The time surrounding a woman's last periods can be smooth sailing for some, or stressful and physically difficult for others - every woman's experience is different. Symptoms may include:

• At menopause, the ovaries stop releasing an egg each month, and their production of the female hormones oestrogen and progesterone declines, sometimes fluctuating widely in the process.
• The hormonal fluctuations cause the hot flushes and night sweats; night sweats may contribute to insomnia.
• The lowered levels of oestrogen cause changes to the sexual organs (e.g. vaginal dryness), ligament strength (which may result in aches and pains) and also cause the bones to lose calcium, increasing the risk of osteoporosis.
• Some of the symptoms (such as itchiness of the skin) may in fact be withdrawal symptoms as the body adjusts to having lower levels of female hormones in its system.
• Increased tendency to put on weight may be due to relatively higher levels of androgens (male hormones), which may also contribute to other symptoms, (e.g. increased facial hair).
• Smoking is associated with an earlier menopause and consequently increases risk of osteoporosis.

• Multivitamin - take a high potency multivitamin that provides a broad spectrum of nutrients to support energy production and help combat nervous tension and stress.
• Evening primrose & vitamin E - which help promote moist, healthy skin.
• Vitamin E - may also help to relieve symptoms of vaginal dryness.
• Calcium - to reduce your risk of developing osteoporosis. Choose a formula that provides around 900mg of calcium per day (preferably in three doses of 300mg), along with co-factors such as vitamin D3, magnesium, manganese and boron to support the absorption of calcium and its uptake into the skeleton.
• Vitamin D3 - improves muscle strength in older people and may therefore reduce the incidence of falls and the risk of hip and other fractures. Vitamin D3 plays an important role in stimulating calcium absorption by the body and may help to improve bone health and bone density.

• Vitex agnus-castus - helps to normalise female hormonal balance and assist in the management of irregular periods. It has traditionally been used to relieve period pain, breast tenderness, nervous tension, moodiness, irritability, fluid retention, headaches, acne and any other symptoms that occur during the premenstrual phase of the reproductive cycle. Vitex is sometimes combined with other herbs and nutrients that provide PMT support. Important ingredients to look for include Evening primrose oil, vitamins B6, C and E and the minerals magnesium and chromium.
• Siberian ginseng - may be particularly beneficial because this herb has traditionally been used to raise energy levels and improve the ability to withstand stress.
• Black cohosh & Dong quai - relieve menopausal symptoms such as hot flushes, night sweats, insomnia, anxiety and fatigue.
• Kava - has traditionally been used to relieve anxiety. Clinical studies have shown it to be just as effective for the condition as some prescribed medicines. Kava is specifically indicated when anxiety symptoms are associated with menopause or insomnia. Look for kava tablets providing 2400mg kava standardised to contain 60mg active kavalactones.
• St. John's wort - another herb clinically proven to relieve mood disorders such as anxiety and depression and, again, may be particularly beneficial when these conditions are associated with menopause.
• Valerian - an effective but gentle sedative with additional anti-anxiety properties and may help to relieve insomnia and improve sleep quality. Valerian is sometimes combined with other herbal sedatives such as Skullcap and Hops and the minerals potassium phosphate, calcium phosphate and magnesium phosphate to relieve anxiety, nervous tension and stress.

• Stick to a low glycaemic index (GI) diet that includes slow-burning carbohydrates (such as oats and legumes) to help you maintain better blood glucose control. Avoid high GI carbohydrates such as sugars, wheat products (e.g. bread) and potatoes, which are metabolised quickly, leading to blood sugar fluctuations.
• Reduce your consumption of animal foods, and instead choose vegetable sources of protein, such as soy products (e.g. tofu and tempeh), legumes (e.g. soy beans, chickpeas, lentils) and nuts and seeds (especially flaxseeds). This increases your intake of phytoestrogens, plant compounds that have oestrogen-like effects in the body and which may help to reduce menopause symptoms and protect skeletal and heart health after menopause.
• At the same time, eat plenty of whole grains, fresh fruit and vegetables, and high quality proteins. Oily fish such as salmon, tuna and sardines are an excellent choice because they are rich in omega-3 fatty acids, which support the health of the cardiovascular, musculoskeletal and nervous systems.
• Unless you are intolerant or allergic to dairy products, they are likely to be the richest source of calcium in your diet. Aim to include two to three serves of low-fat dairy products in your diet every day. If you're not able to consistently consume this much dairy, a calcium supplement is highly recommended.

• Menopausal symptoms such as hot flushes are more common in women who are physically inactive. Exercising more often may help to reduce frequency and severity of your symptoms. After seeking your health professional's approval, aim for at least 30 minutes of moderate exercise on most or all days of the week. A brisk walk is a great start and in addition to helping menopausal symptoms will also promote heart health, a healthy body weight and a balanced mood.
• Exercise is also important for the prevention of osteoporosis. Regular exercise throughout life helps to maintain skeletal health in old age. Exercise helps to improve bone and muscle strength, delays age-related bone loss and improves co-ordination and balance, reducing the risk of falls. The most important forms of exercise for the prevention of osteoporosis are weight-bearing exercise (e.g. jogging, walking, dancing and aerobics) and resistance training (e.g. weight lifting). However, if you already have osteoporosis these activities may not be suitable for you, so talk to your doctor or physiotherapist about an exercise program that's specially tailored to your individual needs.
• Avoid smoking, caffeine, alcohol, sugar, soft drinks and salt, all of which have negative effects on the body's calcium stores.
• Enjoy 10 minutes of sunshine on your hands, face and arms on most days of the week to promote the formation of vitamin D in your skin and reduce your risk of osteoporosis.
• Avoid wearing synthetic fibres, and instead choose cotton and natural fabrics that are naturally cooling and allow the skin to breathe.
• Learn and practise meditation or relaxation techniques in order to improve your ability to cope with stress, depression or anxiety and to help you wind down in the evening. Playing a hypnotherapy or relaxation CD at bedtime may help you sleep.

If symptoms persist consult your healthcare professional. Information provided is of a general nature and should not replace that of your healthcare professional.