During the perimenopause transition, many women begin to develop a wide range of symptoms caused by fluctuating hormone levels that can greatly affect their quality of life. This transitional phase can include everything from mood swings and fatigue to hot flashes, bone density loss, and changes in metabolism and obesity. Studies have shown that 45%-68% of perimenopausal women and 28%-31% of premenopausal women experience significant symptoms of depression. While medical and hormonal interventions should be discussed with a healthcare professional, recent studies highlight the positive impact of regular physical exercise, a balanced diet, educational support, and counselling in helping to improve quality of life during this period.

While a balanced diet is always important, getting all the nutrients needed to fully support the body through these changes can be challenging. Supplements can help fill in nutritional gaps, providing essential vitamins and minerals that support bone health, hormone balance, energy levels, and emotional well-being. By taking the right supplements, women can better manage symptoms and maintain their health and vitality during perimenopause.

Here, I will focus on the importance of vitamins and minerals in supporting women during perimenopause. With the hormonal changes that occur during this time, certain nutrients play a key role in managing symptoms and maintaining overall health. Although all vitamins and minerals are essential, the list is too extensive to cover here. I will highlight key examples, but it is crucial to maintain a balanced diet to ensure adequate levels of all required nutrients. They work in perfect synergy, and a deficiency in one can impact the effectiveness of others.

Vitamin D

Low levels of vitamin D (calciferol) in the blood are linked to osteoporosis, a chronic progressive condition that weakens bones and commonly affects women during menopause. On average, women may lose 10-12% of bone density (bone mineral density) in their spine and hips during the years around menopause. This loss of bone can have serious impacts on bone health. Common perimenopause symptoms, such as joint pain or stiffness, lack of energy, and hair loss, may also be caused by low levels of vitamin D. Vitamin D deficiency also causes calcium deficiency as it is required for calcium absorption.

Most of the vitamin D requirement is made naturally inside your body when your skin is exposed to sunlight. However, when there is not enough sunlight (i.e., UV-B radiation), like in the winter (or all year round if you live in the UK), it is important to get vitamin D from your diet. As we age, our bodies become less efficient at turning vitamin D into its active form, so getting vitamin D from external sources (i.e., supplements, either alone or as part of a multivitamin complex) becomes even more important. A recommended adequate dose of vitamin D is 400-600 IU per day.

Main food sources for vitamin D

Calcium

Calcium is an essential element with a wide range of important functions. For example, it is required for building and maintaining healthy bones and teeth, supporting nerve and muscle function, aiding blood clotting, controlling cholesterol levels, aiding B12 absorption and reducing menstrual cramps. During perimenopause, declining oestrogen levels increase the risk of osteopenia and osteoporosis. Calcium deficiencies can also lead to brittle hair and nails.

Calcium is closely linked to and affected by changes in oestrogen levels. With age, calcium absorption declines, making adequate intake (1000–1200 mg/day) crucial. A diet rich in calcium can meet most needs, while supplements may be considered cautiously (routine supplementation is not recommended due to its cardiovascular risk). Calcium is best absorbed when taken with vitamin D. Combined with vitamin D, calcium supports bone health and may also help improve mood and sleep quality, especially in women who are experiencing mood swings or trouble getting to sleep. A glass of warm milk before bed might help you feel more relaxed before sleeping.

Main food sources for calcium

Vitamin C

Vitamin C is one of the most important vitamins for maintaining a healthy hormone balance, particularly by supporting higher progesterone levels. It is also necessary for bone health. Vitamin C may help reduce stress-induced blood pressure, alleviate anxiety, and enhance cognitive function. It also aids in iron absorption, lowers cholesterol, and supports anti-stress hormone production.

Vitamin C levels naturally decrease during perimenopause. While vitamin C deficiency is rare, factors like poor diet high in refined foods and low in fruit and vegetables, poor absorption, stress, alcohol, infections, and certain medications (e.g., aspirin and barbiturates, contraceptive pills, and antibiotics) can impact levels. To meet the recommended daily intake of 100 mg, focus on a diet rich in vitamin C or consider supplementation.

Main food sources for vitamin C

Magnesium

Magnesium is a vital mineral that works with calcium to maintain thyroid function, bone density, muscle health, and energy production. As a cofactor for numerous enzymes, magnesium plays a role in stress regulation, digestion, immunity, mood stabilisation, and maintaining emotional and energy balance.

Magnesium levels tend to decline with age, which may contribute to thyroid dysfunction and exacerbate perimenopausal symptoms like fatigue, muscle spasms, headaches, insomnia, anxiety, poor digestion, and irritability. These effects are more pronounced with inadequate dietary intake, often due to the consumption of refined foods where magnesium is lost during processing and insufficient green vegetable consumption. Excessive calcium from dairy, proteins, and fats can also deplete magnesium levels.

The recommended daily intake is 320–600 mg, with magnesium citrate being the most bioavailable form. For optimal absorption, it works well in a calcium-to-magnesium ratio of 3:2. Vitamin D can also increase magnesium absorption. Including magnesium in your diet or supplementation can be particularly beneficial in mitigating the symptoms associated with perimenopause.

Main food sources for magnesium

Iron and Zinc

Iron and zinc are essential minerals often present in similar food sources and greatly impact mood and cognition, especially in perimenopausal women. Deficiencies in both minerals are linked to poor cognitive function, low mood, and depression.

Iron deficiency is particularly concerning during perimenopause due to the increased physiological demands driven by hormonal changes, such as fluctuations in oestrogen and progesterone. These hormonal shifts can lead to heavier or irregular menstrual cycles, significantly increasing iron loss. Symptoms of iron deficiency include pale skin, sore tongue, fatigue or listlessness, loss of appetite and nausea, and sensitivity to cold. If taken as a supplement, amino acid-chelated iron is three times more absorbent than iron sulphate or oxide. A daily intake of 14 mg is recommended to support energy, immune function, and overall well-being during this transitional period.

Symptoms of zinc deficiency include white marks on the nails, lack of appetite or lack of appetite control, pallor (skin paleness), infertility, frequent infections, poor growth (including hair growth), poor skin and acne, dermatitis and stretch marks, as well as mental and emotional problems. Zinc deficiency plays a role in nearly all major diseases, including diabetes and cancer. Zinc is required to make insulin and to boost the immune system. It is also necessary to make hormone-like substances called prostaglandins from essential fatty acids, which help balance hormones and control inflammation. It is found in higher levels in animals and fish and, thus, a vegetarian diet may be low in zinc. Stress, smoking, and alcohol can further deplete zinc. The recommended daily intake is 15 mg.

Main food sources for iron and zinc

Vitamin B group

B vitamins play an essential role in maintaining the functions of the nervous system. The concentrations of these compounds decline with age, leading to cognitive dysfunction and resulting in the common perimenopause-associated symptoms, such as brain fog and poor memory and concentration. Low levels can also be associated with low bone mineral density and increased fracture risk.

Vitamin B deficiencies during perimenopause are primarily caused by inadequate dietary intake. An excess of one B vitamin can lead to a deficiency in another, making it advisable to take a B-complex supplement that includes all B vitamins. The B vitamin group functions as a family, with each vitamin playing a distinct role while working synergistically to support overall health.