Anti-Aging · Reference
NAD+ for Women: What the Research Has Looked At, and What to Check First
This page covers what NAD+ is, what research has and has not looked at in women, the considerations that change for women, how it sits alongside perimenopause and menopause, and how Pepti supplies it. For the general evidence, benefit by benefit, see NAD+ benefits; for the product reference, what is NAD+ injection.
The one randomized trial that looked at raising NAD+ in women specifically was a 2021 study in Science that gave oral nicotinamide mononucleotide (NMN), an NAD+ precursor, to postmenopausal women with prediabetes for ten weeks, and reported increased muscle insulin sensitivity compared with placebo. It did not test NAD+ injections, and no randomized trial has tested subcutaneous NAD+ in women or in men. NAD+ is not used in pregnancy or while breastfeeding, and in women the commonest findable causes of low energy, iron deficiency and an underactive thyroid, are worth checking before it. Compounded NAD+ is a prescription injection and is not FDA approved.
This page covers what NAD+ is, what research has and has not looked at in women, the considerations that change for women, how it sits alongside perimenopause and menopause, and how Pepti supplies it. For the general evidence, benefit by benefit, see NAD+ benefits; for the product reference, what is NAD+ injection.
NAD+ for Women
The short answer
| Question | What the live research shows | Strength of evidence |
|---|---|---|
| Has NAD+ been studied in women? | One randomized trial of oral NMN in postmenopausal women with prediabetes (Science, 2021) | A single trial of a precursor, not the injection |
| Does NAD+ decline with age? | Lower NAD+ in older human skin tissue (PLOS ONE, 2012) | Human observational; shows the decline, not that restoring it changes anything |
| Has the injection been tested in women? | No randomized trial of subcutaneous NAD+ in either sex | None |
| Does it help menopause symptoms? | Not tested; NAD+ is not hormone therapy | None |
| Is it used in pregnancy or breastfeeding? | No; no safety data, and the precursor trials did not enrol pregnant women | Clear exclusion |
| Energy and fatigue | Small trials of oral NADH in chronic fatigue syndrome; none of injected NAD+ | Limited, and not the injected molecule |
The honest summary: one relevant trial in women, of a different molecule given by mouth, and nothing yet on the injection itself.
NAD+ for Women
What NAD+ is, in one paragraph
NAD+ is nicotinamide adenine dinucleotide, a coenzyme every cell makes from a form of vitamin B3. It picks up electrons from broken-down glucose and fat, becomes NADH, and hands them to the mitochondria to make ATP, the cell's energy currency. It is also consumed as fuel by sirtuins, enzymes that regulate cell stress responses, and by PARP enzymes, which respond to DNA damage. It is not a peptide, a vitamin or a hormone, and it does not act on estrogen, progesterone or any other part of the reproductive axis. It is prescribed alongside peptides because it is compounded and dispensed the same way.
NAD+ for Women
What research has looked at in women
The 2021 trial in postmenopausal women
This is the study most often quoted when NAD+ comes up for women, and it is worth reading precisely. A randomized, placebo-controlled trial published in Science in 2021 gave postmenopausal women with prediabetes, who were overweight or obese, oral NMN or placebo for ten weeks. On clamp testing, the NMN group showed increased skeletal-muscle insulin sensitivity; the placebo group did not change.
What it shows. That raising NAD+ through a precursor changed one measured metabolic marker in a small, selected group of women.
What it does not show. It used NMN by mouth, not NAD+ by injection. It enrolled postmenopausal women with prediabetes, not women in general. It measured insulin sensitivity in muscle, not energy, weight, sleep, skin or any symptom. And the other well-known precursor trial on insulin sensitivity points the other way: a 2018 trial in the American Journal of Clinical Nutrition gave 40 obese, insulin-resistant men nicotinamide riboside (NR) or placebo for twelve weeks and found no improvement. One positive and one negative trial, both oral, one in each sex.
NAD+ and age
A 2012 study in PLOS ONE measured NAD+ in human skin across age groups and reported lower levels and higher oxidative-stress markers in older tissue. That is human data, and it is observational. It describes a decline; it does not show that replacing NAD+ changes how anyone ages. No human trial has tested NAD+ against any aging outcome in women or men.
