Choosing a supplement is like choosing the right long-term financial investment. You have to first assess your cashflow needs years down the road and then accordingly find the product that suits you in the present moment and in the future. Most people only look at what the supplement does but neglect the long-term side effects and drug interactions. Do your homework before investing in supplements. Once you’ve decided on a product, don’t forget to take it seriously and consistently. Only with compliance and self-awareness can you conclude whether the supplement works for you.
Here I’m reviewing the top 3 supplements that I often recommend to my patients. Again and again, I have seen them working well for most menopausal symptoms and hormonal imbalances.
Disclaimer: products I recommend here are based on best results observed in my clinical experience. I am not affiliated with any of the brands mentioned nor do I have any personal, financial, relational gains or benefits from making these recommendations.
#1 Active vitamin B6, aka pyridoxal-5’-phosphate
I recommend B6 over B complex for menopausal management. The reason is that most B complex formulations offer the less active form of B6 – pyridoxine hydrochloride, and even when they do include the active form, it’s usually insufficient. The optimal dose of active B6 for vasomotor symptoms such as hotflashes and nightsweats is at least 50mg and up to 100mg a day. Vitamin B6 is a cofactor in production of melatonin, which is imperative for sleep, in turn combating the unfavourable effects of high cortisol. B6 is also a cofactor for serotonin production. Since serotonin regulates mood, appetite, and sleep, and given that serotonin level declines with lower estrogen in menopause, additional boost in serotonin production by supplying B6 can be very helpful to combat menopause-associated mood disorders. More importantly, B6 modulates steroid hormone gene expression, meaning that in sufficient level, B6 can optimize estrogen-progesterone ratio, lowering the health risks associated with progesterone deficiency in menopause such as endometriosis, endometrial cancer, anxiety, and insomnia.
Product Recommendation: Genestra Active B6, AOR P-5-P.
#2 Adaptogen combination
Adaptogens are herbs that support the hypothalamus-pituitary-adrenal axis, with the biggest focus on cortisol mitigation. In my previous blogs, I had mentioned that most menopausal symptoms arise from excess cortisol production which disturbs progesterone, estrogen, and androgen production. Once we are able to restore and reset the adrenals using adaptogens, combined with other mind-body practices and/or therapies, we can very quickly bring settlement to menopausal storm, returning to feeling normal again.
There are many adaptogen products in the market. For women beyond 50 years old, I recommend products that contain Ashwagandha (Withania somnifera), Rhodiola rosea, Asian ginseng (Panax ginseng), vitamin B5 (pantethine), and vitamin C.
Product Recommendation: Bioclinical Cortalign, Pure Encapsulations Phyto-ADR.
#3 Vitamin E (aka tocopherols + tocotrienols)
This nutrient deserves more attention than it gets. Underneath hormonal changes associated with menopause is inflammation and accelerated aging. Vitamin E combats inflammation, reducing the risk of cardiovascular disease, at the same time also address vasomotor symptoms. Menopausal women who have long standing insomnia and nightsweats tend to have elevated low lipoprotein (bad cholesterol), for which a dose of mixed tocopherol at 400IU per day can help manage cholesterol and reverse menopausal symptoms such as vaginal dryness, vaginal itchiness, hotflashes, and breast tenderness. Read the label and make sure the product contains mixed tocopherols which includes alpha and gamma forms of tocopherol and tocotrienol. Consult with your healthcare provider after 12 weeks of use to see if it’s adequate to continue.
Product Recommendation: AOR Pro E Complex.
What about other popular herbs like black cohosh, hops, dong-quai?
Most supplements marketed for menopause emphasize estrogen modulation and production. However, it’s important to address hypothalamus-pituitary-adrenal axis first before trying to modulate estrogen. Without working on the adrenals first or at least concomitantly, administering estrogen-modulating supplements or hormone replacement therapy would be less satisfactory on their impact. In addition, estrogen from herbs or medication perform best when cells are healthy. It is absolutely critical to eat healthy and lead a mindful, active lifestyle while on any form of therapy. Supplementation or HRT in the absence of healthy, well-nourished cells actually has harmful consequences associated with hormone-sensitive cancers.
Many people stop taking supplements after 1-2 weeks because they don’t see a difference. Similar to financial investments, an account takes time to grow. The more desperate you are, the slower the growth. Make your decision, commit to it, and re-evaluate after some time. For supplements, unless you’re getting new symptoms or have allergic reaction within a week after taking the supplement, which you’ll have to stop immediately or at least consult a healthcare provide, typically you won’t see a difference until at least 12 weeks of consistent use.
Oka, T. 2001. Modulation of gene expression by vitamin B6. Nutr Res Rev. 14(2):257-66.
Selcer KW, Leavitt WW. 1988 Progesterone down-regulation of nuclear estrogen receptor: a fundamental mechanism in birds and mammals. Gen Comp Endocrinol. 72(3):443-52.