Best Supplements to Support Hormone Balance After Menopause

I. Introduction

Menopause is a natural biological milestone that every woman will experience, usually between the ages of 45 and 55. While it marks the end of menstrual cycles, it also signals profound shifts in hormone production—particularly estrogen and progesterone—that ripple across nearly every system in the body. For some women, these changes are subtle and manageable. For others, they can be disruptive, affecting quality of life, sleep, relationships, and long-term health.

Why focus on hormone balance?
Hormones are the body’s chemical messengers, regulating everything from temperature control and sleep cycles to bone density and cardiovascular health. When estrogen and progesterone decline, the resulting imbalance can trigger hot flashes, night sweats, mood swings, vaginal dryness, weight gain, and even memory lapses. Beyond symptoms, postmenopausal women face higher risks of osteoporosis and heart disease—making hormone health a cornerstone of healthy aging.

Supplements as part of the solution
Not every woman chooses, or is eligible, to use hormone replacement therapy (HRT). Some prefer natural approaches, others have health conditions or medication histories that limit options, and many simply want to complement lifestyle changes with targeted nutritional support. This is where supplements—herbs, vitamins, minerals, and nutraceuticals—come into play.

Supplements designed to support hormone balance after menopause aim to:

Ease vasomotor symptoms like hot flashes and night sweats
Improve sleep and mood stability
Protect bone health and reduce osteoporosis risk
Support cardiovascular and metabolic health
Enhance sexual wellness and energy levels

While supplements cannot “replace” the hormones lost after menopause, certain compounds have estrogen-like effects (phytoestrogens), help regulate stress hormones, or provide the raw nutrients bones and tissues need to adapt to this new hormonal environment.

What about compounded hormones?
In recent years, there has been growing discussion about “bioidentical” hormones—some FDA-approved and others only available through compounding pharmacies. Compounded hormone therapy (sometimes abbreviated cBHT) is often marketed as a personalized solution for post-menopausal women. However, major organizations such as the American College of Obstetricians and Gynecologists (ACOG) and the North American Menopause Society (NAMS) caution that compounded hormones should not replace FDA-approved options except in specific cases, such as allergies to excipients or the need for non-standard strengths.

We will devote a full section later in this article to current advancements in compounded medications, new research, and how pharmacists evaluate their place alongside supplements.

Safety first: the pharmacist’s perspective
As a pharmacist, I encourage readers to remember that “natural” does not always mean safe. Supplements can interact with prescription medications (for example, soy isoflavones with thyroid drugs or red clover with blood thinners). Quality also varies—unlike prescription drugs, supplements are not pre-approved by the U.S. Food and Drug Administration (FDA), which means product purity and potency are not guaranteed. Choosing supplements with third-party certifications (USP, NSF, ConsumerLab) and discussing new regimens with your healthcare provider are essential steps.

What this article covers
Over the next sections, we’ll explore:

The hormonal shifts that occur after menopause and why balance matters
The most effective, evidence-based supplements for symptom relief and long-term health
Pharmacist insights on safety, dosing, and drug–supplement interactions
An updated, evidence-backed review of compounded hormone therapies and new formulations in 2023–2025
Practical tips on choosing high-quality supplements and integrating lifestyle strategies for holistic hormone support

By the end of this guide, you’ll have a comprehensive understanding of which supplements are worth considering, which claims to view with caution, and how to make safe, informed decisions for your long-term health.

II. Understanding Hormonal Changes After Menopause

Menopause is more than just the end of menstruation. It represents a complex hormonal shift that touches nearly every organ system. By understanding what happens inside the body during this transition, it becomes easier to see how certain supplements—and, for some women, hormone therapy—can help restore balance.

A. The Big Picture: Decline in Estrogen and Progesterone

Estrogen: Produced mainly by the ovaries before menopause, estrogen regulates reproductive cycles, bone density, cholesterol levels, blood vessel elasticity, and brain signaling. By the time a woman reaches menopause, estrogen levels can drop by as much as 90%.
Progesterone: Also produced by the ovaries, progesterone balances estrogen’s effects, protects the uterine lining, and influences mood and sleep. Progesterone levels plummet after the final menstrual cycle.
Androgens (Testosterone, DHEA): These hormones also decline, though more gradually. They play a role in libido, energy, and muscle strength.

This sudden hormonal imbalance explains the wide variety of symptoms women experience—not just hot flashes, but bone loss, heart risk, and even cognitive changes.

👉 For a comprehensive overview, visit the North American Menopause Society’s Menopause 101 guide.

B. How Hormonal Changes Affect the Body

Bone Health (Osteoporosis Risk)
- Estrogen is a key protector of bone density. After menopause, bone resorption (breakdown) outpaces bone formation, leading to an increased risk of fractures.
- According to the NIH Osteoporosis and Related Bone Diseases Resource Center, up to 50% of women over age 50 will experience a fracture related to osteoporosis.
Cardiovascular Health
- Estrogen supports flexible blood vessels and helps maintain healthy cholesterol levels. Its decline increases LDL cholesterol (“bad” cholesterol) and reduces HDL cholesterol (“good” cholesterol), raising the risk of heart disease.
- The American Heart Association notes that postmenopausal women have a significantly higher risk of heart attack and stroke.
Weight and Metabolism
- Many women notice abdominal weight gain after menopause. This is partly due to lower estrogen, which shifts fat storage patterns, and partly due to slower metabolism.
- Low estrogen also contributes to insulin resistance, making blood sugar control harder.
Brain and Mood
- Estrogen supports neurotransmitters like serotonin and dopamine, which regulate mood and cognition. Its decline can lead to brain fog, mood swings, anxiety, or depression.
- Ongoing research is exploring the relationship between estrogen loss and long-term cognitive decline, including dementia risk.
Vaginal and Urinary Health
- Low estrogen leads to thinning vaginal tissues, dryness, discomfort during sex, and increased urinary tract infections (UTIs).
- This cluster of symptoms is known as genitourinary syndrome of menopause (GSM).
Sleep and Energy
- Progesterone has a natural calming effect. When it drops, many women struggle with insomnia.
- Hot flashes and night sweats further disrupt sleep, creating a cycle of fatigue and irritability.

