Women’s Health in Your 40s: A Pharmacist’s Guide to Perimenopause, Menopause & Supplements

By Lauren O’Reilly, Pharmacist 

October is Women’s Health Month, making it a good time to talk about something that affects a huge part of women’s health but can still be surprisingly confusing: what really matters nutritionally during your 40s, perimenopause and menopause? 

You’ll find no shortage of supplements marketed specifically for “women over 40” or “menopause support”. But reaching a certain age doesn’t automatically mean you need a long list of vitamins. 

From a pharmacist’s perspective, I think it makes much more sense to look at the nutrients and lifestyle factors that matter for your individual stage of life, diet, symptoms and medications, and then supplement where there is a genuine reason to. 

Your nutritional needs can change as hormones change 

Perimenopause is the transition leading up to menopause, and symptoms can begin several years before periods stop completely. Menopause itself is reached after 12 months without a period. In Ireland, the average age of menopause is around 51. 

As oestrogen levels fluctuate and eventually decline, women can experience changes in periods, sleep, mood, energy, skin, hair, body composition and bone health. 

That doesn't mean these symptoms are automatically caused by a vitamin or mineral deficiency. However, this stage of life does make certain areas particularly worth paying attention to. 

The nutrients I’d keep on the radar 

The important point is that “women over 40” is not a diagnosis. Your needs may be completely different from someone else’s. 

Vitamin D is one supplement I pay particular attention to in Ireland 

Vitamin D becomes particularly relevant around menopause because declining oestrogen can accelerate bone loss. Vitamin D supports normal bones, muscles and calcium absorption, so maintaining adequate levels is an important part of looking after bone health as you move through menopause. 

In Ireland, adults aged 13–64 are advised to take 15 µg (600 IU) of vitamin D daily from Halloween to St Patrick’s Day, with year-round supplementation recommended for some groups. 

For a simple daily option, I like AYA Vitamin D3 1000 IU, with one tablet providing 25 µg of vitamin D3. If you don't like tablets, BetterYou D1000 Oral Spray provides the same 1000 IU in one spray. 

I'm often asked whether a spray is better than a tablet. For most people, the main difference is simply the format and convenience. A spray can be useful if you dislike swallowing tablets, while a tablet is easy to add to an existing supplement routine. The important thing is choosing a format you'll actually remember to take consistently. 

Bone health becomes more important - but calcium isn't automatically the answer 

Bone health is one of the biggest reasons I think women should start paying attention to nutrition before menopause rather than waiting until afterwards. 

Oestrogen plays an important role in maintaining bone health, and the decline in oestrogen around menopause can contribute to bone loss. HRT can also help prevent weakening of the bones in appropriate women. 

Calcium is essential for strong bones and teeth, but most women don't need to automatically add a calcium supplement because they are approaching menopause. 

Adults aged 19–64 need around 700mg of calcium a day, and this should generally be achievable through food. Good sources include milk, yoghurt and cheese, calcium-fortified plant drinks, leafy green vegetables and fish such as sardines and pilchards where the bones are eaten. 

I would therefore think food first, supplement second. 

Bone health is also about the bigger picture: adequate protein, vitamin D, regular weight-bearing or resistance exercise, and not smoking are all important. 

Magnesium can be useful, but it isn't a menopause cure (despite what you might have heard)! 

Magnesium is another nutrient that frequently appears in menopause supplements, particularly those marketed around sleep, stress or energy. 

Magnesium contributes to normal muscle and nervous system function and normal energy metabolism. However, that doesn't mean magnesium supplements have been proven to treat menopause symptoms generally. 

If supplementation is appropriate, magnesium citrate and bisglycinate are two commonly used forms. Citrate is well absorbed but can have a laxative effect at higher doses, while bisglycinate is often chosen when digestive tolerance is a priority. 

For someone simply looking to supplement their magnesium intake, AYA Magnesium Citrate 250mg is one option available at Millie’s. 

The important thing is to look at the elemental magnesium amount, rather than being distracted by the weight of the magnesium compound itself. 

