Before trying any of the following supplements, NAMS recommends discussing them with a healthcare provider. This list is meant to be informational only and should not be interpreted as a recommendation for use by NAMS due to the potential for side effects or drug interactions.

Vitamin D and calcium.
The first item on our list is actually two supplements, although one pill often combines them both (many calcium supplements also contain vitamin D). This combo provides a double dose of good things for the midlife woman -- calcium to build the bones and lessen the chance of osteoporotic fracture and vitamin D to assure proper calcium absorption. However, there’s no reason, other than convenience, that the two nutrients need to be taken in the same supplement. 

NAMS recommends that postmenopausal women over age 65 consume 1,200 to 1,500 mg of calcium per day. It’s best to obtain this amount by eating a calcium-rich diet; a supplement is recommended for women who are unable to do so. The two most common types of calcium contained in supplements are calcium carbonate and calcium citrate. To maximize absorption, calcium should be taken with plenty of water and divided into doses of 250 mg to 500 mg each. Calcium carbonate should be taken with food; calcium citrate may be taken at any time. Neither should be taken at the same time as fiber or iron supplements. 

The recommended intake of vitamin D is 400 IU per day for women aged 51 to 70 and 600 IU per day for women over 70. Vitamin D is naturally manufactured in the skin following direct exposure to sunlight, so for women who always use sunscreen or are never in the sun, more Vitamin D is recommended (600-800 IU/day by US guidelines, although some women may require more). Guidelines from Osteoporosis Canada recommend 800 IU per day for women over age 50.

Black cohosh
This is currently the most widely studied herb for the treatment of menopause-related symptoms. The brand most commonly used in studies is Remifemin. In some clinical trials, women reported improvements in mild hot flashes with a dose of 40 mg per day taken for 8 to 12 weeks, while other trials showed no effect. Side effects are rare and include stomach upset, typically with first-time use. There have been reported cases of liver problems associated with black cohosh as well. Safety beyond 6 months of use is unproven.

Valerian
This supplement makes the list for being a relatively safe treatment for mild sleep disorders. Some studies have shown that valerian improves sleep when taken nightly over 1 to 2 weeks. In controlled clinical trials, it improved sleep quality without serious effects on alertness or concentration after 2 weeks of use. The brand of supplement tested in clinical studies is Sedonium (marketed in the United States by Abkit). No substantial side effects have been noted with recommended dosages, although long-term use may be associated with headache, restlessness, sleeplessness, and cardiac disorders. Unlike other sedatives, mixing valerian with alcohol does not increase drowsiness. The usual daily dose of valerian extract for insomnia ranges from 400 mg to 900 mg. 

St. John’s wort
When menopause is associated with the blues, St. John’s wort may help. It’s a botanical used to treat mild to moderate depression. This supplement has been found in some studies to be as effective as certain antidepressant drugs, but with fewer side effects. However, it is not effective for treating major depression. The usual dose is 300 mg to 600 mg (standardized to contain 3%-5% hyperforin, 0.3% hypericin, or both) three times daily. As with women taking prescription antidepressants, noticing a difference may take 2 to 4 weeks. Many complementary and alternative medicine (CAM) practitioners avoid prescribing this herb for longer than 2 years. Side effects include stomach upset, fatigue, and increased sensitivity to sunlight. St. John’s wort should not be used with blood-thinning drugs (such as Coumadin or aspirin), antidepressants, or drugs for HIV.

Soy
Soy supplements complete the list, for a variety of reasons. Soy protein has been found to slightly reduce low-density lipoprotein (LDL or “bad”) cholesterol and is being studied for its effect on arteries. Getting soy through food (such as soy nuts and soybeans) may be beneficial to heart health also because of its high content of polyunsaturated fats, fiber, vitamins and minerals, and its low content of saturated fat. Soy may also reduce hot flashes (study results vary). Soy does not have a harmful (stimulating) effect on the uterus.