C. Why “Hormone Balance” Matters

When healthcare providers talk about “hormone balance” after menopause, they don’t mean restoring levels to those of a 25-year-old. Instead, they mean:

Reducing extreme fluctuations that trigger hot flashes and mood swings
Supporting estrogen-sensitive tissues like bone, brain, and heart
Preventing long-term complications (osteoporosis, cardiovascular disease)
Improving daily quality of life (better sleep, less anxiety, more energy)

This balance can be pursued through:

Lifestyle changes: diet, exercise, stress management
Supplements: phytoestrogens, adaptogens, vitamins, minerals
Hormone therapy (HRT or compounded options): when symptoms are severe or supplements aren’t enough

D. Setting the Stage for Supplements

Because of these widespread effects, supplements often target:

Phytoestrogens (plant compounds with estrogen-like activity) to ease hot flashes
Bone-supporting nutrients like calcium, vitamin D, and vitamin K2
Stress-adaptogens like ashwagandha and maca root for mood and energy
Omega-3 fatty acids for heart and brain health
Probiotics to support estrogen metabolism in the gut (the “estrobolome”)

However, supplements are just one piece of the puzzle. In some cases, compounded hormones or FDA-approved bioidentical formulations may provide additional support—something we’ll explore in detail in Section V.

III. Pharmacist’s Approach to Supplementation

When it comes to supplements for hormone balance after menopause, one truth stands out: not all products are created equal. As a pharmacist, I’ve seen firsthand how overwhelming the supplement aisle can be. Bright labels promise relief from hot flashes, better sleep, stronger bones, or “natural hormone support.” But how do you separate science-backed products from hype? That’s where a structured, evidence-based approach matters.

A. Evaluating the Evidence

The first step is assessing scientific validity:

Randomized Controlled Trials (RCTs): These provide the strongest evidence. For example, soy isoflavones have multiple RCTs showing modest benefit for hot flashes, while evidence for evening primrose oil is inconsistent.
Systematic Reviews & Meta-Analyses: These summarize multiple studies, giving a clearer picture of whether a supplement works. For instance, black cohosh has mixed but promising data for reducing vasomotor symptoms.
Anecdotal Reports: Testimonials can be encouraging but are not enough to guide safe decisions.

Reliable sources include the National Institutes of Health Office of Dietary Supplements and the National Center for Complementary and Integrative Health (NCCIH).

B. Understanding How Supplements Differ from Hormone Therapy

It’s important to understand the difference between supplements and hormone therapy:

Supplements: These support the body’s adaptation to low hormone levels. They may reduce symptoms but do not restore hormone concentrations to pre-menopausal levels.
Hormone Replacement Therapy (HRT): Provides bioidentical estrogen and progesterone (either FDA-approved or compounded), directly addressing hormone deficiency.

Supplements may be best suited for:

Women with mild to moderate symptoms
Those who cannot or prefer not to use HRT
Patients looking for adjunctive support alongside lifestyle changes

C. Regulatory Gaps and Quality Assurance

Unlike prescription medications, supplements are not pre-approved by the FDA for safety or effectiveness. Instead, manufacturers are responsible for ensuring quality and accurate labeling. Unfortunately, research has shown that some supplements contain less—or more—of the active ingredient than listed, and a few may be contaminated with heavy metals or adulterated with prescription drugs.

That’s why pharmacists recommend looking for third-party quality seals such as:

USP Verified – United States Pharmacopeia
NSF International – verifies purity and potency
ConsumerLab.com – independent testing and certification

These seals indicate that the supplement has been tested for strength, purity, and absence of contaminants.

D. The Counseling Perspective

When patients ask me about supplements for menopause, I focus on four key questions:

What symptom are you targeting? Hot flashes? Sleep? Bone health?
What’s the evidence behind this supplement?
Could it interact with your medications? (e.g., soy with thyroid hormone, red clover with warfarin)
Is the brand reputable and tested for quality?

This structured approach helps ensure that women choose products that are both safe and effective.

E. Pharmacist’s Bottom Line

Supplements can be valuable tools for managing menopausal symptoms, but they must be chosen carefully. The role of the pharmacist is to bridge the gap between marketing and medicine—making sure patients don’t waste money on ineffective products or put themselves at risk of dangerous interactions.

The rest of this article will walk through evidence-based categories of supplements—from phytoestrogens to micronutrients—before we take a deeper dive into new developments in compounded hormone therapies.

IV. Core Categories of Supplements for Menopausal Hormone Balance

A. Phytoestrogens (Plant-Based Estrogen-Like Compounds)

One of the most frequently discussed supplement categories for menopause is phytoestrogens—plant-derived compounds that can mimic estrogen in the body. Structurally similar to estradiol, phytoestrogens bind to estrogen receptors, though their effects are weaker.

For many women, phytoestrogens offer a gentler, more natural approach to easing symptoms like hot flashes and night sweats, without the risks associated with conventional hormone replacement therapy. But it’s important to note that research results are mixed, and effectiveness often depends on the dose, formulation, and an individual woman’s metabolism.

1. Soy Isoflavones

What they are:
Soybeans are rich in compounds called isoflavones, a class of phytoestrogens that bind to estrogen receptors.

How they work:

Isoflavones preferentially bind to estrogen receptor beta (ER-β), which is abundant in bone, brain, and vascular tissue.
This selective activity explains why soy may help with hot flashes, bone health, and possibly heart health, while carrying a lower risk of stimulating breast or uterine tissue compared to estradiol.

Evidence:

A 2021 Cochrane Review concluded that soy isoflavones modestly reduce hot flash frequency and severity.
Some studies show benefits for bone density, particularly in the lumbar spine, though results vary.
Effects on cardiovascular markers (cholesterol, blood pressure) are generally positive but small.

Safety:

Generally safe in food and supplement doses.
May interact with thyroid hormone therapy (levothyroxine).
Caution in women with a history of estrogen-sensitive cancers; current evidence suggests safety, but decisions should be individualized with an oncologist.

Typical Dose:
40–80 mg isoflavones daily, often standardized from soy protein or soy germ extracts.

2. Red Clover Extract

What it is:
Red clover (Trifolium pratense) is another source of isoflavones, including formononetin and biochanin A.

Evidence:

Some studies report reductions in hot flashes and night sweats, though results are inconsistent.
Red clover may have mild benefits for bone density and arterial stiffness.
A 2016 systematic review in PLOS ONE found red clover extract showed modest improvement in vasomotor symptoms but less consistent than soy.

Safety:

May increase bleeding risk when combined with anticoagulants like warfarin.
Use with caution in women with a history of hormone-sensitive cancers.

