What Should I Take During Perimenopause? Start Here.
"What supplements should I be taking?"
It's a question I hear frequently from my clients, women mostly in their 40s through 60s.
Protein? Creatine? Magnesium? Collagen? A multivitamin? Something for hormones?
While the supplement industry has plenty of answers, let's back up with a more useful question: What is actually happening to your body during perimenopause, and what does the evidence say can help?
Perimenopause isn't something to fix. It's a physiological transition that can bring meaningful changes in hormones, sleep, body composition, muscle and bone health. And while supplements may have a role for some women, they're only one piece of a much bigger picture.
What's actually happening during perimenopause?
During the menopausal transition, ovarian hormone production becomes increasingly variable. Estrogen and progesterone don't simply drop steadily until menopause; they can fluctuate considerably from cycle to cycle before eventually settling at lower levels after menopause.
Those hormonal changes can influence a range of physiological processes, including fat distribution, glucose metabolism and bone health.
But there's an important complication: Perimenopause happens alongside other changes that can affect these same systems. Aging, along with changes in body composition, physical activity and sleep are all happening at roughly the same time, making it difficult to separate the effects of menopause from the effects of getting older.
This is particularly true when we talk about metabolism. Some research suggests that resting energy expenditure decreases during the menopausal transition, while newer research suggests that age and changes in body composition may explain more of the decline than menopause itself.
The honest answer? We don't completely know.
What we do know is that the fundamentals matter: Maintaining muscle through resistance training; eating enough protein and nutrient-dense foods; getting regular movement; protecting your sleep; and, when appropriate, working with a healthcare professional to address symptoms, nutritional deficiencies or other health concerns.
Again, there is no magic menopause fix.
Instead, the evidence gives us good reason to prioritize the things that support our health as our bodies and hormones change.
Build and protect muscle
If there's one thing worth prioritizing as you move through midlife, it's resistance training.
A large systematic review and meta-analysis published in 2026 looked at 126 studies involving more than 4,000 women across their lifespan. The researchers found that resistance training significantly improved strength in both premenopausal and postmenopausal women, with no meaningful difference between the groups.
That's good news. Your ability to get stronger doesn't disappear when you enter menopause.
And that's particularly important during this stage of life. Muscle mass and strength tend to decline with age, while the menopausal transition is also associated with changes in body composition and bone health. Resistance training can help maintain or increase lean body mass, improve strength and provide mechanical loading that can support bone health.
Strength also supports everyday function, from carrying groceries and lifting your kids to getting up from the floor and maintaining independence as you age.
And there's another reason I like resistance training for women in midlife: It puts you in the driver's seat of your own strength.
You may not be able to control when your hormones fluctuate. You can't choose where your body stores fat. But you can progressively challenge your muscles and become stronger.
More good news: There is no perfect menopause workout.
You need a program you can do consistently, that challenges your muscles appropriately and that can progress as you get stronger.
That might mean lifting dumbbells at home twice a week. It might mean using machines at a gym. It might mean working with a trainer. It might mean joining with a group of women each morning for a boot camp.
The best program is the one you will do.
Eat enough protein, but don't make it a magic bullet
Once you start talking about building muscle, protein inevitably enters the conversation.
And if you've spent any time on social media lately, you might think the answer to every health question is: Eat more protein.
The current recommended dietary allowance (RDA) for protein is 0.8 grams per kilogram of body weight per day. That's the amount intended to meet the basic needs of most healthy adults, not necessarily a universal target for optimizing muscle health as we age.
Researchers have studied whether eating more protein can help women maintain muscle and strength, particularly when combined with resistance training. The results aren't as simple as you might expect.
A 2022 systematic review and meta-analysis found that protein intake above the RDA can be beneficial for muscle-related outcomes, particularly in conjunction with resistance training. Other research has found that protein supplementation can contribute to gains in muscle mass and strength when paired with resistance training, but that the benefits appear to level off beyond a certain intake.
And then there's a particularly useful randomized trial in postmenopausal women. Researchers compared women consuming protein around the RDA with women consuming approximately 1.2 grams per kilogram per day while participating in resistance exercise. The higher-protein group saw a small improvement in functional capacity, but researchers did not find additional improvements in strength or lean-mass quality compared with the lower-protein group.
In other words, more wasn't automatically better.
This leads many women to ask, "How much protein do I need?"
That answer depends on the individual. Age, body size, activity level, overall diet and health status all matter. Women with diagnosed muscle loss or other specific nutritional needs may require more individualized guidance from a registered dietitian or healthcare professional.
Remember: Protein is one piece of the picture and not the only thing your muscles need. They need a reason to get stronger, enough energy and nutrients to support that work, and adequate recovery between workouts.
What about creatine?
If protein is the supplement women ask about most, creatine is now a close second.
