Can you take supplements with HRT? What to check, ingredient by ingredient

Updated 15 October 2026. We make the Flissie Perimenopause Supplement, which contains chaste tree, one of the two herbs on this page for which EU monographs advise anyone using oestrogen to consult a doctor first, so we have an interest, and ours is marked wherever it appears. Most of what follows comes from NHS pages, the official product information for HRT medicines, EU herbal monographs and expert reference monographs, read on 15 October 2026; brand statements are dated where we read them earlier. It is general information, not medical advice: your GP or pharmacist can check your own HRT and supplements together.

If you take HRT and a supplement, or are thinking of adding one, the official answer is shorter than most people expect, because almost nobody has tested supplements together with HRT. Here is what the NHS, the HRT leaflets and the herbal monographs do say, ingredient by ingredient.

Can you take supplements with HRT? The quick answer

Quick answer: there is no blanket yes. The NHS says “It's not possible to say that other herbal remedies and supplements are safe to take with HRT”, because they are “generally not tested for the effect they can have on other medicines”.

What the official sources do name is short:

• Two documented interactions: St John's wort can make HRT tablets and capsules work less well, with patches less affected, and HRT raises melatonin levels.
• Two herbs to check with your doctor first: chaste tree (agnus castus), which is in the Flissie Perimenopause Supplement we make, and black cohosh. EU herbal monographs tell anyone using oestrogen to consult a doctor before taking chaste tree, and not to take black cohosh with oestrogen unless a doctor advises it.
• Four more named by the NHS: evening primrose oil, soya, red clover and ginseng, which its HRT pages say might affect other medicines.
• No vitamins or minerals: no NHS HRT page, HRT leaflet or prescriber information we checked names a vitamin or mineral to avoid.
• Everything else: no interaction with HRT is listed in the sources we checked, but supplements are rarely tested with HRT, so check with your GP or pharmacist.

That last group covers most of what people ask about, including magnesium, collagen, turmeric and creatine; ashwagandha has a small hormone signal, covered below. A pharmacist can check your HRT and your supplements together, so take the packs or a list with you.

What the NHS and HRT leaflets say about supplements

All four NHS guides to HRT medicines, for continuous combined HRT, sequential combined HRT, oestrogen-only HRT and Utrogestan, say the same thing: it is not possible to say that other herbal remedies and supplements are safe to take with them. They ask you to tell your doctor or pharmacist about any “herbal remedies, vitamins or supplements” you take. Three of them name “evening primrose oil, soya, red clover, black cohosh, ginseng and St John's wort” as herbal products sold for menopause symptoms. Two add “All of these products might affect other medicines you're taking”, and the third says “Any herbal product may affect other medicines you're taking”. The four pages were last reviewed in January 2023 and were due for review in January 2026, so they may change.

The official product information that prescribers use, the summary of product characteristics (SmPC), names just one herb. Every HRT SmPC we checked, from Oestrogel and Lenzetto to Evorel and Estradot patches, Femoston and Kliovance tablets, Utrogestan capsules and the Mirena coil, names St John's wort as able to speed up the breakdown of oestrogen or progestogen, and several add that this “may lead to decreased effect and changes in the uterine bleeding profile”. None of them names a vitamin or mineral in its interactions section.

The only other everyday things they mention: grapefruit juice can raise hormone levels from the Mirena coil; Utrogestan “should not be taken with food and should be taken at bedtime”; and alcohol-based skin products and sunscreen timing matter if you use a gel or spray.

Patches and gels are less exposed, but not immune. The NHS says “HRT patches will be less affected” by St John's wort, and the patch and gel SmPCs say oestrogens given through the skin “might be less affected” than tablets by substances that speed up hormone breakdown. Less affected does not mean unaffected, and the NHS also says St John's wort “may stop Utrogestan from working as well”, so if your HRT pairs a patch or gel with progesterone capsules, the capsules are still exposed. The precautions for chaste tree and black cohosh apply to oestrogen in any form.

The NHS menopause treatment page, reviewed on 19 May 2026, adds a broader caution about herbal remedies sold for menopause symptoms: “But there is very little evidence to show how well they work, or how safe they are.”