What the precursor trials say about raising levels
Oral precursors reliably raise blood NAD+. NR did so in healthy volunteers (PLOS ONE, 2017), in healthy middle-aged and older adults (Nature Communications, 2018) and in healthy overweight adults (Scientific Reports, 2019), and NMN raised blood NAD+ dose-dependently over 60 days in 80 middle-aged adults (GeroScience, 2023). None of these is described as reporting separate findings for women.
The injected molecule is a different question. The only published study of NAD+ given directly to people, a 2019 pilot in Frontiers in Aging Neuroscience, infused it intravenously and found plasma NAD+ did not rise for the first two hours: it was cleared as fast as it arrived. The likeliest reading is that injected NAD+ is broken down outside cells into fragments, NMN among them, that tissues rebuild. Nothing equivalent has been published for the subcutaneous route.
NAD+ for Women
What changes for women
Low energy has findable causes that are more common in women
Fatigue is the reason most people ask about NAD+. Iron deficiency and an underactive thyroid produce fatigue, hair shedding, cold intolerance, brain fog and low mood, and both are far more common in women than in men: iron deficiency because of menstrual blood loss, and thyroid disease because autoimmune thyroiditis is heavily skewed toward women. Ferritin can be low while a full blood count reads normal. Low B12 does the same with brain fog added. Neither responds to NAD+, and each is inexpensive to find.
The live guidance is consistent: NAD+ suits flat energy once thyroid, iron and B12 have been considered and found normal, and a candid conversation about sleep has happened. If B12 is the issue, methylcobalamin is the direct answer rather than NAD+. More on the order a physician works through is in peptides for energy and fatigue.
Perimenopause and menopause
The perimenopausal transition typically begins in the forties, and ovarian hormone output fluctuates rather than declining smoothly. Fatigue, poor sleep and low mood in these years are often the transition itself, or the night sweats and fragmented sleep it brings. NAD+ is not hormone therapy, does not act on the hormones that change, and has not been tested for hot flashes, sleep, bone or any menopause outcome. If the transition is the driver, it belongs in the conversation with your physician rather than being treated around. Pepti does not prescribe menopausal hormone therapy. The wider picture is in peptides for menopause and peptides for women.
Pregnancy and breastfeeding
There is no safety data for supplemental NAD+ in pregnancy or lactation, and none of the randomized precursor trials enrolled pregnant or breastfeeding women. NAD+ is not prescribed in either situation. Methylcobalamin is the useful contrast: B12 is a required nutrient in pregnancy and part of prenatal supplementation, but NAD+ is not a vitamin in that sense and has no pregnancy data as an injectable. If you become pregnant on treatment, stop and contact your physician the same day. Can you take peptides while pregnant covers the detail, and do peptides affect fertility covers trying to conceive.
Contraception and the cycle
NAD+ is not a hormone, does not suppress any endocrine axis and is not described as affecting the cycle or hormonal contraception. No study has looked at that directly, so any cycle change on treatment is worth reporting, even if the transition or another cause is the likelier explanation.
Cancer history
The cautions in the live pages for NAD+ apply to women and men alike: an active or recent cancer, where a 2019 mouse study in Nature Cell Biology reported that the NAD+ recycling pathway drives tumor-promoting secretions of aging cells, so the question is unsettled; and significant kidney or liver disease. A history of breast, ovarian or endometrial cancer goes on the intake in full, and active malignancy without your oncologist involved is a situation in which NAD+ is very unlikely to be prescribed.
NAD+ for Women
What the evidence does not establish
- That NAD+ injection changes energy, weight, skin, sleep or aging in women. Those trials have not been run.
- That the 2021 NMN result transfers to an injection. Precursor results cannot simply be transferred to NAD+ injections.
- Any effect on menopause symptoms, bone density or hormone levels. None was tested.
- An effect size or a timeline. Prescriber reports of subjective change over weeks are clinical experience, and many people notice nothing.
- Long-term safety by any route. The precursor trials ran six weeks to six months.
- Efficacy for any condition as an approved treatment. NAD+ is not approved for anything.
There is also no validated routine clinical test for tissue NAD+, so nobody can show you your levels going up.