For years, creatine was associated primarily with bodybuilders, competitive athletes and people trying to get noticeably bigger.
That's changing.
Creatine is one of the most extensively studied sports supplements, and researchers are increasingly interested in what it might offer women as they age, particularly when it comes to maintaining muscle and strength.
Creatine is a compound your body makes naturally and stores primarily in skeletal muscle. You also get some creatine from foods, such as meat and fish.
Your muscles use creatine as part of the system that rapidly produces energy during short, high-intensity efforts. Supplementing with creatine increases the amount stored in muscle, which can help support repeated high-intensity efforts. This is one reason it has been studied so extensively alongside resistance training.
That's an important distinction: Creatine doesn't build muscle by itself. It may help support the work that gives your muscles a reason to adapt.
A 2026 systematic review and meta-analysis looked specifically at creatine supplementation in postmenopausal women. The researchers included seven randomized controlled trials involving 608 women and found small but measurable improvements in lean mass and strength, particularly when creatine was combined with resistance training.
So is creatine worth taking?
Maybe.
For a healthy woman who is resistance training, creatine monohydrate has a relatively strong evidence base for supporting strength and lean mass. The newest research in postmenopausal women adds to that evidence.
But it doesn't replace the things that make the biggest difference.
If you're not resistance training, taking creatine doesn't recreate the benefits of resistance training. If your diet is chronically lacking in overall nutrition, creatine isn't going to fix that. And if you're looking for a supplement that will prevent all of the changes associated with menopause, this isn't it.
A supplement can support a foundation, not replace one.
What about the rest of the supplement aisle?
That said, a woman walking into any health-food store, or glancing through her social media feed, is promised products that support everything from stronger bones and healthier skin to better sleep and "balanced hormones."
Collagen is a good example of why the answer isn't always “supplements work” or “supplements don't work.”
A 2018 randomized controlled trial found that daily collagen peptides were associated with small improvements in bone mineral density and markers of bone formation in postmenopausal women after 12 months.
That's interesting evidence.
But it's also one relatively small study from one research group.
Other research has found benefits from hydrolyzed collagen for measures such as skin hydration and elasticity, although the evidence varies by outcome and study design. Evidence specifically linking collagen supplementation to reduced joint pain in menopausal women is limited.
So what's the takeaway?
The strength of the claim should match the strength of the evidence.
Before buying another bottle, ask a few questions:
What problem am I actually trying to solve?
Has this specific supplement been studied for that outcome?
Were people like me included in the research?
Was the study large and well controlled?
Did researchers measure an outcome that actually matters to me, or just a biological marker?
Does the evidence support the claim being made on the label?
Get comfortable asking: Show me the evidence.
Don't underestimate sleep
We've spent a lot of time talking about what women might add to their routines. Now let's talk about one of the most important things you can do for your health during perimenopause that doesn't come in a bottle at all.
Sleep.
Sleep disruption is common during the menopausal transition. In one study of women in their 40s and 50s, about 56 percent of perimenopausal women reported difficulty maintaining sleep, compared with about 32 percent of premenopausal women of a similar age.
And there are good physiological reasons for that.
As reproductive hormones fluctuate during perimenopause, changes in estrogen and progesterone can influence the systems involved in sleep regulation. Vasomotor symptoms, particularly hot flashes and night sweats, can repeatedly interrupt sleep. Changes in circadian rhythms and other biological processes may contribute as well.
Hormones aren't the whole story, either. Research points to factors including physical activity, alcohol use, anxiety, age and other health conditions as contributors to sleep problems during this stage of life.
That's useful to remember because it means there is more than one lever you can pull to improve your sleep.
First, start with the basics: A consistent sleep schedule, a cool and comfortable bedroom, regular daytime movement, limiting caffeine and alcohol close to bedtime, and creating a wind-down routine are all reasonable ways to support healthy sleep.
If you're regularly struggling to fall asleep or stay asleep, waking frequently because of night sweats, or experiencing significant daytime fatigue, it's worth talking with a healthcare professional rather than simply adding another supplement to your routine.
Sleep isn't a luxury you earn after everything else on your to-do list is finished. It's part of the foundation that helps you function, recover and stay healthy.
The bigger picture: There is no menopause supplement stack
So, what should you take during perimenopause?
It depends.
Your nutritional needs, health history, medications, diet and symptoms all matter. Some women may benefit from targeted supplementation; others may not.
But there's something I'd put ahead of the supplement aisle:
Build and maintain muscle
Eat a varied, nutrient-dense diet with adequate protein
Prioritize sleep and recovery
Get medical guidance when needed
None of these is particularly flashy. None comes in a $79 bottle.
But they're the foundation.
And maybe that's the most important thing to remember as your body changes:
You don't need to fix it. You need to support it.
