Treatments · before your appointment

Where supplements fit alongside HRT.

The supplement aisle in midlife is loud, expensive, and mostly unregulated. This is the version of the conversation a menopause-trained doctor would actually have with you, what's worth your money, what isn't, and how it sits next to MHT.

The honest framing

Supplements are a treatment category, not a workaround. They're best thought of as companions to medical care, sometimes filling a real nutritional gap, sometimes nudging a symptom, occasionally interfering with the prescription you're already taking. A few have solid evidence, a handful are promising, most are marketing, and almost none of them replace hormone therapy when hormone therapy is what your body needs. The curated library sorts the bottles; this page is the map.

01
The three honest tiers
A few have solid evidence, a handful are promising, most are marketing, and almost none replace hormone therapy when hormone therapy is what your body needs.
When we curated the supplement library, we sorted everything into three buckets and left out the rest. The same map applies here, so you can tell at a glance where any new bottle on your shelf actually sits.
- Strong evidence
  Multiple randomised trials or guideline backing for a midlife-relevant outcome. Vitamin D3 (when you're low), calcium from food first then supplement to top up, creatine monohydrate for muscle and bone loading, omega-3 EPA/DHA for cardiovascular risk.
- Promising
  Reasonable human data, generally safe, mainstream use. Magnesium glycinate for sleep and cramps, B12 if you're vegetarian or on metformin, a basic probiotic during or after antibiotics, soy isoflavones for mild flushes in some women.
- Traditional use
  Long history, modest evidence, safe with usual caveats. Ashwagandha, chamomile, ginger, turmeric.
02
Complementary therapies, the honest middle
Low harm, modest signal, no menopause-society endorsement. Fine to try alongside the real plan, not a substitute for it.
A few non-supplement, non-drug things sit in a quieter middle ground. Small trials, modest short-term signal for specific symptoms. We're comfortable naming them as long as nobody pretends they replace HRT, CBT-I, strength training or a proper workup. The line we won't cross is medicalising them, no 'ear seeds for estrogen detox', no acupuncture point that 'resets your HPA axis'. If a practitioner is making endocrine claims, that's the cue to walk.
- Auricular acupressure / ear seeds
  Tiny seeds or magnets taped to specific points on the outer ear. Small trials suggest a modest short-term benefit for hot flushes, sleep and anxiety in midlife women. Low cost, low harm, self-applied. Reasonable to try alongside, not a stand-in for HRT or CBT-I.
- Acupuncture
  Mixed evidence; the better trials show a modest reduction in hot-flush frequency and bother, often comparable to placebo needling. If you find it calming and can afford it, fine. If it isn't doing anything after 6 to 8 sessions, stop.
- Reflexology, massage, aromatherapy
  No strong symptom-specific evidence, real evidence for stress and sleep generally. Treat as wellbeing care, not menopause treatment.
- Yoga, tai chi, qigong
  Decent evidence for sleep, mood and balance in midlife. These earn their place as movement, not as hormonal interventions.
03
What we deliberately don't recommend
The loudest products in the menopause aisle didn't make any of the three tiers. Either the safety signal is real, or the evidence is too thin to recommend honestly.
These are the ones we get asked about most, and the ones we're most consistent about declining to endorse. Naming them by name is part of doing this honestly.
- Compounded "bioidentical" hormones
  Marketed as natural, actually unregulated and inconsistently dosed. Regulated body-identical estradiol and micronised progesterone (the standard MHT options) are chemically the same molecule and properly studied. There is no upside to the compounded version, and there are real downsides.
- "Detox", "hormone reset" and DIM/I3C blends
  The premise (that your body needs help clearing estrogen) is not how endocrinology works. The blends are usually expensive and occasionally interact with real medication.
- Mega-dose multivitamins and high-dose iodine
  More is not more. High-dose iodine in particular can destabilise thyroid function in midlife.
- Black cohosh and sage leaf
  Mixed evidence for hot flushes, real (if rare) liver-injury reports for black cohosh. Most menopause societies have stepped back from recommending them.
04
Where supplements actually sit next to HRT
