During menopause, estrogen levels drop, and this changes more than just your cycle: bone breakdown accelerates, the need for magnesium becomes more noticeable due to sleep disturbances and muscle tension, and the skin loses collagen faster. Dietary supplements cannot stop this process and are no substitute for medical advice or hormone therapy, but specific nutrients have been well-researched for certain aspects. This guide assesses what studies have actually shown regarding magnesium, vitamin D, ashwagandha, and collagen – and where the evidence is still thin.

Why does nutrient demand change during menopause?

Estrogen influences much more than the reproductive organs: it regulates bone metabolism, collagen production in the skin, and calcium absorption in the gut, among other things. As estrogen levels drop during perimenopause and after menopause, bone breakdown accelerates noticeably, which is why the current DVO Osteoporosis Guideline 2023 from the German Osteology Association is aimed specifically at postmenopausal women. At the same time, many women in this phase report sleep disturbances, muscle tension, and mood swings, which overlap with typical signs of magnesium deficiency, even if the two are not necessarily causally linked. Dietary supplements can be a targeted approach here, but they do not replace a balanced diet or medical evaluation if symptoms are severe.

→ Source: Dachverband Osteologie e.V. (German Osteology Association), DVO Guideline on Osteoporosis 2023 – Prevention, diagnosis, and therapy of osteoporosis in postmenopausal women and men

Magnesium: What the studies show regarding sleep, muscles, and mood

The German Nutrition Society (DGE) sets an estimated value of 300 milligrams of magnesium per day for women aged 19 and older (men: 350 milligrams). Several EFSA-approved health claims are permitted for magnesium: it contributes to normal muscle function, normal psychological function, the reduction of tiredness and fatigue, and normal functioning of the nervous system. These claims apply generally to adults; there is no claim specifically approved for menopausal symptoms. Some individual review articles suggest that sufficient magnesium can have a positive influence on muscle tension and mild sleep problems, but robust randomized studies specifically on magnesium for menopausal symptoms are still rare. If you do not meet the estimated value through your diet (leafy green vegetables, nuts, whole grains, legumes), you may consider a supplement; organic compounds such as magnesium bisglycinate are particularly well-researched and well-tolerated.

→ Source: DGE, Reference values for nutrient intake – Magnesium · EFSA, Register of authorised nutrition and health claims

Vitamin D and K2: Bone health after menopause

Several EFSA claims are approved for vitamin D, including its contribution to normal calcium absorption, the maintenance of normal bones and normal muscle function, as well as the normal function of the immune system. For vitamin K, there is also an approved claim for the maintenance of normal bones. Because accelerated bone breakdown after menopause is a central topic of the DVO Osteoporosis Guideline, sufficient vitamin D intake is one of the most well-supported pillars of supplementation during this life phase, especially with limited sunlight exposure, which is the case for most people in Germany from October to March. You can find more on exact dosage in our Vitamin D3 Dosage Guide. Vitamin K2 is often taken as a supplement because it is involved in regulating calcium incorporation; here, too, the approved claim refers to normal bone function in general, not specifically to menopause.

→ Source: EFSA, Register of authorised nutrition and health claims (Vitamin D and Vitamin K) · Dachverband Osteologie e.V., DVO Guideline on Osteoporosis 2023

Reference values: DGE. EFSA claims are abbreviated; they apply generally to adults and not specifically to menopause.

Ashwagandha: What the 2021 Gopal study really shows

Ashwagandha (Withania somnifera) is mostly marketed as an adaptogen for stress, but there is also targeted research on menopausal symptoms. In a randomized, double-blind, placebo-controlled study by Dr. Vidya Gopal et al. (2021, Journal of Obstetrics and Gynaecology Research), 100 perimenopausal women with symptoms were enrolled, 91 completed the study. Participants received 300 milligrams of ashwagandha root extract or placebo twice daily for eight weeks. The ashwagandha group showed a statistically significant reduction in the total score on the Menopause Rating Scale (MRS) as well as MENQoL scores compared to placebo at the end; additionally, estradiol levels rose significantly, while FSH and LH fell significantly. Important for context: this is a single, relatively small 8-week study; independent replications with larger sample sizes are pending, and there is no EFSA-approved claim for ashwagandha regarding menopausal symptoms. For more on the general body of evidence for ashwagandha regarding stress and sleep, check our Ashwagandha Study Check and our Dosage Guide.

→ Source: Gopal, V. et al., Effect of an Ashwagandha (Withania Somnifera) Root Extract on Climacteric Symptoms in Women During Perimenopause: A Randomized, Double-Blind, Placebo-Controlled Study, Journal of Obstetrics and Gynaecology Research (2021), DOI 10.1111/jog.15030

Expert Perspectives & Protocol Breakdown

EFSA uses a strict, population-wide assessment approach for health claims on dietary supplements: a claim is only authorized if submitted human studies prove a causal, reproducible link for the general adult population. It was precisely this standard that caused proposed claims regarding collagen and hyaluronic acid for skin structure to fail – the available evidence was deemed insufficient, regardless of individual positive study results.

→ Source: EFSA, Register of authorized nutrition and health claims

Gopal and her team, by contrast, follow a targeted, hypothesis-driven RCT approach: Instead of testing a claim for the general population, they investigated a narrowly defined target group (perimenopausal women with climacteric symptoms) over a fixed period with a fixed dose and several validated measurement tools (MRS, MENQoL, hormone levels). This design provided a clear, statistically significant result for this specific population – without a general, EFSA-approved health claim being derivable from it yet. For consumers, the juxtaposition means: A lack of an EFSA claim does not rule out an effect in a specific study population; it only means that the evidence has not yet reached the high threshold for a universally applicable statement.

