The Top Nutritional Supplements for Perimenopause

Dr. Rebecca Tocher-Richmond, ND

Almost everyone has heard of menopause but the definition of perimenopause can be a little confusing.  Menopause and perimenopause are 2 distinct stages of life.  They are different in terms of hormone levels and symptoms.  Menopause is diagnosed once a woman has gone without a menstrual period for a full 12 months.  The average age of menopause is 51.  The most common symptoms of menopause are hot flashes, night sweats, vaginal dryness and depressed mood.  These symptoms are largely due to declining estrogen levels.  Perimenopause is a stage of hormonal fluctuation that typically lasts for 2 to 10 years leading up to menopause.  Women in their 40’s commonly experience perimenopause symptoms such as heavier periods, irregular periods, sleep issues, brain fog, and exaggerated/magnified PMS symptoms such as irritability, anxiety, and breast tenderness.   Perimenopause is typically a state of “estrogen dominance”.  This means that estrogen levels are actually high in relation to progesterone.  Estrogen excess causes heavy periods and breast tenderness.   Low relative progesterone is the main contributor to irritability and anxiety.

For the treatment of perimenopause symptoms medical doctors will typically prescribe birth control pills, anti-anxiety medications or anti-depressants.  IUDs or even hysterectomies are recommended to deal with extremely heavy menstrual flow.   Unfortunately, these treatments are associated with a wide array of side effects and none of these treatments fix the underlying hormonal imbalance!  Fortunately, there is another way to balance these hormones and resolve perimenopause symptoms.  As you might have suspected, Naturopathic Medicine is the solution!

A specific treatment protocol for perimenopause will vary depending on a woman’s specific symptoms but these are some of the supplements which I have found work the best.

1. Chaste tree berry.  This amazing herb is also known as chaste tree, or by its latin name vitex agnus castus (vitex for short).  It works on the communication between the pituitary gland and the ovaries.  It does a fantastic job at regulating ovulation and therefore helping with the timing of your cycling.  It also boosts progesterone levels which helps with the PMS symptoms such as moodiness.  It can take some time to see changes with Chaste tree but it’s worth the wait since it’s actually balancing your hormones and addressing the root of the problem. While we wait for this herb to balance things out I will often prescribe other supplements for more immediate symptom relief.

2.  DIM (or IC3).  These natural compounds are derived from cruciferous vegetables such as broccoli and cauliflower.  Eating more of these vegetables can certainly help but the best results come from taking these in supplement form.  DIM helps your body to get rid of excess estrogen.  I think of it primarily when women have heavy, long periods.  Many women see results in as little as one cycle but it will continue to bring more improvement over several cycles.

3.  Magnesium. This mineral is involved in hundreds of different reactions in the body and is one of the most common nutritional deficiencies.  Magnesium helps with eliminating excess estrogen from the body to balance the hormones. It is also calming, helping mood and sleep.  Muscle tension and headaches indicate a need for more magnesium.

4.  Vitamin B6. The active form of this vitamin, called pyridoxal-5-phosphate., is needed in perimenopause.  Many women have trouble making the active form of vitamin B6 from their food and therefore supplementing with this form is required.  Vitamin B6 helps with reducing PMS symptoms and it is also involved in making serotonin.  Serotonin elevates mood.  Often I will recommend this B vitamin in conjunction with an entire B complex if a woman is tired and stressed.

There are many nuances involved in prescribing nutritional supplements and important details that are beyond the scope of this article.  It is recommended that you visit one of our naturopathic doctors for help with your perimenopause symptoms in order to get on a program that is right for you.  Relief from perimenopause symptoms is well within your reach!



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Cerqueira RO, Frey BN, Leclerc E, Brietzke E.  Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review.  Arch Womens Ment Health. 2017 Dec;20(6):713-719. doi: 10.1007/s00737-017-0791-0. Epub 2017 Oct 23.