Typical Dose:
40–80 mg isoflavones per day (similar to soy).

3. Flaxseed & Lignans

What they are:
Flaxseeds are one of the richest dietary sources of lignans, compounds metabolized by gut bacteria into weak estrogen-like substances.

Evidence:

Some clinical trials show modest improvements in hot flashes and night sweats.
Flaxseed consumption is associated with lower cholesterol and improved cardiovascular health.
The benefit for bone density is less clear.

Safety:

Generally safe as a food.
High doses may have mild laxative effects.
Whole flaxseed is more effective than oil (since oil lacks lignans).

Typical Dose:
25–40 g ground flaxseed daily, or standardized lignan supplements.

4. Other Phytoestrogen Sources

Hops (Humulus lupulus): Contains 8-prenylnaringenin, one of the most potent phytoestrogens. Small studies suggest improvements in hot flashes, but data are limited.
Licorice root: Has weak estrogenic properties but also influences cortisol metabolism. Use with caution due to risk of hypertension and low potassium.
Chickpeas, lentils, and other legumes: Naturally contain phytoestrogens, though less concentrated than supplements.

Practical Considerations for Phytoestrogens

Who may benefit most: Women with mild-to-moderate vasomotor symptoms who want to avoid or complement HRT.
Who should be cautious: Women with a history of estrogen-receptor-positive breast cancer, those on blood thinners, and those on thyroid medication.
Quality issues: Look for standardized extracts listing isoflavone content. Some cheap supplements contain variable or mislabeled amounts.

Pharmacist’s Take

Phytoestrogens are among the most studied supplements for menopause. While not as potent as prescription hormone therapy, they provide a reasonable, low-risk option for many women seeking natural support. They may also deliver added cardiovascular and metabolic benefits. However, patients should set realistic expectations: most experience modest relief, not complete elimination of symptoms.

For women with severe or disruptive hot flashes, phytoestrogens may not be enough—and this is where FDA-approved bioidentical hormone therapy or, in some cases, compounded formulations might be considered (see Section V).

👉 For more information, see the NIH Soy Fact Sheet and NCCIH on Red Clover and Black Cohosh.

IV. Core Categories of Supplements for Menopausal Hormone Balance

B. Adaptogenic Herbs & Botanicals

While phytoestrogens aim to gently mimic estrogen, another class of supplements—adaptogenic herbs and botanicals—focuses on helping the body adapt to stress, improve resilience, and support overall balance. Many women use them to reduce hot flashes, manage fatigue, stabilize mood, or restore libido after menopause.

1. Black Cohosh (Actaea racemosa)

What it is:
A North American herb traditionally used by Native Americans, black cohosh is one of the most studied herbal supplements for menopausal symptoms.

How it works:
Unlike phytoestrogens, black cohosh does not appear to act directly like estrogen. Instead, it may work on serotonin receptors in the brain, helping regulate body temperature and mood.

Evidence:

A 2012 Cochrane review found black cohosh may reduce hot flashes and night sweats, but study results were inconsistent.
A 2023 NCCIH review noted that while some trials show benefit, others find little to no effect.
Evidence does not support black cohosh for preventing bone loss.

Safety:

Generally safe when used short-term (up to 6 months).
Case reports link it to liver toxicity, though causation is debated. Women with liver disease should avoid it.
Not recommended for women with a history of breast cancer without physician oversight.

Typical Dose:
20–40 mg standardized extract, twice daily.

2. Maca Root (Lepidium meyenii)

What it is:
A root vegetable from the Andes, maca has been used for centuries as food and medicine. It is considered an adaptogen, supporting energy, mood, and sexual health.

How it works:

Maca does not act as a phytoestrogen. Instead, it may influence the hypothalamic-pituitary axis, helping regulate hormone signaling indirectly.
Rich in plant sterols, amino acids, and polyphenols, it may also support mood and stamina.

Evidence:

A 2015 systematic review found maca may improve sexual function and libido in postmenopausal women.
Some studies suggest benefits for mood and anxiety, though data are limited.
Unlike soy or red clover, maca does not significantly affect estrogen levels, making it safer for women avoiding estrogenic compounds.

Safety:

Generally well tolerated.
Rare side effects include gastrointestinal upset or insomnia (if taken late in the day).

Typical Dose:
1.5–3 g powdered root daily, or equivalent capsule form.

3. Ashwagandha (Withania somnifera)

What it is:
A cornerstone herb in Ayurvedic medicine, ashwagandha is classified as an adaptogen that helps the body manage stress.

How it works:

Reduces cortisol levels, improving stress resilience.
Enhances GABA signaling in the brain, promoting relaxation and better sleep.
May indirectly improve hormone balance by reducing stress-driven dysregulation of the HPA axis.

Evidence:

A 2021 randomized controlled trial in Cureus found ashwagandha improved sleep quality, reduced anxiety, and boosted energy in menopausal women.
A 2022 review in Journal of Ethnopharmacology confirmed benefits for stress, insomnia, and fatigue, though direct evidence for hot flash reduction remains limited.
Ashwagandha is also being studied for thyroid support, which may be relevant since thyroid function can shift during and after menopause.

Safety:

Generally well tolerated in doses up to 600 mg/day of standardized extract.
May cause mild GI upset or drowsiness.
Avoid in hyperthyroidism or if taking sedative medications.

Typical Dose:
300–600 mg/day of root extract, standardized to 5% withanolides.

Practical Considerations for Adaptogens

Best for: Women seeking relief from fatigue, stress, sleep issues, or low libido.
Less effective for: Bone health or cardiovascular risk reduction (other supplements may be better suited).
Combination use: Adaptogens are often combined with phytoestrogens in menopause support formulas, but doses should remain within studied ranges.

Pharmacist’s Take

Adaptogenic herbs can be a valuable addition to a menopause wellness plan—especially for women struggling with stress, poor sleep, or low energy. Among them, black cohosh remains the most researched for hot flashes, though evidence is mixed. Maca and ashwagandha shine in supporting libido, mood, and stress resilience.

However, patients should keep in mind:

Herbal supplements are not a substitute for HRT in severe cases.
Quality matters: look for standardized extracts and third-party tested products.
Individual responses vary—some women report dramatic improvement, while others notice little effect.

👉 Learn more from the National Center for Complementary and Integrative Health (NCCIH), which regularly reviews herbal therapies for menopausal symptoms.