What vitamins should you not take with HRT?

None is named. No NHS HRT page, HRT leaflet or SmPC we checked names a vitamin or mineral to avoid with HRT. What matters more is the total you take across every product, because the usual limits still apply.

• Vitamin B6: the NHS says not to take more than 10mg a day from supplements unless a doctor advises. Multivitamins and menopause supplements often both contain it, so add them up.
• Vitamin D: the NHS advises everyone to consider 10 micrograms a day in autumn and winter, and not to take more than 100 micrograms a day.
• Calcium: the Royal Osteoporosis Society says most adults need 700mg a day, ideally from food, and that “Taking more than 1,500mg of calcium supplements a day can be bad for your health”.
• Calcium and iron with levothyroxine: the NHS lists calcium and iron supplements among things that do not mix well with levothyroxine, and the usual advice is to leave four hours between them.
• Vitamin K: some multivitamins contain it, which matters if you take warfarin.

Patient.info's interaction pages list vitamin D, magnesium and folic acid as having “no known” interaction with Oestrogel, although those pages name no author or references.

Supplements and HRT, ingredient by ingredient

We checked every ingredient below against UK product information, NHS pages, EU herbal monographs, the ESCOP herb and drug interaction table, and reference monographs from Memorial Sloan Kettering (MSK) and the US National Institutes of Health (NIH). No official or reference source grades how serious an interaction is, and we found no study of any of these supplements in women taking HRT. Ingredients in the Flissie Perimenopause Supplement are marked (in ours).

Can you take ashwagandha with HRT?

No NHS page, HRT leaflet, SmPC or MHRA source we checked names ashwagandha and HRT together, and nobody has tested ashwagandha in women taking HRT. So the answer is the same as for most supplements: no interaction is listed, it is untested with HRT, and you should check with your GP or pharmacist before combining them.

One interaction checker flags it anyway: Patient.info rates ashwagandha with Oestrogel a “Moderate Interaction Risk”, calling it “pro-oestrogenic”, but cites no evidence, and the page, first published on 25 January 2026, names no author or references. The closest evidence is a 2026 randomised trial of 60 women aged 45 to 55, none on recent hormone therapy, in which 600mg a day of KSM-66 ashwagandha for 56 days raised progesterone from 0.28 to 0.43 ng/mL and nudged oestradiol up by about 1 pg/mL, with no liver or kidney signal (the paper gives conflicting statistics for the oestradiol change). Those are small changes, in women not taking HRT, and nobody has tested what happens in women taking HRT.

The other cautions matter as much at this age. The US National Institutes of Health says ashwagandha “might interact with thyroid hormone medications”, and describes three women who developed an overactive thyroid while taking it. It may also interact with diabetes and blood pressure medicines, immunosuppressants and sedatives, it has been linked to rare liver injury, and NCCIH says it should be avoided in pregnancy. The NIH says it “appears to be well tolerated for up to about 3 months of use, but its long-term safety is not known”.

Its UK status is unsettled too. The Food Standards Agency says “In the UK there are no safe levels established or set limits for its use in food supplements”, and asked the Committee on Toxicity to assess it. The committee discussed a third draft statement on 8 September 2026, its 2025 annual report said a final statement was expected in 2026, and ashwagandha is not on its 20 October 2026 agenda. Denmark banned ashwagandha in supplements in 2023.

We make the Flissie Perimenopause Supplement, which contains KSM-66 ashwagandha, so we have an interest here. The trial above was not of our product, and we make no claim that it changes hormone levels. If you use HRT, we advise checking with your GP or pharmacist before taking it.

Can I take ashwagandha with HRT if I take thyroid medicine?

Speak to your GP first. Ashwagandha has reported effects on thyroid hormone levels, and HRT product information notes that oestrogen raises a protein that carries thyroid hormone in the blood, which can change thyroid test results.

Can you take collagen with HRT?

No interaction between collagen supplements and HRT is listed. MSK's collagen monograph, updated in May 2025, lists no drug interactions and does not mention oestrogen or HRT, and collagen does not appear on any NHS HRT page. Like most supplements, it has not been tested with HRT, so mention it to your pharmacist.

