Welcome back to Making Sense of Women's Health.

I'm Roberta Bass. I am a women's health physiotherapist, a Pilates instructor, menopause mentor, remedial hypnotist and founder of Thrive and Shine Women's Wellness. Today, we are looking at something that's everywhere and that is supplements. Now, if you've searched online for help with menopause symptoms, you almost certainly come across pills, powders and drinks claiming to ease hot flushes, balance your hormones, improve sleep or boost your mood.

But how many of these claims are actually backed by evidence? And are any of them worth it? And could some actually do more harm than good?

Now, before we dive in, it's important to say I'm not a supplement expert and this podcast is not medical advice. And always speak to a healthcare professional before starting any new supplements, especially if you have a medical condition or take any medication. And remember, the best way to get most nutrients is actually through a varied and balanced diet. Food first is ideal, but for some women, supplements can fill gaps, support specific symptoms help.

So with that in mind, let's look at what the evidence says. Firstly, let's just think what supplements are. Now, they might be obvious, but supplements are concentrated sources of nutrients, usually vitamins, minerals or herbal compounds, and they are taken in capsules, powder or liquid form.

Now women might take them to help manage symptoms like hot flushes, fatigue or mood swings, but they can also support bone or joint health, can improve your sleep, your brain function or your energy. They also prevent deficiencies due to diet, age or medical conditions, but they are not tightly regulated like medications — especially in the UK. That means that quality, dosage and purity can vary.

Now some products do contain unlisted ingredients and don't match the label. That's why it's important to get any supplements from a trusted source and why evidence and professional guidance really matter.

So let's start with the supplements that you should be very cautious about or avoid altogether unless you are advised:

Vitamin E. Now this was once thought to be helpful for hot flushes but has mixed evidence and actually can increase bleeding risks if it's taken at high doses.

High dose iron. So unless you have been diagnosed with an iron deficiency anaemia, extra iron can cause problems such as constipation, gut irritation, and can potentially cause toxic overload.

Hormone-based herbal blends. Now some, particularly when you get them off the internet from random places, can contain unregulated plant-based hormones or phytoestrogens that can interfere with certain medications or hormone therapy.

Detox teas or cleansing supplements. As they may be sold, often contain laxatives or diuretics — so that makes you go for a wee — and they have no proven benefit and could potentially cause harm to your gut and cause dehydration which causes many other issues.

Without clear ingredient lists or dosage, they may seem convenient but often rely on clever marketing rather than science. Bottom line is, natural doesn't always mean that it is safe.

There are, however, supplements that have strong evidence for supporting specific menopausal or health-related concerns:

Vitamin D is one of the biggies because even though we get it from the sun and certain foods, many women and men have a lack of vitamin D. Now this is really important for bone health, for immunity and possibly for mood as well. Now Public Health England recommends 10 micrograms daily if you're in the UK. It also helps calcium to be absorbed and is especially important after the age of 50 when our bone health starts to decline.

Magnesium is another supplement that has some good evidence. People find that this is helpful for nervous system regulation, for anxiety, for sleep in particular, and also muscle function. Now magnesium glycinate or citrate forms are usually better absorbed.

Omega-3, so fish oils. So this is something that people have been taking for many years, but there is good evidence to say that it can help with joint pain — is often why people take it — but also could help with mood, your cardiovascular and your brain health. There are many on the market but ideally look for EPA or DHA on the label. They may also help to reduce inflammation and improve low mood particularly in menopause.

Turmeric, also known as curcumin, can be really helpful. You could just use it within your cooking, but you can also get supplements for it and it has been shown to reduce inflammation. Now this is good for joint pain, but also general inflammation in the body is piperin.

Collagen. Now this seems to be like a big thing at the minute, going around and you see all the celebs taking collagen. It can actually be helpful for skin elasticity and joint health. And hydrolyzed collagen peptides taken consistently for eight to twelve has been shown to be beneficial to your skin and joints.

Folic acid. Now this is often associated with pregnancy because you're meant to take it in pregnancy, but there has also been some evidence to suggest that it can possibly help reduction in hot flushes and also support cognition. It also helps to lower homocysteine which supports your brain and your cardiovascular health. So again, these things are all worth trying as long as you've got no medical issues that would stop you from taking them.