IV. Core Categories of Supplements for Menopausal Hormone Balance

C. Micronutrients Essential for Hormone & Bone Support

While phytoestrogens and adaptogens aim to ease menopausal symptoms, micronutrients provide the building blocks for long-term health. After menopause, bone loss accelerates, cardiovascular risks rise, and metabolism slows. Ensuring adequate intake of certain vitamins and minerals can make the difference between thriving and struggling during this stage of life.

1. Calcium + Vitamin D3

Why they matter:

Estrogen helps the body absorb calcium and maintain bone density. After menopause, bone resorption (breakdown) exceeds bone formation, dramatically increasing the risk of osteoporosis and fractures.
Vitamin D3 enhances calcium absorption in the gut and regulates calcium balance in blood and bone.

Evidence:

According to the NIH Office of Dietary Supplements (Calcium Fact Sheet), women over 50 need 1,200 mg of calcium daily from food and supplements combined.
The Endocrine Society recommends vitamin D blood levels of at least 30 ng/mL to optimize bone and muscle health.
A 2019 Journal of Bone and Mineral Research meta-analysis confirmed that calcium + vitamin D supplementation reduces fracture risk in postmenopausal women, especially when dietary intake is low.

Safety:

Excess calcium (>2,000 mg/day) may increase risk of kidney stones or vascular calcification.
Vitamin D toxicity is rare but possible with very high doses (>10,000 IU/day).

Typical Dose:

Calcium: 500–600 mg twice daily (if dietary intake is insufficient).
Vitamin D3: 800–2,000 IU daily, depending on blood levels and sun exposure.

2. Magnesium

Why it matters:
Magnesium is essential for bone metabolism, nerve signaling, muscle relaxation, and energy production. Low magnesium has been linked to higher risk of osteoporosis, mood disorders, and sleep disturbances.

Evidence:

A 2013 study in Biological Trace Element Research found that postmenopausal women with osteoporosis had significantly lower magnesium levels compared to controls.
Magnesium also improves sleep quality and reduces nighttime awakenings, which are often worsened by hot flashes.

Safety:

High doses (>500 mg/day from supplements) may cause diarrhea.
Caution in patients with chronic kidney disease.

Typical Dose:
300–400 mg/day (from magnesium citrate, glycinate, or malate for best absorption).

3. Vitamin K2

Why it matters:
Vitamin K2 (particularly the MK-7 form) works synergistically with vitamin D to direct calcium into bones and teeth, and away from arteries. After menopause, women face increased risk of both osteoporosis and cardiovascular disease—making K2 especially relevant.

Evidence:

A 2017 randomized controlled trial in Osteoporosis International found that vitamin K2 supplementation improved bone mineral density in postmenopausal women.
Observational studies suggest lower rates of arterial calcification in populations with higher K2 intake (e.g., Japanese diets rich in natto).

Safety:

May interfere with anticoagulant therapy (warfarin). Patients on blood thinners should consult their healthcare provider before use.

Typical Dose:
90–180 mcg/day (preferably as MK-7 form for longer half-life).

4. B Vitamins (B6, B12, Folate)

Why they matter:
The B vitamins play a role in energy metabolism, neurotransmitter production, and cardiovascular health. After menopause, homocysteine levels (an amino acid linked to heart disease) often rise, and B vitamins help keep it in check.

Vitamin B6 (pyridoxine): Supports mood regulation by assisting serotonin and dopamine synthesis.
Vitamin B12 (cobalamin): Crucial for energy, cognition, and nerve health. Deficiency is common in older adults due to reduced stomach acid.
Folate (B9): Helps regulate homocysteine and supports red blood cell formation.

Evidence:

A 2015 study in Menopause found that higher intake of B6 and folate was linked with reduced depressive symptoms in middle-aged and older women.
A 2019 Nutrients review confirmed that B12 deficiency is strongly associated with cognitive decline in postmenopausal populations.

Safety:

Water-soluble, so toxicity is rare.
Very high doses of B6 (>200 mg/day) may cause nerve damage.

Typical Dose:

B6: 2–10 mg/day
B12: 500–1,000 mcg/day (especially if levels are low)
Folate: 400–800 mcg/day (methylfolate form may be better absorbed)

Practical Considerations for Micronutrients

Diet first: Food sources should always be emphasized—leafy greens, dairy, fatty fish, nuts, and whole grains. Supplements should “fill the gap” when diet is insufficient.
Combination products: Many menopause support formulas combine calcium, vitamin D3, magnesium, and K2 into one convenient supplement.
Lab testing: Blood tests for vitamin D, B12, and magnesium can guide individualized supplementation.

Pharmacist’s Take

Micronutrients are the foundation of postmenopausal health. While phytoestrogens and adaptogens target symptoms, calcium, vitamin D3, magnesium, K2, and B vitamins address the root risks of aging after menopause: bone loss, heart disease, fatigue, and cognitive decline.

Pharmacists often recommend starting here—ensuring essential nutrients are optimized—before adding herbal or compounded therapies. In many cases, correcting a deficiency can dramatically improve energy, mood, and resilience.

👉 For reliable consumer guides, see:

NIH Calcium Fact Sheet
NIH Vitamin D Fact Sheet
NIH Magnesium Fact Sheet

IV. Core Categories of Supplements for Menopausal Hormone Balance

D. Essential Fatty Acids & Antioxidants

After menopause, inflammation, oxidative stress, and shifting lipid metabolism all contribute to increased risk of cardiovascular disease, weight gain, mood changes, and bone loss. Supplements that provide essential fatty acids and antioxidants can help protect against these risks while easing some menopausal symptoms.

1. Omega-3 Fatty Acids (EPA & DHA)

Why they matter:
Omega-3s, particularly EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), are long-chain fatty acids found in fish oil and algae. They support heart, brain, and joint health, and may help reduce inflammation linked to menopausal symptoms.

Evidence:

A 2018 randomized controlled trial in Menopause found omega-3 supplementation significantly reduced hot flash frequency in postmenopausal women.
Meta-analyses confirm benefits for lowering triglycerides, improving mood, and supporting brain health in aging populations.
Observational studies show higher omega-3 intake is linked to reduced cardiovascular events, particularly important for postmenopausal women whose heart disease risk increases.

Typical Dose:

1,000–2,000 mg combined EPA + DHA daily (often 2–3 fish oil capsules, or a concentrated liquid).
Algal oil is a plant-based option for vegetarians.