MHT is the most effective treatment for vasomotor symptoms, genitourinary symptoms and bone protection in early postmenopause. Supplements earn their place in the spaces MHT doesn't fully reach.
No supplement competes with hormone therapy where hormone therapy works. The honest job for supplements is the supporting cast around it, or the primary plan when MHT isn't on the table.
- Bone and muscle, alongside MHT
  Vitamin D3 to a doctor-confirmed level, calcium topped up to about 1,200 mg/day from food and supplement combined, and creatine monohydrate (3 to 5 g/day) layered with resistance training. MHT slows bone loss; the supplements support the structural side.
- Cardiovascular risk, alongside MHT or instead of
  Omega-3 EPA/DHA, fibre from food, and the boring lifestyle pieces are doing the heavy lifting here regardless of hormonal status.
- Sleep, when MHT isn't enough
  Magnesium glycinate at night, a consistent wind-down, light exposure in the morning. Useful adjuncts, not a substitute for treating night sweats with hormones if night sweats are what's waking you up.
- When MHT isn't an option
  After certain cancers, with specific clotting histories, or by personal choice, supplements move up the list as part of a non-hormonal plan that also includes lifestyle, CBT for hot flushes and non-hormonal prescription options where appropriate. Have that conversation with a menopause-trained doctor or specialist, not a supplement website.
05
The interactions worth flagging before you start
"Natural" doesn't mean "no interactions." Bring this short list to your doctor or pharmacist before you stack anything new on top of an existing prescription.
Most of the trouble we see isn't the supplement itself, it's the supplement plus something already prescribed. A two-minute mention at the appointment usually settles it.
- St John's wort
  Reduces the blood level of many drugs including some hormonal contraceptives, some antidepressants, and tamoxifen. Avoid alongside MHT, contraception, or after breast cancer without a specialist conversation.
- High-dose fish oil, vitamin E, ginkgo and turmeric
  Can additively thin the blood. Worth flagging if you're on an anticoagulant or before a planned procedure.
- Calcium and iron
  Compete for absorption with thyroid replacement (levothyroxine). Take levothyroxine first thing, leave a four-hour gap.
- Soy isoflavones and red clover
  Weak estrogen-like activity. Generally fine; the conversation worth having is after estrogen-receptor-positive breast cancer, where opinion is split and specialist input matters.
- Grapefruit juice (not a supplement, but)
  Changes the metabolism of a long list of midlife-common drugs (some statins, some blood-pressure pills, some sleep medications). Worth knowing.
06
How to think about a "stack"
Three to five supplements, chosen for one or two named goals, taken consistently for 12 weeks before you decide if they're earning their place.
A clean approach beats a clever one. The fastest way to a confused, expensive cabinet is buying one bottle per symptom from one influencer per week. A reasonable starting frame: one bone-and-muscle item (vitamin D3 or creatine), one cardiometabolic item (omega-3 or fibre top-up), one sleep-or-mood item (magnesium glycinate or a B-complex if your diet is light on whole grains), and an honest conversation about whether MHT is doing the job you're asking the supplements to do.
07
What to bring to the appointment
The actual list, the actual reasons, and the honest test: which of these would you miss if you stopped them tomorrow?
A specific page of notes turns a vague 'I take some supplements' conversation into a useful one. Photos of the labels are fine.
- The actual list
  Brand, dose, how often, how long. Photos of the labels are fine.
- What you're hoping each one does
  In your own words, not the marketing copy on the bottle.
- What's already prescribed
  Including MHT, contraception, thyroid replacement, antidepressants, blood-pressure pills, anticoagulants.
- Allergies and upcoming procedures
  Any known allergies and any planned procedures in the next eight weeks (some supplements need pausing before surgery).
- The honest test
  "Which of these would I miss if I stopped them tomorrow?" The answer usually trims the stack faster than your doctor will.

Editorial, not medical advice. Supplements interact with prescriptions and with each other. The right stack for your body depends on what's already on board, your bloodwork, and what you're actually trying to fix. Use this page to walk into a real conversation with a menopause-trained doctor or pharmacist, not as a prescription.

Where to next

The library