Check the rest of the label, though. Collagen drinks and powders often add vitamins, minerals or herbs, and those are the ingredients to check against the table above and against anything else you take.

Can you take collagen supplements with HRT patches?

The same applies to patches, gel, spray and tablets: no interaction between collagen and HRT is listed for any form. The only interaction difference the HRT leaflets draw between forms is about herbs that speed up hormone breakdown, such as St John's wort, and collagen is not one of them.

Can you take magnesium with HRT?

No interaction is listed. The NIH magnesium fact sheet, updated in January 2026, covers bisphosphonates, some antibiotics, diuretics and acid-reducing medicines, and does not mention oestrogen or HRT. Patient.info lists “no known” interaction between magnesium and Oestrogel. Like most supplements, it has not been tested with HRT, so mention it to your pharmacist.

The usual magnesium cautions still apply whatever HRT you use. Take it at least two hours apart from bisphosphonates such as alendronic acid, and away from tetracycline and quinolone antibiotics. High doses cause diarrhoea, the NIH sets an upper limit of 350mg a day from supplements for adults, and kidney disease raises the risk of too much building up.

Magnesium glycinate and HRT

We found no data specific to magnesium glycinate. The general magnesium cautions above apply to it in the same way.

Can you take evening primrose oil with HRT?

The EU herbal monograph lists “None reported” for interactions, but the NHS includes evening primrose oil in its list of menopause products that “might affect other medicines”, so ask your pharmacist.

MSK says evening primrose oil “does not have intrinsic estrogenic properties”, but notes that some products combine it with plant oestrogens, so check the label for soya or red clover. It may add to the effect of blood thinners, and MSK advises caution with hormone-sensitive cancers.

St John's wort, black cohosh, red clover and soya with HRT

Can you take St John's wort with HRT?

Avoid it unless your doctor says otherwise. It is the one herb every HRT leaflet names: the NHS says it “may stop HRT tablets and capsules from working as well”, and a registered St John's wort medicine lists HRT in every form (tablets, patches, gel and vaginal ring) with the instruction “Do not take with this product”. The MHRA also says it should not be taken with hormonal contraception.

Can you take black cohosh with HRT?

Only if your doctor advises it. The EU herbal monograph says black cohosh “should not be used together with oestrogens unless advised by a doctor”, and the Boots Black Cohosh leaflet says not to take it “If you are taking a medicine containing estrogen unless your doctor advises it is safe to do so”. The MHRA has linked black cohosh with rare liver injury since 2006, and the monograph says not to take it for more than six months without medical advice.

Can you take red clover with HRT?

No interaction is listed, but red clover contains oestrogen-like isoflavones, it is on the NHS list, and MSK says people with hormone-sensitive cancers should avoid it. A 2014 review said similar compounds in soy may “distort the final effect of the hormone agent” when taken with oestrogens. Women's Health Concern says “Isoflavones, red clover and black cohosh are not recommended for those who have had breast cancer”. So ask your doctor before combining red clover and HRT.

Lion's mane, mushroom gummies, turmeric, creatine and berberine with HRT

Can you take lion's mane with HRT?

No interaction is listed. MSK's lion's mane monograph has no interactions section and says only that supplements “can also interact with some medications and affect how they work”; oestrogen and HRT are not mentioned. It has not been tested with HRT, so mention it to your pharmacist.

Can you take mushroom gummies with HRT?

Check which mushrooms are in them. Lion's mane has no listed interactions, but reishi “can increase the risk of bleeding” with blood thinners and has been linked to liver injury, and cordyceps affected sex hormones in animal studies. None of them has been tested with HRT.

Can you take turmeric with HRT?

ESCOP reports no interactions, and MSK lists none with oestrogen. Turmeric can add to the effect of blood thinners, and it has been linked to liver injury, including autoimmune hepatitis that resolved when people stopped taking it. It has not been tested with HRT, so mention it to your pharmacist.

Can you take creatine with HRT?

No interaction is listed: MSK names only caffeine, and nothing we found links creatine and HRT. The NIH notes that it often adds some water weight. It has not been tested with HRT, so mention it to your pharmacist.