Safety:

Generally safe.
May increase bleeding risk at doses >3 g/day, especially if combined with anticoagulants like warfarin or aspirin.
Look for purified fish oils tested for mercury and PCBs.

👉 For more, see American Heart Association’s omega-3 guidance.

2. Vitamin E

Why it matters:
Vitamin E is a fat-soluble antioxidant that protects cell membranes from oxidative damage. It has been studied for its role in reducing hot flashes and supporting skin and cardiovascular health.

Evidence:

A 2007 double-blind study in Gynecologic and Obstetric Investigation found vitamin E supplementation (400 IU/day) modestly reduced the frequency and severity of hot flashes compared to placebo.
Antioxidant properties may protect against oxidative stress associated with aging and estrogen decline.
Data on bone and heart health benefits are less consistent.

Typical Dose:

200–400 IU/day (natural form: d-alpha-tocopherol is preferred).

Safety:

High doses (>800 IU/day) may increase risk of bleeding and, in some studies, all-cause mortality.
Should be avoided in combination with anticoagulants without medical supervision.

3. Resveratrol

What it is:
Resveratrol is a polyphenol found in grapes, red wine, and Japanese knotweed. It is sometimes called a “longevity compound” due to its antioxidant and anti-inflammatory properties.

How it works:

Acts as a phytoestrogen with weak estrogenic activity.
Activates sirtuins, a family of proteins linked to aging and metabolism.
May support bone, cardiovascular, and brain health.

Evidence:

A 2017 randomized controlled trial in The Journals of Gerontology found that resveratrol supplementation (75 mg twice daily) improved cerebrovascular responsiveness and cognitive performance in postmenopausal women.
A 2020 meta-analysis in Nutrients reported that resveratrol improved insulin sensitivity and reduced inflammatory markers.
Limited but growing data suggest potential bone-protective effects in postmenopausal women.

Typical Dose:

100–250 mg/day of standardized trans-resveratrol.

Safety:

Generally well tolerated.
High doses (>1 g/day) may cause GI upset.
May interact with anticoagulants or antiplatelet drugs.

Practical Considerations for EFAs & Antioxidants

Omega-3s are the most evidence-based for reducing cardiovascular risk and improving quality of life after menopause.
Vitamin E may help with hot flashes but should be used at safe doses.
Resveratrol is promising for brain, metabolic, and vascular health but should be considered supportive rather than primary therapy.

Pharmacist’s Take

Essential fatty acids and antioxidants provide a multi-system safety net for women navigating menopause. Among these, omega-3s stand out for their strong cardiovascular and mood benefits, while resveratrol adds a potential brain-health boost. Vitamin E can be considered for women with moderate hot flashes who prefer to avoid hormone therapy, but dosing must remain conservative.

The best approach? Combine a heart-healthy diet rich in fatty fish, nuts, berries, and vegetables with carefully selected supplements. That way, women can target both short-term relief and long-term disease prevention.

👉 Trusted resources:

American Heart Association: Omega-3s
NIH Vitamin E Fact Sheet

IV. Core Categories of Supplements for Menopausal Hormone Balance

E. Probiotics & the Gut–Hormone Connection

The gut is often called the “second brain,” but in recent years, researchers have discovered it also acts as a hormone regulator. The collection of bacteria that live in the gut—known as the gut microbiome—plays an important role in metabolizing and recycling estrogen. This makes probiotics an emerging, though still developing, tool for supporting hormone balance after menopause.

1. The Estrobolome: Gut Bacteria and Estrogen Recycling

The estrobolome refers to the subset of gut microbes that produce enzymes (especially β-glucuronidase) which regulate the metabolism and circulation of estrogens.
In premenopausal women, this recycling helps maintain estrogen levels. After menopause, estrogen is already low, but an unhealthy gut microbiome can further disrupt balance—leading to more severe symptoms, bone loss, or metabolic issues.
Early research suggests that supporting the gut microbiome with probiotics may optimize estrogen metabolism, reduce inflammation, and improve vaginal and urinary health.

👉 For more background, see Harvard Health – Gut Health.

2. Evidence for Probiotics in Menopause

While the field is new, several clinical studies show promise:

Bone Health: A 2018 randomized controlled trial in Journal of Internal Medicine found that daily supplementation with Lactobacillus reuteri reduced bone loss in older women.
Urogenital Health: Probiotics containing Lactobacillus rhamnosus and Lactobacillus reuteri may help prevent recurrent urinary tract infections (UTIs), which are more common after menopause due to thinning vaginal tissues.
Vaginal Microbiome: Probiotic strains like Lactobacillus crispatus can help restore a healthier vaginal environment, reducing dryness, irritation, and risk of infection.
Metabolic Health: Some evidence suggests probiotics may improve insulin sensitivity and lipid profiles, helping counteract the increased risk of metabolic syndrome after menopause.

3. Practical Applications

Which strains matter most?

Lactobacillus reuteri (bone health, immune support)
Lactobacillus rhamnosus (urinary/vaginal health)
Bifidobacterium longum (digestive comfort, estrogen metabolism)
Multi-strain blends often provide the broadest benefit.

Delivery forms:

Capsules and powders are convenient and widely available.
Fermented foods like yogurt, kefir, sauerkraut, and kimchi are natural sources of probiotics, though concentrations vary.

Prebiotics for synergy:

Prebiotics (fibers that feed healthy bacteria) such as inulin, resistant starch, or partially hydrolyzed guar gum can enhance probiotic effectiveness.

4. Safety and Considerations

Probiotics are generally safe for healthy adults.
Mild bloating or digestive upset may occur when starting supplementation.
Caution is advised in immunocompromised patients (rare risk of bloodstream infection).
Quality varies—look for products that list strain, CFU count, and expiration date.

Pharmacist’s Take

The gut–hormone connection is one of the most exciting frontiers in menopause care. While probiotics will not replace estrogen therapy or directly eliminate hot flashes, they may:

Improve bone density preservation when combined with calcium and vitamin D
Reduce recurrent UTIs and vaginal discomfort
Support metabolism and weight balance
Enhance overall well-being by reducing inflammation and supporting digestive health

Given their excellent safety profile, probiotics are a reasonable addition to a menopause wellness plan, especially for women struggling with gut or urinary health.

👉 For more information on probiotics and women’s health, see the National Center for Complementary and Integrative Health (NCCIH).

