[ad_1]
December 19, 2025
6 min read
Key takeaways:
- Open discussion with patients about supplement use is important.
- Celebrity endorsements and social media have led to more women seeking out prescriptions for weight loss and diabetes prevention.
Susan Weiner, MS, RDN, CDN, CDCES, FADCES, talks with Courtney Cameron, PharmD, BCACP, about tips for discussing supplement use with women and recommendations for different stages of life.
Weiner: How can clinicians approach questions about supplements?
Cameron: It is important to have an open discussion about supplement use and questions patients have about supplements. Start by listening and asking the patient to expand upon their question or concern. In other words, to adequately understand, sometimes we need to answer a question with another question. I like to expand on the patient’s question by asking them what they have already read or heard about the supplement. I also ascertain what they hope to gain and what they perceive as a risk with a new supplement. Once I have a more well-rounded understanding of the context of their question, then I can answer to the best of my ability.
Understandably, it can be difficult to address supplement questions or concerns in a standard 10- to 20-minute visit. Additionally, providers often have other competing priorities to address during a visit. If possible, perhaps a clinician could offer a telephone follow-up with the patient to address their questions or concern on the use of supplements. Additionally, if the provider has access to a clinical pharmacist in their practice, they could refer the patient’s question to the clinical pharmacist.
Susan Weiner
Weiner: What are the guideline recommendations for supplements?
Cameron: Currently, there is no one-stop-shop guideline available for practitioners recommending the use of supplements. However, the National Center for Complementary and Integrative Health (NCCIH) offers a compilation of existing disease state guidelines that mention complementary and alternative medicine, including supplements, as a component of comprehensive treatment (Clinical Practice Guidelines | NCCIH). For providers looking for broad recommendations on the use of supplements in the general population, I suggest reviewing the recommendation statements available from the U.S. Preventive Services Task Force.
Weiner: What supplements are most beneficial for women?
Cameron: As mentioned in part one of this Nourish to Flourish series, women interested in adding a supplement should consider taking a multivitamin in addition to implementing a healthy plant-focused diet, unless directed otherwise by their physician. For women of childbearing age, I recommend a prenatal multivitamin that contains 0.4 mg to 0.8 mg folic acid, even if not yet planning pregnancy.
Overall, it is important to recognize that the USPSTF has stated that available data are insufficient to suggest that, broadly, regular use of a multivitamin in a community-dwelling population impacts mortality.
For women who live in a particularly cold climate or otherwise don’t receive regular exposure to sunlight, I would consider low-dose vitamin D supplementation (400-1,000 IU daily) if they are not already taking a multivitamin. Vitamin D deficiency can impact mood and energy levels and can cause muscle cramps. However, providers should be aware that according to the same USPSTF recommendation statement, data are insufficient to demonstrate that broad vitamin D supplementation with or without calcium impacts all-cause mortality, cancer incidence or cardiovascular disease events such as myocardial infarction or stroke in community-dwelling, otherwise relatively healthy individuals. It is unclear if supplementing a population deficient in vitamin D could result in significant reductions in morbidity and mortality.
Lastly, we have to acknowledge the ever-growing rise of nutrient-stimulated hormone-based therapy (semaglutide [Ozempic/Wegovy, Novo Nordisk], tirzepatide [Mounjaro/Zepbound, Eli Lilly]) availability and prescribing. Some of this is due in part to celebrity and influencer endorsements — for example, Serena Williams recently shared her GLP-1 weight-loss journey. More women are seeking out prescriptions for weight loss and diabetes prevention. Nutrient-stimulated hormone-based therapy is commonly associated with constipation, for which adding fiber supplementation to the diet can be particularly effective. Fiber supplementation can also help control overeating by increasing feelings of fullness. In the general population, a healthy plant-focused diet high in fruits, vegetables and whole grains could contain sufficient fiber content without the need for additional supplementation. For women, the recommended daily intake of fiber is 22 g to 28 g depending on age. Fiber supplements are available in a range of dosage forms; the most practical, perhaps, is adding fiber powder to water and drinking throughout the day, to ensure adequate hydration too.
Of course, it is important to remember that no supplement can replace good health practices that include a healthy plant-based diet, regular moderate to vigorous exercise, social connection, adequate sleep and regular doctor’s office visits.
Weiner: What are the recommendations for women in midlife?
Cameron: Many women in midlife struggle with insomnia, especially as they are approaching menopause. While I would first counsel on proper sleep hygiene and rule out other causes for their insomnia, if a woman is looking for a supplement recommendation, I feel safest recommending low-dose melatonin. Melatonin is widely used for jet lag, shift workers, and can be safely used for most women. Melatonin is relatively safe because the brain already produces it; we are simply supplementing, if and when needed. I recommend low-dose melatonin 30 minutes before bedtime to help with sleep. Though we often see high doses (5-10 mg or more) marketed, 1 mg to 2 mg is usually sufficient to help promote sleep. Higher doses can be associated with morning grogginess or vivid dreams.