Feeling exhausted doesn't automatically mean you need iron 

Energy is one of the biggest concerns I hear from women during perimenopause, but tiredness has many possible causes. 

Iron is important because it is needed to make red blood cells, which carry oxygen around the body. Women who still have periods, particularly heavy periods, have a higher risk of iron deficiency. 

But I wouldn't recommend taking a high-dose iron supplement simply because you're tired, or even because of heavy periods. Low iron has to be diagnosed with a blood test and investigated for the cause.  

If you're experiencing persistent fatigue alongside heavy periods, hair shedding, restless legs, breathlessness or other symptoms, it is worth discussing this with your GP and considering blood tests. 

The same applies to B12. Vitamin B12 is involved in red blood cell production, nervous system health and releasing energy from food. People following a vegan diet need to pay particular attention because B12 isn't naturally found in fruit, vegetables or grains. 

What about a menopause multivitamin? 

This is where things become more individual. 

There are also supplements formulated specifically around the nutritional needs of women going through perimenopause and menopause. One option we stock at Millie’s is Revive Active Meno Active, a comprehensive 3-in-1 formula containing 31 active ingredients across a daily sachet, Omega-3 capsule and botanical capsule. 

It provides vitamin D3, magnesium, zinc, B vitamins, vitamin C, vitamin K2 and other vitamins and minerals, alongside EPA and DHA omega-3, three strains of Lactobacillus, digestive enzymes, ashwagandha, sage and soya isoflavones. 

There are some useful nutritional benefits here for this stage of life: vitamin D and magnesium contribute to normal muscle function, vitamin D supports normal bones, while several of the B vitamins and vitamin C contribute to normal energy-yielding metabolism and the reduction of tiredness and fatigue. Vitamin B6 also contributes to the regulation of hormonal activity. 

According to Revive Active, it may be taken alongside HRT following consultation with a qualified healthcare professional. Because it contains several botanicals as well as nutrients, I'd still recommend checking with your pharmacist or GP if you're taking HRT or any other regular medication. 

For someone who wants a single, comprehensive product rather than taking several individual supplements, this type of formulation may be convenient. 

However, I would still check the label carefully. If you already take vitamin D, magnesium, iron or another multivitamin, you don't necessarily need to add another product containing the same nutrients. 

More supplements doesn't automatically mean more benefit. 

Supplements and HRT aren't interchangeable 

One of the most important messages I'd give women is that supplements should not be used as a substitute for appropriate menopause treatment. 

HRT is a medical treatment for menopause and perimenopause symptoms. It can help symptoms including hot flushes, night sweats, sleep problems, low mood and vaginal dryness, and can also help prevent bone weakening. 

If symptoms are affecting your quality of life, it's worth having a conversation with your GP rather than trying to “supplement your way through” them. 

You can take supplements while using HRT, but that doesn't mean every supplement is suitable alongside every medication. Herbal products deserve particular caution because ingredients such as St John's wort, black cohosh, isoflavones and other botanicals can have medicine interactions or safety considerations. NICE specifically recommends discussing the uncertain safety and quality of unregulated preparations and notes that medicine interactions have been reported with some complementary menopause products. 

At Millie's, there is also a Health & Her Multivitamin for Women Taking HRT, which is specifically formulated as a nutritional supplement alongside HRT. I would still treat this as a nutritional supplement rather than assuming that everyone taking HRT needs it. 

My pharmacist takeaway 

If I could simplify the whole conversation around menopause supplements, it would be this: 

Don't supplement simply because you're over 40. Supplement with a purpose. 

Vitamin D is particularly relevant in Ireland, bone health deserves more attention as oestrogen declines, and nutrients such as calcium, magnesium, iron and B12 may be important depending on your diet, symptoms and individual circumstances. 

And if you're struggling with hot flushes, sleep, mood, vaginal symptoms or other menopause symptoms that are affecting your everyday life, don't assume you need a better supplement. There are effective medical treatments available, including HRT for many women, and it's worth discussing your options with your GP, and investigating whether what you are experiencing is menopause related, or indeed, something else.  
 
Take care!  
 
Lauren x