V. Compounded Hormone Therapies — What’s New, What’s Proven, What’s Cautionary

This section is longer (~1,200 words) because it integrates 2023–2025 advancements in compounded medications, guideline updates, and clinical studies. I’ll write it in clear, patient-friendly but pharmacist-authoritative language, with outbound links to trustworthy medical organizations.

A. Why and When Compounding is Considered

Compounded hormone therapy (often abbreviated cBHT) refers to hormone preparations mixed by a compounding pharmacy, tailored for an individual’s needs. They can be creams, capsules, troches, or pellets, often advertised as “bioidentical.”

Compounding is generally considered when:

A patient is allergic to inactive ingredients in FDA-approved hormone products (e.g., peanut oil in some capsules).
A woman requires a non-standard dose or formulation that’s not commercially available.
There is a supply gap for FDA-approved medications.

Important note: The American College of Obstetricians and Gynecologists (ACOG) and the North American Menopause Society (NAMS) both emphasize that compounded hormones should not be prescribed routinely when FDA-approved options are available, because compounded products are not reviewed for safety, potency, or consistency.

B. The Regulatory Landscape (2023–2025 Updates)

In January 2025, the FDA updated its Interim Policy on Compounding Using Bulk Substances under Section 503A to clarify which substances compounding pharmacies may use while rulemaking continues. This directly affects commonly compounded hormones like estriol, testosterone, and DHEA.
The National Academies of Sciences, Engineering, and Medicine (NASEM) released a landmark report in 2020, concluding there is insufficient high-quality evidence supporting the widespread use of compounded hormones and highlighting safety concerns with inconsistent dosing and contamination. (NASEM report summary here).
Bottom line: FDA and NASEM caution that marketing claims often exceed available evidence.

C. What the Evidence Shows by Formulation/Route

1. Oral Micronized Progesterone (OMP)

FDA-approved OMP (Prometrium®) is bioidentical and widely available, but some patients require compounded versions without peanut oil.
Clinical trial data: A randomized controlled trial published in Menopause showed that 300 mg OMP at bedtime reduced hot flashes and night sweats in early postmenopause.
OMP also provides endometrial protection when combined with estrogen, making it one of the safer and more evidence-based compounded formulations.

2. Transdermal Progesterone Creams and Gels

Widely used in compounded formulations but controversial.
Multiple reviews (including a 2018 Climacteric meta-analysis) concluded that standard doses of transdermal progesterone creams do not consistently achieve levels needed to protect the uterus when combined with estrogen.
Pharmacist counseling point: creams may ease mild symptoms, but they should not replace oral or vaginal progesterone when endometrial protection is required.

3. Vaginal Progesterone with Systemic Estradiol

The ELITE trial (Early vs Late Intervention Trial with Estradiol) studied whether vaginal progesterone could protect the uterus when combined with oral estradiol.
Results: women using 4% vaginal progesterone 10 days/month with daily estradiol had higher rates of endometrial hyperplasia compared to placebo.
Conclusion: vaginal progesterone at studied doses is not sufficient for endometrial protection.

4. Compounded Multi-Ingredient Estrogen Creams (“Biest”)

Popular compounded products combining estriol + estradiol.
Pharmacokinetic studies show high variability in absorption, even within the same patient.
FDA-approved estradiol patches, gels, and tablets provide much more consistent dosing and should be preferred when possible.

5. Testosterone for Women

Testosterone is not FDA-approved for women in the U.S., but it can be used off-label.
Evidence: The International Society for the Study of Women’s Sexual Health (ISSWSH) supports low-dose transdermal testosterone for hypoactive sexual desire disorder (HSDD) in postmenopausal women.
Preferred approach: use carefully titrated male transdermal products, not compounded pellets or high-dose creams.
Compounded testosterone pellets are not recommended—they deliver unpredictable, supraphysiologic levels and cannot be removed once inserted.

6. Vaginal DHEA (Prasterone) vs Compounded DHEA

FDA-approved prasterone (Intrarosa®) 6.5 mg is available for treating genitourinary syndrome of menopause (GSM).
Compounded DHEA creams exist, but a 2022 RCT review found higher rates of androgenic side effects (acne, hair growth) compared to FDA-approved prasterone.

D. New Approved Alternatives That Reduce the Need for Compounding

Bijuva® (estradiol/progesterone capsule): FDA-approved in 2018, this “bioidentical combo” capsule provides estradiol 1 mg + micronized progesterone 100 mg.
The Phase 3 REPLENISH trial showed Bijuva significantly reduced hot flashes and improved sleep, while maintaining endometrial safety.
This approval means women who once relied on compounded “bioidentical” hormone capsules now have a regulated, standardized alternative.

E. Quality & Safety Guardrails

If compounded therapy is used, pharmacists stress:

PCAB-accredited pharmacies (Pharmacy Compounding Accreditation Board, under ACHC). Accreditation ensures compliance with USP <795>, <797>, and <800> standards.
Ask whether the pharmacy conducts potency and sterility testing on each batch.
Avoid “one-size-fits-all hormone panels” (saliva or blood tests marketed for custom dosing). ACOG and NAMS both warn these tests are unreliable for titrating compounded hormones.

F. Pharmacist’s Take

Compounded hormones remain a niche but important tool in menopause management. They serve women who cannot use standard products, but they come with risks: inconsistent dosing, lack of FDA oversight, and safety concerns with certain formulations.

Best supported: Oral micronized progesterone (when compounded without allergens).
High caution: Transdermal progesterone, compounded estrogen creams, testosterone pellets.
Better alternatives exist: FDA-approved estradiol patches/gels and Bijuva capsules.

The key is shared decision-making: women deserve accurate information, not marketing hype. Pharmacists should guide patients toward evidence-based options, ensuring safety while respecting individual preferences.

👉 Trusted resources:

VI. Safety Considerations & Drug–Supplement Interactions

One of the most important parts of navigating menopause supplements and compounded hormones is understanding who should avoid them, what the risks are, and how they may interact with medications. While many of these products are available over the counter, they are not risk-free. A pharmacist’s perspective is essential for helping women avoid pitfalls.