Vitamin C is another vitamin that is really important, ideally getting it from our food, but a supplement can be helpful as well. It's antioxidant support, it helps with our immune function and possibly our bone density as well. It may also support skin and collagen production. Again, it's well worth looking at taking some.

So calcium is another thing that we need. Ideally, we should get this from our diet. But if we have a low amount of calcium in the diet, then it can be that we can take a supplement. Always have food first. It's always so much better. If we take it as a supplement, ideally, we also need to take it with vitamin D because that helps it to be absorbed into the body better. It is really vital for our bone density, particularly postmenopausal.

Vitamin K is another thing that works along with our calcium and vitamin D to support bone health and it also helps with our cardiovascular system.

Vitamin B12. If we're low in this, then we often struggle with energy, but it also helps with our brain function. It's really important, particularly if you are a vegetarian or have digestive issues, because we don't get the amounts that we need.

Vitamin B6. Now this can help with mood support. It's involved with our serotonin, so our feel-good hormones, and it's involved with that production. Deficiency may worsen low mood or anxiety symptoms. So again, all of these supplements are worth looking into. Doesn't mean that you have to be taking every single one of them.

There are some supplements that have some anecdotal evidence and there is some early research into them, but the evidence is either mixed or limited. So it might be worth considering, but know that the evidence behind them is lower.

Sage is one of those. Now I have many women that have tried this and some of them have found it helpful because it can help to reduce hot flushes and night sweats. Again, if you get it in the food, great. There is low risk to taking it and is often taken as a tea. So it might be something to try.

Red clover. Now this contains plant oestrogens and results vary and it may not suit those that have hormone-sensitive conditions. But again, look into it.

Black cohosh is another one that has been used in the past, things like hot flushes, but studies do conflict on whether it's more effective than a placebo.

Glucosamine. Now there has been some studies that show that it can be helpful for joint pain, particularly knees is what the most studies have looked into. But again, it's not a guaranteed fix and you have to be taking it quite regularly for a while before you notice the difference.

Evening primrose oil. Now some women report reduced breast tenderness or hot flushes, but again, research is mixed.

Macaroot. Now this has been marketed for energy, libido and mood, but there is limited human research. But what there is does look promising from the early results.

Probiotics is another thing that might be worth looking at as it's been shown that there may be some support to our gut and vaginal health and early research on this gut-hormone connection is still ongoing, but many women find it helpful. However, there are some that find taking probiotics causes them some discomfort within the bowels and that might be if you've got an overgrowth of bacteria.

With any of these supplements, obviously stop taking them if they cause you any further symptoms, but it might be worth trying some of these things if you do have a mild symptom and if you're not on any medication or if you're not managing a medical condition, but do approach with weariness and definitely stop if you get any side effects.

When should we not take supplements?

Now, there are times that it is best to not take them, particularly without medical guidance. So if you are on any medications, including antidepressants, HRT, thyroid meds or blood thinners, some supplements will interfere with the absorption or the effectiveness.

If you have a chronic health condition, especially affecting liver, your kidneys, your heart or your immune system, best to stay clear unless you've had the okay from your doctor.

And if you are pregnant or trying to conceive or breastfeeding, it's always worth being wary.

If you're already eating a balanced diet and you're taking multiple supplements, more is not always better.

So what's the bottom line?

Some supplements are backed by good evidence — vitamin D, magnesium, omega-3, turmeric, collagen, folic acid — and a few others support specific symptoms in menopause and beyond.

Others are less conclusive but may still be helpful for some women, as long as they're safe and used with awareness. And some are best avoided altogether, especially if they are unregulated, if they're poorly studied or potentially harmful.

Always aim to get your nutrients from food first. And then if you need anything more, then seek professional advice before you're adding supplements to your routine.

Your body deserves this evidence-based care and not empty promises.

Thank you so much for listening today. Please be careful where you're getting your supplements from if you are taking them. If you've got anything that we've spoken about today in terms of medical conditions, always get it checked first from your doctor or another healthcare professional.

Any further questions, then feel free to reach out in the Facebook group. But for now, take care and I will see you next time.