Can you take berberine with HRT?

No interaction is listed, but in people berberine slowed several of the liver enzymes that clear medicines, and HRT product information says substances that slow those enzymes “may increase circulating levels” of the hormones. That is theory, not a tested interaction between berberine and HRT. Berberine also affects ciclosporin, tacrolimus and some diabetes medicines.

Can you take pumpkin seed oil with HRT?

ESCOP reports no interactions for pumpkin seed, and we found no other monograph or caution, but it has not been tested with HRT either. For melatonin, NMN, DIM, sage, starflower oil, saw palmetto, astaxanthin, iron, vitamin D and omega-3, see the table above.

Can you take menopause supplements with HRT? What the brands say

It depends on what is in them, and the brands' own answers range from “can be taken with or without” HRT to “speak to your GP”. Here is what each says on its own website, with the ingredients worth checking against the table above.

Pages checked on 15 October 2026 unless stated. For what is in each of these products and what each is allowed to claim, see our hormone balance supplements comparison, and for perimenopause products more widely, our perimenopause supplements roundup.

Where the Flissie Perimenopause Supplement fits

We make the Flissie Perimenopause Supplement, so here is what matters in it if you take HRT:

• Chaste tree, 75mg (10:1): the EU monograph says interactions with oestrogens “cannot be excluded” and that people using oestrogens should consult their doctor first, and MSK notes laboratory studies suggesting it may reduce the effects of hormone therapies. It is not suitable with hormonal contraception, including a hormonal coil (IUS), and the Mirena coil is also licensed to protect the womb lining during oestrogen HRT, so if a hormonal coil is part of your HRT, it is not for you. If you use any other HRT, check with your GP or pharmacist before taking it.
• Wild yam, 60mg (8:1): not suitable if you have, have had, or are at increased risk of a hormone-sensitive condition. There is no evidence the body turns it into progesterone, and we make no such claim.
• KSM-66 ashwagandha, 600mg: no HRT interaction listed, but untested with HRT, and if you take thyroid medication, speak to your GP first. It is under the UK safety review described above.
• Maca, 350mg (10:1): oestrogen-like activity in laboratory studies; no HRT interaction listed.
• No soya isoflavones or red clover, two of the herbs on the NHS list. That does not make it safer with HRT, or free of plant compounds with oestrogen-like activity: maca, wild yam and chaste tree all show some in the sources above.

It is not an alternative to HRT, and it has not been tested with HRT. What we can offer is a label with every dose on it, so your pharmacist can check it properly: KSM-66 ashwagandha 600mg, fennel 500mg, maca 350mg, chamomile 220mg, rhodiola 80mg, chaste tree 75mg, wild yam 60mg, broccoli sprout 50mg, gymnema 50mg, rosemary 25mg and vitamin B6 2.07mg, three vegan capsules a day.

What are the best vitamins to take with HRT?

The only supplement the British Menopause Society recommends for menopausal women is vitamin D, 10 micrograms a day, and its nutrition advice for clinicians says “Additional supplements should only be taken where there is a clinical need”. That applies whether or not you take HRT.

The NHS advises everyone to consider 10 micrograms of vitamin D a day in autumn and winter, and its menopause self-help page simply says “take vitamin D supplements”. For bones, the Royal Osteoporosis Society says most adults need 700mg of calcium a day, ideally from food, and notes that “HRT appears to be as effective as other osteoporosis medicines” (ROS). In the specialists' view, then, the best supplements to take with HRT are vitamin D and whatever a clinician says you need.

Does HRT deplete vitamins?

No official UK source we checked, from the NHS, NICE and HRT product information to the British Menopause Society and the Royal Osteoporosis Society, says HRT depletes vitamin B6, magnesium, folate or any other nutrient. The idea appears in supplement marketing. Health & Her says its HRT multivitamin “Replenishes the nutrients that can deplete when taking HRT”, while saying its evidence “is based on scientific research of oral hormone replacement therapy (HRT)”. It leaves out copper “Because HRT can increase levels of Copper”, which echoes a note in HRT product information that oestrogen raises a copper-carrying protein, but no official advice tells women on HRT to change their supplements because of it.

