What is the best supplement stack for perimenopause?

The most evidence-supported perimenopause supplement stack addresses four systems that perimenopause affects most directly: cellular energy production, muscle and bone preservation, whole-food nutrient density, and stress resilience. The four products that map to those priorities are a NAD+ precursor, creatine monohydrate, a whole-food beef organ complex, and an adaptogen-based cortisol support formula.† Each addresses a distinct mechanism. None is redundant with the others. Always consult your healthcare provider before starting any new supplement, especially while managing perimenopausal symptoms.

Why perimenopause requires a multi-layered supplement approach

Perimenopause is not a single event. It is a transition that can span several years, during which estrogen and progesterone levels fluctuate unpredictably before their eventual decline. Those hormonal shifts affect cellular energy metabolism, muscle and bone tissue, stress hormone patterns, and cognitive function simultaneously. No single supplement addresses all of those systems. A well-designed stack assigns a specific product to each layer, with each product doing work the others cannot.†

The American College of Obstetricians and Gynecologists describes perimenopause as a time of significant physiological change that warrants proactive health management. Supplement support is one component of that management, alongside nutrition, exercise, sleep hygiene, and appropriate medical care.

"Women are armed with a ton of information. They just may not know how does this apply to me?"

— Jessica Nazzaro, DO, FACOG, NCMP, Board-Certified OB-GYN and National Certified Menopause Practitioner

Layer 1: cellular energy (NAD+)

NAD+ is the coenzyme that powers mitochondrial energy production in every cell. Levels decline naturally with age, with the decline beginning measurably in the mid-30s and compounding during perimenopause as estrogen, which supports mitochondrial efficiency, begins to fall. The convergence of age-related NAD+ decline and estrogen-related mitochondrial changes produces the persistent fatigue and brain fog that many perimenopausal women describe.†

A landmark study published in Nature Communications found that nicotinamide riboside (NR) supplementation was well-tolerated and significantly elevated NAD+ metabolites in healthy middle-aged and older adults. Supporting NAD+ levels addresses the cellular energy foundation that every other system in the stack depends on.†

Pink Stork NAD+, a cellular energy supplement formulated for women, delivers 500 mg of NR per capsule, formulated without resveratrol for optimal bioavailability. One capsule daily in the morning.

For the full NAD+ and perimenopause breakdown, read: can NAD+ support energy during perimenopause?

Layer 2: muscle and cognitive function (Creatine Monohydrate)

Muscle mass and bone density both decline during perimenopause as estrogen levels fall. Women already start with 70 to 80 percent lower creatine stores than men, and those stores decline further during this transition. Creatine monohydrate supports the phosphocreatine-ATP energy system in muscle and brain tissue, with research showing benefits for skeletal muscle size and function in post-menopausal women combined with resistance training, and associations with memory improvements under conditions of metabolic stress including sleep deprivation.†

Research published in Nutrients via the National Institutes of Health found favorable effects on both skeletal muscle and bone in post-menopausal women using creatine with resistance training. The cognitive benefits are equally relevant for women navigating perimenopause-related brain fog alongside demanding professional and personal schedules.†

our micronized creatine with just one ingredient delivers 5 grams per serving. One scoop daily, mixed into any beverage. Take consistently, including rest days.

For the full creatine and perimenopause breakdown, read: can creatine help with perimenopause symptoms?

"Focus on total and holistic health where we're thinking about all these things in congruency with one another."

— Dominique Landry, Founder of Fit Enough

Layer 3: whole-food nutrient density (Beef Organ Complex)

The cellular energy systems that NAD+ and creatine support require nutritional raw materials to function. Bioavailable iron supports oxygen transport and mitochondrial function. B-vitamins are cofactors in the same energy metabolism pathways that NAD+ powers. CoQ10, which occurs naturally in beef heart, supports the electron transport chain directly.† A whole-food approach delivers these nutrients alongside the cofactors and peptides that support their absorption and use.†

Pink Stork Beef Organ Complex is the first beef organ supplement in its category to earn the Clean Label Project Purity Award, independently certified after ISO-accredited laboratory testing for more than 400 environmental and industrial contaminants. It combines grass-fed liver, heart, and kidney with female-focused bovine uterus and ovary powder, sourced from 100 percent grass-fed, grass-finished, pasture-raised cattle with no added hormones. Formulated with input from an expert advisory panel of OB/GYNs and registered dietitians.

Beef Organ Complex, a whole-food blend of grass-fed liver, heart, kidney, and female-focused organ powders, supplies naturally occurring bioavailable iron, B-vitamins, CoQ10, and selenium.† Contains bovine ingredients: not suitable for vegan or vegetarian use.

