Should women in perimenopause take folic acid or folate?

Most women in perimenopause do not need a folate supplement; food provides the 200 micrograms a day adults need. If you are planning a pregnancy, UK advice is 400 micrograms of folic acid a day before conceiving and until 12 weeks.

• Adults need 200 micrograms of folate a day, from foods such as broccoli, Brussels sprouts, leafy greens, peas, beans and fortified cereals.
• Pregnancy is still possible in perimenopause and HRT is not contraception. Anyone planning a pregnancy is advised to take 400 micrograms of folic acid daily until 12 weeks.
• Folic acid above 1 mg a day can hide the signs of vitamin B12 deficiency, so check combined doses across products and take higher doses only if a doctor advises them.

The number

Adults need 200 micrograms of folate a day [1]. Broccoli, Brussels sprouts, leafy green vegetables, peas and beans, and fortified breakfast cereals are good sources [1]. Most people eating a varied diet reach it without a supplement, and there is no UK advice for women in perimenopause to take one.

The exception: pregnancy is still possible

Periods become irregular in perimenopause, but pregnancy is still possible, and HRT is not contraception [2]. Ask your GP or nurse when it is safe to stop contraception. If you are planning a pregnancy, UK advice is to take a 400 microgram folic acid supplement every day before conceiving and until 12 weeks of pregnancy, and some women are advised to take a higher dose [1]. That is an important reason to take folic acid that can still apply in midlife.

What folate is authorised to say it does

Folate carries several GB-authorised health claims. Among them: folate contributes to the reduction of tiredness and fatigue, to normal psychological function, to normal blood formation, and to normal homocysteine metabolism [3]. They describe the vitamin's normal work at any age. None is a claim about perimenopause.

Too much folic acid

Taking more than 1 mg of folic acid a day can mask the symptoms of vitamin B12 deficiency [1]. That matters because a B12 deficiency that goes unrecognised needs assessment and treatment. Check combined daily amounts across products, particularly multivitamins and B-complexes, and take more than 1 mg only if a doctor advises it.

Folic acid or methylfolate

Folic acid is the synthetic form used in fortified foods and in the trials behind UK pregnancy advice. Methylfolate, often labelled 5-MTHF or L-methylfolate, is the form folate takes in the body. A review of the two argues that methylfolate may have advantages, including absorption regardless of a common variant in the MTHFR gene and less potential to mask B12 deficiency [4]. It is a review rather than a trial in women in midlife, and it does not establish methylfolate as a substitute for the folic acid that UK pregnancy guidance specifies. If pregnancy is a possibility, follow the folic acid advice above.

Where this leaves you

If you are planning a pregnancy, take 400 micrograms of folic acid daily and talk to your GP. If you are not, food is usually enough. Either way, ask your GP or nurse about contraception, because perimenopause does not end the need for it on its own. If you are tired and wondering about B vitamins, a GP blood test for B12 and folate is a better starting point than a supplement.

Published by: Suggestic Inc, herstack.co.uk. The HerStack editors. 2026-10-02. This page has not been reviewed by a clinician.