For other menopausal symptoms such as hot flashes, women may seek out combination supplements that contain primarily black cohosh. Black cohosh can be found alone or formulated with chaste tree extract, grape seed extract, soy isoflavones or myriad other botanicals. Based on one meta-analysis (Sadahiro, et al), black cohosh, alone or in combination with other supplements or botanicals, is proposed to help with hot flashes and somatic symptoms over a mean treatment period of 15 weeks. In this same meta-analysis, black cohosh was not associated with improvements in anxiety or depression. Side effects were not discussed, though the dropout rate was noted to be similar to placebo. As noted previously, the supplement-drug interactions between black cohosh and prescription medicines might not be well defined. I recommend speaking with a primary care provider to discuss available therapies before reaching for a supplement that contains black cohosh.
Weiner: What are the recommendations for women after menopause?
Cameron: One supplement combination that is often discussed after menopause is the use of calcium-vitamin D for bone health. According to the USPSTF, data for calcium-vitamin D supplementation at a daily dose of 400 IU of vitamin D and 1,000 mg of calcium or higher in community-dwelling postmenopausal women without a known bone metabolism disorder (osteoporosis or vitamin D deficiency) or previous fracture are insufficient to suggest supplementation could prevent first fracture. However, the USPSTF endorsed that data are sufficient to suggest that supplementation in this population does increase the risk for nephrolithiasis. Postmenopausal women should be regularly screened for osteoporosis and receive exercise interventions to reduce fall risk. Of course, if a diagnosis of osteoporosis is established, we would then evaluate the supplemental dose of vitamin D and calcium needed.
Weiner: What’s your take-home recommendation regarding supplements?
Cameron: Keep the conversation going. Providers can really build rapport and trust with their patients by keeping an open mind about their patients’ curiosity about supplements. At the very least, our patients are clearly expressing a desire to improve their health. By opening up the conversation, being honest about what we know and, more importantly, being honest about what we don’t know, we then in turn encourage open communication and honesty from patients about their use of supplements.
Second, think critically about an advertisement or paid sponsorship for a new supplement. Do some research on the active ingredients and recognize that a supplement that works for one individual may not necessarily work for everyone.
Finally, emphasize a well-rounded approach to health. Get active everyday (outdoors, if you can), build social connection, get enough sleep, eat a plant protein-focused diet and find healthy stress coping strategies.
Editor’s note: This is part two of a two-part Nourish to Flourish series on the benefits, risks and controversies surrounding supplement use in women. Read part one here.
For more information:
Courtney Cameron, PharmD, BCACP, is a clinical pharmacy specialist at Boston Medical Center. Cameron can be reached at crcameron5@gmail.com.
Susan Weiner, MS, RDN, CDN, CDCES, FADCES, is the owner of Susan Weiner Nutrition PLLC and the Healio Nourish to Flourish column editor. She can be reached at susan@susanweinernutrition.com or on X @susangweiner.
Sources/Disclosures
Source:
Expert Submission
References:
- Bibbins-Domingo K, et al. JAMA. 2017;doi:10.1001/jama.2016.19438.
- Cleveland Clinic Health Essentials. Herbal Supplements: Are They Safe? https://health.clevelandclinic.org/herbal-supplements-use. Published Feb. 13, 2024. Accessed Aug. 20, 2025.
- Cleveland Clinic Health Essentials. Your Fiber Intake: What’s the Right Amount? https://health.clevelandclinic.org/how-much-fiber-per-day. Published April 30, 2025. Accessed Sept. 7, 2025.
- Grossman DC, et al. JAMA. 2018;doi:10.1001/jama.2018.3185.
- Johns Hopkins Medicine. Calcium Supplements: Should You Take Them? https://www.hopkinsmedicine.org/health/wellness-and-prevention/heart-health. Published approximately 1 year ago (as of August 2025). Accessed Aug. 20, 2025.
- National Center for Complementary and Integrative Health. Clinical Practice Guidelines. https://www.nccih.nih.gov/health/providers/clinicalpractice. Last updated Sept. 3, 2025. Accessed Sept. 3, 2025.
- National Center for Complementary and Integrative Health. Using Dietary Supplements Wisely. https://www.nccih.nih.gov/health/using-dietary-supplements-wisely. Last updated July 2023. Accessed Aug. 20, 2025.
- National Institutes of Health. Dietary Supplements: What You Need to Know. https://ods.od.nih.gov/healthinformation/ds_whatyouneedtoknow/. Published April 7, 2020. Accessed Aug. 20, 2025.
- Sadahiro R, et al. Menopause. 2023;doi:10.1097/GME.0000000000002196.
- Sleep Foundation. Melatonin Dosage: How Much Melatonin Should I Take? https://www.sleepfoundation.org/melatonin/melatonin-dosage-how-much-should-you-take. Published July 15, 2025. Accessed Sept. 10, 2025.
Disclosures:
Cameron and Weiner report no relevant financial disclosures.
Ask a clinical question and tap into Healio AI’s knowledge base.
- PubMed, enrolling/recruiting trials, guidelines
- Clinical Guidance, Healio CME, FDA news
- Healio’s exclusive daily news coverage of clinical data
[ad_2]
Source link