NAD+ for Women
Side effects and considerations
Most of what people feel on NAD+ is driven by how fast it enters the circulation rather than by the molecule. Nothing in the live research suggests the profile differs between women and men.
| What is reported or relevant | When | What to do |
|---|---|---|
| Stinging or burning at the site, redness, a small lump | Common | Inject slowly; rotate sites between abdomen and thigh |
| Flushing, warmth, chest or abdominal tightness, or nausea during the injection | Common, fading within minutes | Usually rate-related; inject slowly and report it |
| Headache, light-headedness | Uncommon | Report it |
| A wired feeling that disrupts sleep | Uncommon, more with evening doses | Report it; timing can be changed by your care team |
| Chills, shaking or vomiting after a dose | Not expected | Contact your physician the same day |
| Facial or throat swelling, widespread rash, difficulty breathing | Rare | Emergency care first (call 911), then tell your physician |
| Pregnancy, trying to conceive, or breastfeeding | Before and during treatment | Not used; tell your physician |
NAD+ is not named on the 2026 WADA Prohibited List, but women who compete in a tested sport should check with their governing body first.
NAD+ for Women
Where NAD+ stands with the FDA
NAD+ is in Category 1, "Bulk Drug Substances Under Evaluation," on the FDA's 503A list updated 14 May 2026. It was never in Category 2. Under the FDA's interim policy, state-licensed 503A pharmacies may compound it while the evaluation is pending. In October 2024 the FDA warned that food-grade NAD+ powder is not suitable for sterile injections after reports of endotoxin reactions, which is about ingredient sourcing rather than the molecule and is why the pharmacy matters. Compounded NAD+ is not FDA approved.
NAD+ for Women
How Pepti supplies NAD+
| Product | What is in it | Typical directions | Price |
|---|---|---|---|
| NAD+ Injection | 10 mL multi-dose vial, 100 mg/mL (1000 mg NAD+) | 0.83 mL (83 units) subcutaneously three times per week | $249/mo |
| NAD+ Injection (500 mg) | 10 mL multi-dose vial, 50 mg/mL (500 mg NAD+) | 0.83 mL (83 units) subcutaneously three times per week | $229/mo |
| Glutathione | 5 mL multi-dose vial, 200 mg/mL (1000 mg glutathione) | A separate product, often prescribed alongside | $199/mo |
Each NAD+ vial holds 12 doses at that volume, about four weeks, so refills run every 28 days, one vial per fill. The 500 mg vial is the same volume at half the concentration, which some prescribers describe as easier on the injection site; see what is NAD+ 500. Your physician sets your directions after reviewing your intake, and they are printed on the vial.
Every price is all-in, covering medication, physician review, refill management and shipping, with no membership fee. Pepti is cash-pay and does not bill insurance. Vials arrive as solutions ready to use, with sterile syringes and alcohol prep pads, shipped refrigerated with ice packs. NAD+ degrades with heat and light, so keep it in the fridge. Lot test results are at /quality/lab-results.
NAD+ for Women
Where to get NAD+ prescribed
NAD+ injections cannot be bought legitimately without a prescription, and with NAD+ the FDA has specifically warned about unsuitable ingredients. The prescription route:
- Complete a free online intake covering your history, medications, pregnancy and contraception status, and what you want help with.
- A physician licensed in your state reviews it, usually within 24 hours.
- If it is appropriate, a PCAB-accredited, FDA-registered US 503A compounding pharmacy prepares it to that prescription. Lot test results are published at /quality/lab-results.
- It ships refrigerated with your directions printed on the vial.
- Your physician stays reachable for questions and side effects.
Step by step: how to get NAD+ prescribed online. Bloodwork is not required for any Pepti treatment. If your physician wants labs for your care, they'll ask through your account.
References
What this is based on.