What to tell your GP or pharmacist

Take the packs, or a list of everything you take with the doses, and say which HRT you use: tablet, patch, gel, spray or coil. Mention in particular:

• thyroid treatment, including levothyroxine
• blood thinners, such as warfarin
• diabetes or blood pressure medicines
• antidepressants, sleeping tablets or other sedatives
• any history of breast or another hormone-sensitive cancer
• liver disease
• any chance you could be pregnant, and any hormonal contraception you also use

These are the cautions that come up again and again in the monographs above. The NHS asks you to tell your doctor or pharmacist about any herbal remedies, vitamins or supplements, so you will not be wasting their time.

What we will not tell you

We will not tell you that any supplement is safe to take with HRT, the Flissie Perimenopause Supplement included, because the NHS says it is not possible to say. We will not tell you a supplement works with HRT, tops it up or does anything HRT does, and we will not suggest one as an alternative to it. And we will not tell you that HRT drains your vitamins, because no official UK source we checked says so. What we can tell you is what the official sources say, ingredient by ingredient, and exactly what is in ours.

Where a supplement is not the answer

If you are on HRT and still struggling with symptoms, talk to your GP or menopause specialist rather than adding a supplement: the British Menopause Society's consensus statement, amended in July 2026, says “no treatment is as effective as estrogen”. If you are thinking of stopping HRT and trying supplements instead, talk to your GP first. NICE tells clinicians to explain that the safety of isoflavone and black cohosh products is uncertain and that “interactions with other medicines have been reported”, and that for complementary products generally “the quality, purity and constituents of products may be unknown”. And if you have had breast cancer or another hormone-sensitive cancer, ask your specialist before taking anything on this page.

Supplements with HRT: your questions

Can I take supplements while on HRT?

There is no blanket yes: the NHS says it is not possible to say that herbal remedies and supplements are safe to take with HRT, because they are generally not tested with other medicines. Avoid St John's wort, check with your doctor before taking melatonin, black cohosh or chaste tree, and check everything else with your pharmacist.

What should I avoid while on HRT?

St John's wort, which can make HRT work less well, especially tablets and capsules, though patches are not immune; and melatonin unless it is prescribed, because HRT raises melatonin levels. Check with your doctor before taking black cohosh or chaste tree (agnus castus). HRT product information also says Utrogestan should be taken away from food, and that some skin products affect gels and spray.

Can you take magnesium with HRT patches?

No interaction is listed between magnesium and HRT in any form, patches included. The usual magnesium cautions still apply: keep it two hours apart from bisphosphonates, away from some antibiotics, and ask first if you have kidney disease. It has not been tested with HRT, so mention it to your pharmacist.

Can you take ashwagandha with HRT patches?

No source we checked names ashwagandha with HRT in any form. Patches and gels are less affected than tablets by substances that speed up hormone breakdown, and laboratory studies disagree on whether ashwagandha does that; MSK says the clinical relevance is not known. It has not been tested with HRT, so check with your GP or pharmacist first.

Can I take collagen with HRT?

No interaction is listed: the MSK collagen monograph lists no drug interactions and does not mention oestrogen or HRT, and collagen is not on any NHS HRT page. It has not been tested with HRT, so check anything else in the product, such as added herbs or vitamins, and mention it to your pharmacist.

Does ashwagandha interact with HRT?

No official source says so, and nobody has tested it in women taking HRT. Patient.info rates ashwagandha with Oestrogel a moderate risk but cites no evidence, and a 2026 trial in women not on HRT found a small rise in progesterone and a possible small rise in oestradiol. Ask your GP or pharmacist, especially if you take thyroid medicine.

Can you take Hormone Harmony with HRT?

Check with your GP or pharmacist first. Happy Mammoth's UK product page did not mention HRT when we checked on 15 October 2026, and it names chaste tree and wild yam among its ingredients; chaste tree's EU monograph tells anyone using oestrogens to consult their doctor first. The same applies to the Flissie Perimenopause Supplement (we make it), whose ingredients match the 11 that Happy Mammoth's UK product page names.

