Key Points
- Symptoms reduced after 7 days
- Hot flashes, bloating, and poor sleep improved
- The ratio of estradiol to estrone increased, shifting estrogen balance
- Markers of NAD⁺ metabolism changed showing biological activity
Overview of Methods
Forty healthy women over age 35 took part in a 7-day clinical trial.
- MS Group: Thirty-two women reported symptoms related to the menopause transition. These included hot flashes, bloating, and poor sleep.
- No-MS Group: Eight women reported no or minimal menopause-related symptoms.
All participants took the same daily supplement combination:
NRPT: 250 mg NR + 50 mg pterostilbene orally for 7 days
Participants completed a symptom survey at the beginning and end of the study. They rated how often they experienced bloating, hot flashes, and poor sleep, as well as how unpleasant those symptoms felt.
Researchers also measured estrogen-related markers and markers of NAD⁺ metabolism.

Hot Flashes, Bloating, and Sleep Improved
After 7 days, women who had menopause-related symptoms reported significant improvements in all three symptoms measured.
“In the MS group, significant decreases in both the frequency and unpleasantness of bloating, hot flashes, and poor sleep were observed at day 7.”
Most women in the symptom group reported at least some improvement:
- 78% reported improved bloating
- 75% reported fewer hot flashes
- 84% reported less unpleasant hot flashes
- 84% reported less frequent poor sleep
- 91% reported less unpleasant poor sleep
This indicates the improvements were mainly seen in women who were already experiencing symptoms.
Those already taking supplements saw more effective results, suggesting a synergistic effect.
“Participants who reported taking vitamins seemed to respond better to NRPT treatment… a greater proportion of vitamin takers experiencing a complete alleviation of menopausal symptoms.”
Estradiol Balance Increased
Estradiol (E2) is the stronger form of estrogen and is more common before menopause. Estrone (E1) is a weaker form that becomes more common after menopause.
“NRPT significantly increased the E2/E1 ratio in the MS group.”
“The 7-day change in E2 levels trended upward with respect to baseline while the 7-day change in the levels of E1 trended downward.”
In simpler terms, this means their estrogen balance shifted in a direction that may reflect more estradiol activity compared to estrone.
NAD⁺ Metabolism Shifts
After supplementation, markers of NAD⁺, increased showing the supplement was biologally active.
“Me-NAM increased following NRPT administration. In the broader AUCbased metabolite panel, 2/4-Me-PY also increased following NRPT supplementation.”
These findings suggest that the NR-containing supplement changed vitamin B3 and NAD⁺ metabolism over the 7-day study.

Conclusion
NR plus pterostilbene successfully improved symptoms associated with menopause transition in women, especially in those already taking supplements.
“Significant reductions in the frequency and unpleasantness of bloating, hot flashes and poor sleep were reported.”
The study also found an increase in the estradiol-to-estrone ratio suggesting a possible link between NAD⁺ metabolism and menopause-related symptoms.
“NRPT provides a safe, non-hormonal way of increasing endogenous E2/E1 ratio for women undergoing the menopause transition (perimenopause), mitigating undesirable menopausal symptoms. ”
Larger trials can help confirm NR plus pterostilbene can reliably support menopause-related symptoms and estrogen metabolism.