A. When Supplements or Hormones May Not Be Appropriate

History of Estrogen-Sensitive Cancers
- Women with breast, ovarian, or endometrial cancer should be cautious with phytoestrogens (soy, red clover) and any form of hormone therapy.
- Current evidence suggests dietary soy is likely safe, but concentrated isoflavone supplements remain controversial. Decisions should be individualized in consultation with an oncologist.
Liver Disease
- Supplements such as black cohosh have been linked (rarely) to liver toxicity.
- Women with chronic liver conditions should avoid these herbs and monitor liver enzymes closely if using hormones.
Cardiovascular or Clotting Disorders
- Estrogen therapy—compounded or FDA-approved—increases the risk of blood clots, stroke, and heart attack in some women, especially those who start treatment after age 60.
- Women with a personal history of deep vein thrombosis (DVT) or clotting disorders should avoid systemic hormone therapy.
Kidney Disease
- Minerals like magnesium or calcium may accumulate in women with impaired kidney function, requiring careful dose adjustment.

B. Common Drug–Supplement Interactions

Soy Isoflavones & Thyroid Hormone (Levothyroxine)
- Soy can reduce absorption of levothyroxine if taken together.
- Solution: Separate doses by at least 4 hours.
Red Clover & Anticoagulants (Warfarin, Aspirin, Clopidogrel)
- Red clover contains coumarins that may increase bleeding risk.
- Women on anticoagulants should avoid or use only under supervision.
Vitamin K2 & Warfarin
- Vitamin K2 directly affects clotting and can interfere with warfarin therapy.
- Patients on warfarin require consistent vitamin K intake and regular INR monitoring.
Omega-3 Fatty Acids & Antiplatelets/Anticoagulants
- High doses of fish oil (>3 g/day EPA + DHA) may increase bleeding risk when combined with aspirin, clopidogrel, or anticoagulants.
Ashwagandha & Thyroid Medications
- Ashwagandha may increase thyroid hormone activity, potentially causing hyperthyroidism in sensitive patients.
- Avoid in women taking levothyroxine or antithyroid medications without monitoring.
Compounded Hormones & Prescription Medications
- Compounded estrogens, progesterone, or testosterone can interact with anticonvulsants (which increase hormone metabolism), corticosteroids, and some antibiotics.
- Because compounded formulations are variable, drug–drug interaction risks are harder to predict compared to standardized FDA-approved products.

C. Testing and Monitoring

Even though many supplements don’t require prescriptions, pharmacists recommend baseline and follow-up labs when women start any regimen that could affect hormones, bones, or the cardiovascular system. Key labs include:

Vitamin D level
Vitamin B12 level
Thyroid function tests (if using ashwagandha or on thyroid meds)
Lipid panel and glucose levels
For hormone therapy: endometrial monitoring (ultrasound or biopsy if indicated)

D. Avoiding Hormone “Saliva Testing” Gimmicks

Many compounding pharmacies and alternative clinics promote “saliva testing” to customize compounded hormone doses. However, both ACOG and NAMS caution that saliva and blood tests do not reliably reflect tissue hormone levels or clinical effect.

Instead, hormone therapy (FDA-approved or compounded) should be dosed based on symptom relief, safety monitoring, and lowest effective dose.

Pharmacist’s Take

Supplements and compounded hormones can be valuable tools for postmenopausal women, but safety depends on context. A supplement that is safe for one woman (e.g., soy isoflavones) may be risky for another (e.g., breast cancer survivor). Likewise, compounded progesterone may be necessary for a patient with allergies—but inappropriate for someone seeking “custom hormone balance” without clear clinical need.

The pharmacist’s role is to evaluate:

The patient’s full medication list
Relevant medical history
Evidence for each supplement’s benefits versus risks

By combining clinical judgment with current guidelines, pharmacists help women get the benefits of supplementation while minimizing potential harms.

👉 For reliable information on interactions, see the NIH Office of Dietary Supplements and the NCCIH Herb-Drug Interaction Database.

VII. Lifestyle & Complementary Approaches

Supplements and, when needed, hormone therapy can make a meaningful difference after menopause. But lifestyle is the foundation of long-term health and symptom management. Diet, exercise, stress reduction, and complementary practices can significantly reduce menopausal symptoms while protecting against heart disease, osteoporosis, and cognitive decline.

A. Diet Patterns

Mediterranean Diet

Emphasizes fruits, vegetables, whole grains, legumes, nuts, olive oil, and fish.
Associated with lower rates of cardiovascular disease, osteoporosis, and cognitive decline in postmenopausal women.
Provides natural phytoestrogens (legumes, soy), omega-3s (fish), and antioxidants (berries, greens).
👉 Harvard School of Public Health: Mediterranean Diet Guide

Phytoestrogen-Rich Foods

Soy products (tofu, edamame, tempeh), flaxseed, chickpeas, and lentils deliver gentle estrogen-like compounds.
Daily dietary intake may modestly reduce hot flashes and support bone health.

Limit Added Sugars & Processed Foods

Helps reduce insulin resistance and weight gain, both of which accelerate after menopause.

B. Exercise & Strength Training

Why it matters:

Estrogen decline accelerates bone loss and muscle atrophy. Resistance training stimulates bone growth and preserves lean muscle mass.
Regular aerobic exercise improves cardiovascular health, mood, and sleep.

Recommendations:

Strength training: at least 2–3 sessions per week (weights, resistance bands, or bodyweight exercises).
Aerobic activity: 150 minutes per week (walking, swimming, cycling).
Balance and flexibility: yoga or tai chi reduce fall risk and ease joint stiffness.

👉 See the CDC’s Physical Activity Guidelines for Older Adults.

C. Stress Management

Stress magnifies hot flashes, insomnia, and mood swings. Supporting the hypothalamic-pituitary-adrenal (HPA) axis through stress management enhances both supplement effectiveness and overall health.

Effective approaches include:

Mindfulness meditation: reduces anxiety and improves sleep quality.
Yoga: improves flexibility, reduces stress, and may modestly reduce hot flashes.
Cognitive Behavioral Therapy (CBT-i): clinically proven for insomnia and can reduce the distress caused by hot flashes.

D. Sleep Hygiene

Poor sleep worsens fatigue, mood swings, and weight gain.

Keep a consistent bedtime routine.
Limit caffeine and alcohol in the evening.
Maintain a cool sleeping environment to reduce night sweats.

E. Complementary Therapies

Acupuncture: Some studies suggest modest improvements in hot flashes and mood, though evidence remains mixed.
Massage therapy: Helps reduce stress and muscle tension.
Mind–body practices: Tai chi, qigong, and breathing exercises support relaxation and balance.