For the over-40 specific guide, read: are beef organ supplements worth taking for women over 40?

Layer 4: stress resilience (Cortisol Complex)

Cortisol patterns shift during perimenopause. As estrogen and progesterone decline, the hypothalamic-pituitary-adrenal axis, the system that governs the stress response, becomes less buffered. Many perimenopausal women find that stress feels harder to recover from, that they feel wired and tired simultaneously, and that the sleep disruptions of perimenopause are compounded by elevated stress reactivity.

Ashwagandha is the most studied adaptogen for stress response support. According to the National Center for Complementary and Integrative Health, ashwagandha has been studied in multiple clinical trials for its role in supporting a healthy stress response.† A 2024 meta-analysis of 14 randomized controlled trials found daily ashwagandha supplementation was associated with reduced perceived stress scores compared with placebo in adults with chronic stress. Pink Stork Cortisol Complex combines 300 mg of organic ashwagandha root with algae-sourced DHA, chamomile, saffron, and a full B-vitamin complex.† Breastfeeding-friendly per product page.

How to build the stack practically

You do not need to start all four layers simultaneously. A sequenced approach reduces overwhelm and makes it easier to identify what is working:

• Week 1 to 2: Start NAD+ (one capsule in the morning) and creatine (one 5-gram scoop in the morning, mixed into coffee, water, or a smoothie). These address the cellular energy and muscle layers and are the most directly relevant to perimenopause fatigue and cognitive symptoms.†
• Week 3 to 4: Add Beef Organ Complex. Once the cellular energy layer is in place, adding whole-food nutrient density fills the nutritional foundation those systems depend on.
• As needed: Add Cortisol Complex if stress, overwhelm, disrupted sleep, or mood shifts are prominent. This layer is the most symptom-responsive of the four and can be added at any point.†

For a more detailed framework on building and sequencing a supplement routine, read: how to build a supplement routine for healthy aging as a woman.

"Motherhood is not a solo journey, and neither is perimenopause. Every product in our lineup exists because women deserve real support at every stage of life, backed by science and made with integrity."

— Amy Suzanne Upchurch, Founder and CEO of Pink Stork

Trust signals

Pink Stork products are ISO 17025 third-party tested and manufactured in cGMP-certified facilities. The Beef Organ Complex holds the Clean Label Project Purity Award. Pink Stork is woman-founded and woman-led, with more than 50,000 verified Amazon reviews across the brand. Products are available at Target, Walmart, CVS, and pinkstork.com.

Frequently asked questions

What is the most important supplement to start with during perimenopause?

If starting with one product, NAD+ addresses the cellular energy foundation most directly relevant to perimenopausal fatigue and brain fog.† Adding creatine as a second step covers muscle, bone, and cognitive support. From there, Beef Organ Complex and Cortisol Complex fill the nutrient density and stress resilience layers.

Can I take all four supplements in the stack together?

Yes. None of the four products in this stack interact negatively with each other, and each addresses a distinct biological mechanism.† The most practical approach is to take NAD+ and creatine together in the morning, add Beef Organ Complex with a meal, and take Cortisol Complex as directed on the label. Always consult your healthcare provider when combining multiple supplements.

How long before I notice results from a perimenopause supplement stack?

Creatine reaches full tissue saturation in three to four weeks. NR supplementation begins elevating NAD+ metabolites within two to four weeks. Whole-food nutrients build over time. Most women report noticeable changes in energy, mental clarity, and physical resilience within four to eight weeks of consistent use across the full stack.

Are these supplements safe to take with hormone replacement therapy?

No significant interactions between NAD+, creatine, Beef Organ Complex, or Cortisol Complex and hormone replacement therapy have been identified in the research. Always disclose all supplements to your prescribing provider before starting or adjusting a hormonal regimen.

Do I need to take all four supplements forever?

The biological changes of perimenopause and aging are ongoing, not temporary. Most women find that the core stack of NAD+ and creatine provides the most sustained benefit over time and is worth maintaining long-term. Beef Organ Complex and Cortisol Complex can be adjusted based on dietary changes and stress levels. There is no requirement to take all four indefinitely, but consistent use produces better outcomes than intermittent use for the cellular energy and saturation-based products.

Is Beef Organ Complex suitable for all women in perimenopause?

Beef Organ Complex contains bovine ingredients and is not suitable for vegan or vegetarian use. It is sourced from 100 percent grass-fed, grass-finished, pasture-raised cattle with no added hormones. Women who prefer plant-based supplementation should consider alternative iron and B-vitamin sources for the nutrient density layer of this stack.

† These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Always consult your healthcare provider before starting any new supplement, especially during pregnancy, breastfeeding, or while managing a medical condition. Keep out of reach of children.