Can I take menopause supplements with HRT?

Not without checking. Some brands say yes, some say ask your GP, and the NHS says it is not possible to say supplements are safe with HRT. Check the label for St John's wort, black cohosh, chaste tree, red clover, soya or ginseng, and ask a pharmacist. The Flissie Perimenopause Supplement (we make it) contains chaste tree, so if you use HRT, check with a GP or pharmacist before taking it.

Can you take vitamin D with HRT?

No interaction between vitamin D and HRT is listed, and vitamin D is the one supplement specialists recommend: the British Menopause Society advises 10 micrograms a day for menopausal women, and the NHS advises everyone to consider it in autumn and winter. Do not take more than 100 micrograms a day.

Can I take melatonin with HRT?

Only on your doctor's advice. HRT raises melatonin levels by slowing its breakdown, according to the product information for Circadin, and melatonin is prescription-only in the UK; the NHS says shop and online versions are not authorised for sale.

What supplements can I take with HRT?

None is cleared as safe with HRT, but most have no listed interaction. Vitamin D is the one specialists recommend for menopausal women. Avoid St John's wort, check with your doctor before taking melatonin, black cohosh or chaste tree, and check everything else with your pharmacist.

What vitamins can I take with HRT patches?

The same as with tablets: no vitamin is named as a problem with either. Patches are less affected than tablets by herbs that speed up hormone breakdown, such as St John's wort, but not immune, so still avoid it; and the NHS advice to tell your pharmacist about vitamins and supplements applies to every form of HRT.

Does HRT deplete vitamins?

No official UK source we checked says so. The idea appears in supplement marketing, based on research into oral HRT, and none of the NHS, NICE, HRT product information, the British Menopause Society or the Royal Osteoporosis Society gives women on HRT different vitamin advice.

Sources

• NHS: HRT with other medicines and herbal supplements, for continuous combined HRT, sequential combined HRT, oestrogen-only HRT and Utrogestan (last reviewed January 2023); menopause treatment (19 May 2026); things you can do; B vitamins; vitamin D; melatonin; levothyroxine
• Product information (emc): Oestrogel, Lenzetto, Evorel, Estradot, Femoston, Kliovance, Utrogestan, Mirena, Circadin, Care St John's Wort and Boots Black Cohosh leaflet
• EU herbal monographs: agnus castus, black cohosh, evening primrose oil, sage, fennel, rhodiola, ginseng, chamomile and rosemary; ESCOP herb and drug interactions
• MSK: ashwagandha, collagen, lion's mane, reishi, cordyceps, turmeric, creatine, berberine, red clover, soy, maca, wild yam, evening primrose oil, chamomile, DIM, saw palmetto, borage, omega-3, dong quai, Asian ginseng, chasteberry and broccoli sprouts
• US National Institutes of Health: ashwagandha, magnesium, vitamin D, calcium, iron, multivitamins, vitamin B6, creatine; NCCIH: ashwagandha; LiverTox: gymnema
• Research: Vani et al. 2026; Zabłocka-Słowińska et al. 2014; Patient.info on ashwagandha, vitamin D, magnesium and folic acid with Oestrogel; NutraIngredients ashwagandha timeline
• UK regulators and specialists: Food Standards Agency; Committee on Toxicity 8 September 2026, annual report 2025 and 20 October 2026 agenda; MHRA on black cohosh; MHRA on St John's wort; British Menopause Society consensus statement and nutrition tool; Women's Health Concern; NICE NG23; Royal Osteoporosis Society on calcium and HRT
• Brand pages: Vitabiotics Menopace, A.Vogel Menopause Support, Wild Nutrition, MyOva Menoplus, MyOva Hormone Balance, Health & Her and Happy Mammoth

Sources read on 15 October 2026 unless stated. Guidance and product information change, so check with your pharmacist for your own medicines.

Related reading

• Hormone balance supplements: what is in them, and what they are allowed to claim
• Perimenopause supplements UK: 8 compared on dose, claims and price
• Menopace review: what is in each formula, and who it suits
• KSM-66 ashwagandha: what it is and why the dose matters