnesium, Health Professional Fact Sheet (updated January 6, 2026).
- NIH Office of Dietary Supplements: Black Cohosh, Health Professional Fact Sheet (updated June 3, 2020).