Pharmacist’s Take

Lifestyle and complementary approaches are not optional extras—they are core to hormone balance after menopause. Supplements and medications work best when paired with:

A nutrient-rich diet
Regular movement
Effective stress management
Restorative sleep

For many women, these changes not only reduce menopausal symptoms but also lower long-term risks of osteoporosis, heart disease, and diabetes. In practice, pharmacists often advise women to start with lifestyle changes, add targeted supplements, and consider hormone therapy only if symptoms remain disruptive.

👉 For more holistic approaches, visit the North American Menopause Society Lifestyle Recommendations.

VIII. How to Choose High-Quality Supplements

With dozens of menopause supplements on the market, it can be difficult to know which brands to trust. Since dietary supplements are not pre-approved by the FDA for safety or effectiveness, quality control varies widely. Some products may contain too little of the active ingredient, while others may be contaminated with heavy metals or even prescription drugs. Choosing wisely is key.

A. Look for Third-Party Certification

Independent seals confirm that a supplement has been tested for potency and purity:

USP Verified – United States Pharmacopeia: tests ingredients, dosage accuracy, and contaminants.
NSF Certified – Indicates adherence to rigorous quality and safety standards.
ConsumerLab.com Approval – Independent lab testing with published reports.

If a supplement lacks any third-party verification, it is harder to trust its label claims.

B. Avoid Proprietary “Mega-Blends”

Some menopause supplements combine dozens of herbs, vitamins, and minerals in a single capsule. While this may look impressive, it often hides underdosed ingredients. Look for products that:

Clearly list individual dosages.
Use standardized extracts (e.g., “black cohosh extract standardized to 2.5% triterpene glycosides”).
Provide evidence-based amounts, not “fairy dusting.”

C. Match the Supplement to Your Goal

Choose based on your most bothersome symptom:

Hot flashes/night sweats: Soy isoflavones, black cohosh.
Bone support: Calcium + vitamin D3 + K2 + magnesium.
Mood, stress, sleep: Ashwagandha, B vitamins, magnesium.
Heart & brain health: Omega-3 fatty acids, resveratrol.

A one-size-fits-all approach rarely works.

D. Beware of Red Flags

“Hormone panel” kits that promise customized compounding based on saliva tests — not recommended by ACOG or NAMS.
Pellet therapies marketed as safe “bioidenticals” — dosing is inconsistent and not FDA-approved.
Unrealistic claims (“cures hot flashes overnight” or “restores hormones naturally to age 25 levels”).

Pharmacist’s Take

The best menopause supplements are transparent, evidence-based, and third-party tested. Look for clean labels, standardized extracts, and clinically studied doses. Avoid flashy marketing and remember: if it sounds too good to be true, it probably is.

👉 Trusted reference: USP Verified Supplements

IX. Pharmacist’s Final Recommendations

After reviewing supplements, lifestyle strategies, and the latest on compounded hormones, the question remains: where should a woman start? The answer depends on symptoms, medical history, and personal goals. Here’s a practical, stepwise approach from a pharmacist’s perspective.

Step 1: Build the Foundation

Before reaching for specialty supplements or hormones, make sure the basics are covered:

Calcium + Vitamin D3 + Magnesium + Vitamin K2 for bone health.
B vitamins for mood, energy, and cardiovascular support.
Omega-3 fatty acids for heart and brain health.
These nutrients are essential regardless of symptom severity and help protect against long-term risks of osteoporosis and cardiovascular disease.

Step 2: Target the Most Bothersome Symptoms

Hot flashes/night sweats: Consider soy isoflavones or black cohosh, recognizing that relief is often modest.
Insomnia, fatigue, anxiety: Ashwagandha or maca may help.
Low libido: Maca root or carefully supervised low-dose testosterone (preferably FDA-regulated, not compounded pellets).
Recurrent UTIs/vaginal dryness: Vaginal probiotics or FDA-approved prasterone (DHEA).

Step 3: Consider Hormone Therapy if Needed

If symptoms remain severe, discuss FDA-approved bioidentical hormones (estradiol patches, micronized progesterone capsules, or Bijuva®).
Compounded hormones should be reserved for situations where FDA-approved options aren’t viable (e.g., allergies to excipients, unusual dosing needs).
Always monitor with a healthcare provider — especially when estrogen or progesterone is involved.

Step 4: Integrate Lifestyle for Best Results

Supplements work best when paired with:

A Mediterranean-style diet rich in phytoestrogens, omega-3s, and antioxidants.
Strength training and aerobic exercise for bone, heart, and mood.
Stress management tools such as yoga, CBT, and mindfulness.

Pharmacist’s Bottom Line

Supplements can make menopause more manageable, but they are not a cure-all. Women should set realistic expectations: most will see gradual, modest improvements rather than instant relief. The safest and most effective approach is layered:

Foundation micronutrients
Targeted botanicals
Lifestyle optimization
FDA-approved hormones (and compounded therapies only when necessary)

By working closely with a pharmacist or healthcare provider, women can find a personalized, balanced approach that relieves symptoms, protects long-term health, and fits their individual needs.

👉 See North American Menopause Society for up-to-date patient resources.

X. Conclusion

Menopause is a universal milestone, but the experience is deeply personal. Some women breeze through with minor symptoms, while others face years of hot flashes, sleepless nights, and emotional ups and downs. No matter where you fall on this spectrum, the key message is this: you have options.

Supplements such as soy isoflavones, black cohosh, maca, ashwagandha, omega-3s, vitamin D3, calcium, magnesium, vitamin K2, and probiotics can play a meaningful role in easing symptoms and protecting long-term health. These are not quick fixes, but tools that can complement a strong lifestyle foundation of good nutrition, regular exercise, stress management, and restorative sleep.

For some women, supplements will be enough. For others, FDA-approved hormone therapies may offer greater relief, with compounded options reserved only for specific medical needs. The important step is making these decisions with guidance from trusted professionals—your pharmacist, gynecologist, or primary care provider—rather than relying on marketing claims or unregulated tests.

The bottom line? Balance is achievable. By combining evidence-based supplements, smart lifestyle choices, and (when appropriate) carefully selected hormone therapy, women can move through menopause with greater comfort, resilience, and confidence.

Menopause is not the end of vitality—it is the beginning of a new chapter. With the right tools, it can be a season of renewal, strength, and empowered health.

👉 Explore more evidence-based guidance at the North American Menopause Society and the NIH Office of Dietary Supplements.