References
- Massudi H, Grant R, Braidy N, et al.. Age-associated changes in oxidative stress and NAD+ metabolism in human tissue · PLOS ONE (2012) · PMID 22848760
- Yoshino J, Baur JA, Imai SI. NAD+ Intermediates: The Biology and Therapeutic Potential of NMN and NR · Cell Metabolism (2018) · PMID 29249689
- Verdin E. NAD⁺ in aging, metabolism, and neurodegeneration · Science (2015) · PMID 26785480
- Martens CR, Denman BA, Mazzo MR, et al.. Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults · Nature Communications (2018) · PMID 29599478
- Dollerup OL, Christensen B, Svart M, et al.. A randomized placebo-controlled clinical trial of nicotinamide riboside in obese men: safety, insulin-sensitivity, and lipid-mobilizing effects · American Journal of Clinical Nutrition (2018) · PMID 29992272
- Yoshino M, Yoshino J, Kayser BD, et al.. Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women · Science (2021) · PMID 33888596
- Yi L, Maier AB, Tao R, et al.. The efficacy and safety of β-nicotinamide mononucleotide (NMN) supplementation in healthy middle-aged adults: a randomized, multicenter, double-blind, placebo-controlled, parallel-group, dose-dependent clinical trial · GeroScience (2023) · PMID 36482258
- Brakedal B, Dölle C, Riemer F, et al.. The NADPARK study: A randomized phase I trial of nicotinamide riboside supplementation in Parkinson's disease · Cell Metabolism (2022) · PMID 35235774
- McDermott MM, Martens CR, Domanchuk KJ, et al.. Nicotinamide riboside for peripheral artery disease: the NICE randomized clinical trial · Nature Communications (2024) · PMID 38871717
- Shiffman S, Stone AA, Hufford MR. Ecological momentary assessment · Annu Rev Clin Psychol (2008) · PMID 18509902
- Conze D, Brenner C, Kruger CL. Safety and Metabolism of Long-term Administration of NIAGEN (Nicotinamide Riboside Chloride) in a Randomized, Double-Blind, Placebo-controlled Clinical Trial of Healthy Overweight Adults · Scientific Reports (2019) · PMID 31278280
- Nacarelli T, Lau L, Fukumoto T, et al.. NAD+ metabolism governs the proinflammatory senescence-associated secretome · Nature Cell Biology (2019) · PMID 30778219
Citations are provided for educational purposes. They do not constitute medical advice. Always discuss any peptide protocol with your prescribing physician.
Common questions
NAD+ for Women, answered.
Research has looked at it in women once: a 2021 randomized trial of oral NMN, an NAD+ precursor, in postmenopausal women with prediabetes reported increased muscle insulin sensitivity. That is a single trial of a different molecule by mouth. No trial has tested NAD+ injections in women, so any benefit for women is described, not established.
Research describes NAD+'s role in energy metabolism and DNA repair in everyone. For women specifically, the only trial is the 2021 NMN study in postmenopausal women with prediabetes. Claims about energy, skin, weight or hormones in women have not been tested for the injection.
It has not been tested for any menopause symptom. NAD+ is not hormone therapy and does not act on estrogen or progesterone. Hot flashes, night sweats and bone loss belong in a conversation about the transition itself. See peptides for menopause.
No trial has tested subcutaneous NAD+ for fatigue in either sex; the fatigue trials used oral NADH. In women, iron deficiency, thyroid disease and low B12 are common, findable causes of fatigue and are worth ruling out first.
NAD+ is not a hormone and is not described as acting on the reproductive axis. No study has looked at cycle effects. Report any change to your physician; it is more likely to have another cause, but it should be looked at.
No. There is no safety data in either situation, and none of the trials enrolled pregnant or breastfeeding women. If you become pregnant on treatment, stop and contact your physician the same day.
Tell your physician before starting. NAD+ has no pregnancy data as an injectable, and the usual approach is not to start elective injectables while actively trying. Do peptides affect fertility covers the conversation.
No interaction has been described, and NAD+ does not act on hormones, but no study has looked at either combination. List both on your intake so your physician can review them together, and tell whoever manages your hormone therapy what you are adding.
Nobody has compared them. NMN is the molecule in the 2021 trial in postmenopausal women; NAD+ injection bypasses the gut but has no randomized trial. On the 2019 infusion data, injected NAD+ may be broken down into fragments including NMN, so the two may use the same pathway. Pepti supplies NAD+ as an injection and does not supply NMN.
The same as for men: mostly stinging at the site and flushing, chest tightness or nausea during the injection that fade within minutes, usually tied to injecting too fast. Chills or vomiting after a dose are not expected and should be reported the same day.
At Pepti, NAD+ Injection (1000 mg) is $249 a month and NAD+ Injection (500 mg) is $229 a month, all-in, covering medication, physician review, refill management and shipping.
No. Bloodwork is not required for any Pepti treatment. If your physician wants labs for your care, they'll ask through your account. The free assessment goes to a physician licensed in your state. A consultation does not guarantee a prescription.
Next step
See what a physician recommends for you.
A licensed physician in your state reviews your intake and decides what is appropriate. A consultation does not guarantee a prescription.