→ Source: Gopal, V. et al., Effect of an Ashwagandha (Withania Somnifera) Root Extract on Climacteric Symptoms in Women During Perimenopause, Journal of Obstetrics and Gynaecology Research (2021), DOI 10.1111/jog.15030

Collagen for skin and joints: What is proven and what is not

The body's own collagen production decreases as estrogen levels drop, which contributes to the changes in skin elasticity frequently reported during menopause. Important for context: The EU has rejected health claims regarding collagen and hyaluronic acid in relation to skin structure and joint health due to a lack of sufficient scientific evidence, as the consumer advice center (Verbraucherzentrale) also confirms. Therefore, collagen supplements may not be officially marketed in the EU for improved skin elasticity or joint health, regardless of what individual manufacturers might suggest. This does not automatically mean that collagen peptides are ineffective; individual independent studies show positive effects on skin hydration and elasticity, but the overall evidence base is considered insufficient for an official claim. You can find more about dosage, the study situation, and side effects in our detailed guides: Collagen Dosage, Which Collagen is the Best, and Collagen Side Effects.

→ Source: EFSA, Register of authorized nutrition and health claims · Verbraucherzentrale, Collagen drinks for beauty – beauty in a can?

Other nutrients in focus: Iron, Omega-3, and B-vitamins

With the cessation of menstruation, many women's iron requirements decrease after menopause compared to their fertile years; in perimenopause, however, with sometimes heavy or irregular bleeding, iron can still be an issue—more on this in our Iron for Women guide. Omega-3 fatty acids are associated with normal heart function, which can be relevant in a life phase with increasing cardiovascular risk after menopause; details on dosage can be found in our Omega-3 Dosage Guide. B-vitamins, especially B6, B12, and folate, contribute to normal energy metabolism and psychological function according to authorized EFSA claims; a vitamin B12 deficiency is more common, especially with plant-based diets—explained in detail in our Vitamin B12 Deficiency Guide.

Some women also notice new or increased bloating during perimenopause, which can be related to the hormonal fluctuations of this phase. A more in-depth assessment—including the role of estrogen in intestinal transit and what really helps according to studies—can be found in our guide Bloating in Women: Hormonal Causes.

The bladder can also be affected: According to a Cochrane review, low estrogen levels after menopause can contribute to involuntary urine loss. Which measures are best supported by guidelines and studies, from pelvic floor training to local estrogens, is explained in our guide Bladder Weakness in Women: What guidelines and studies show.

When to see a doctor?

Severe hot flashes, bleeding disorders, pronounced insomnia, or depressive moods should be clarified medically before relying solely on dietary supplements. Hormone replacement therapy is the most effective option for many women with severe symptoms and is not replaced by supplements, though they can be a useful accompaniment. A bone density scan is also a sensible addition to simple nutrient supplementation if there is an increased risk of osteoporosis, as advanced bone loss cannot be reliably stopped by dietary supplements alone.

Limitations of this guide

This article does not replace individual medical or gynecological advice. Menopausal symptoms vary greatly, and what works for one woman may not have the same effect on another. The state of research on individual nutrients and plant substances for menopausal symptoms is generally thinner than for established medical topics like osteoporosis prevention; in particular, there is only a limited number of randomized studies on Ashwagandha so far. In the case of existing illnesses, medication use, pregnancy, or breastfeeding, any dietary supplement should be coordinated with a doctor beforehand.

Frequently asked questions

Which nutrients are particularly important during menopause?

Best supported by guidelines and EFSA claims are adequate supplies of Vitamin D, Vitamin K, and magnesium, as bone loss accelerates after menopause due to falling estrogen levels. Ashwagandha and collagen are also frequently used, but the evidence base here is more limited.

How much magnesium should I take during menopause?

The DGE (German Nutrition Society) provides a general estimate of 300 milligrams per day for adult women. There is no official reference value increased specifically for menopausal symptoms.

Does Ashwagandha really help against hot flashes?

A randomized, placebo-controlled study with 91 participants (Gopal et al. 2021) found a greater improvement in hot flash and overall symptom scores compared to placebo after 8 weeks. This is a single, comparatively small study; larger independent confirmations are still pending. A detailed assessment of hormone therapy, Fezolinetant, and further studies specifically on hot flashes is provided in the VEYT article Hot flashes during menopause.

Can collagen firm the skin during menopause?

There is no EU-authorized health claim for this effect; the EFSA considered the scientific evidence insufficient. Individual independent studies show positive effects on skin hydration, but the overall evidence is considered insufficient for an official statement.

Why does osteoporosis risk increase after menopause?

Estrogen normally inhibits bone breakdown. If estrogen levels drop after menopause, bone breakdown accelerates, which is why the DVO Guideline on Osteoporosis 2023 specifically addresses postmenopausal women.

Does a dietary supplement replace hormone therapy?

No. For severe menopausal symptoms, hormone replacement therapy is often the most effective medically prescribed option. Dietary supplements can be a useful accompaniment to treatment, but cannot replace it.

References & Scientific Citations

• Dachverband Osteologie e.V. (2023). DVO-Guideline Osteoporosis 2023
• Deutsche Gesellschaft für Ernährung (DGE). Reference values for nutrient intake – Magnesium
• EFSA. Register of authorized nutrition and health claims (Magnesium, Vitamin D, Vitamin K, Collagen/Hyaluronic acid)
• Gopal, V. et al. (2021). Effect of an Ashwagandha (Withania Somnifera) Root Extract on Climacteric Symptoms in Women During Perimenopause: A Randomized, Double-Blind, Placebo-Controlled Study, Journal of Obstetrics and Gynaecology Research, DOI 10.1111/jog.15030
• Verbraucherzentrale. Collagen drinks for beauty – beauty in a can?