As women start to produce less estrogen and enter perimenopause, they are likely to experience a mix of challenging symptoms. These include hot flashes, insomnia, night sweats, vaginal dryness, and mood swings.

Menstrual periods may get lighter or heavier and less regular, but once a woman has not had a period for 12 months, they are in menopause. Then, the symptoms experienced over the previous years begin to subside.

There is a range of vitamins and supplements available to help women manage the symptoms of perimenopause and menopause. We look at them here.

Vitamin E

Many different foods, such as nuts, sunflower seeds, spinach, broccoli, kiwi, mango, and tomato contain vitamin E.

Vitamin E is particularly beneficial for menopause. The reason is it may ease stress, which many women experience during menopause because of imbalanced hormone levels, such as that of cortisol.

Cortisol is produced by the adrenal glands and is the hormone most closely linked with stress.

The physical, emotional, and psychological symptoms of menopausal stress can feed the hormone imbalances. As a result, day-to-day worries can feel much more stressful for women in menopause than they usually feel.

The body can suffer oxidative stress, as well. This happens when antioxidants are in short supply, and cells become damaged by what are called free radicals. High-energy free radicals enter the body from the environment, when people smoke, in alcohol, and in some foods.

Vitamin E has antioxidant properties, and some scientists believe that it can help to relieve stress symptoms by reducing oxidative stress.

Also, some studies have found that people with low levels of vitamin E are more likely to experience depression than those with higher levels. Depression is a common side effect of stress.

If a woman is unable to get enough vItamin E in her diet, then supplements are available. Women should only take the recommended dose unless told otherwise by their doctor.

Vitamin D

Vitamin D is not present in many foods. It is a vitamin that is produced in the body when the skin is exposed to sunlight.

Vitamin D is essential for good bone health, and people who do not have a lot of it may develop brittle bones, often called osteoporosis.

To stay healthy, bone goes through a constant process of remodeling, where new bone tissue replaces old tissue. During menopause, these processes can become skewed, resulting in more bone being reabsorbed by the body than is rebuilt.

As a result of this, bones can become weaker and break more easily, when a woman is in menopause. To help keep the bones strong, women must ensure they have enough calcium and vitamin D.

The United States' Office on Women's Health recommend that women up to the age of 70 should get 600 international units (IU) of vitamin D each day.

Eating salmon, tuna, liver, and egg yolks will add vitamin D to someone's diet. Also, milk, some cereals, and some orange juices are fortified with vitamin D.

Most people already get enough vitamin D and calcium to keep their bones healthy. But, despite this, almost half of all postmenopausal women take vitamin D or calcium supplements to help bone strength.

Supplements are easy to buy, but people should always check with a doctor before taking them, as too much vitamin D or calcium can cause other health problems.

Also, evidence of their effectiveness is mixed. Some studies have found that an excess of vitamin D or calcium can contribute to kidney stones, vitamin D toxicity, constipation, and a raised risk for cardiovascular disease.

In one study, women who took too many high-dose vitamin D supplements were found to be more likely to have bone problems than those who did not.

Doctors may recommend having vitamin D and calcium levels checked before supplements are taken. Also, they can advise on how much to take, as well.

Vitamin A

Vitamin A is also essential for good bone health, and for maintaining healthy teeth, soft tissue, and skin.

The best sources of vitamin A are:

• cod liver oil
• eggs
• fortified breakfast cereals
• fortified skim milk
• orange and yellow vegetables and fruits
• broccoli
• spinach
• dark green leafy vegetables

However, a 2002 study found that use of vitamin A supplements was linked with a 40 percent increase in the risk of hip fractures among postmenopausal women.

Medical opinion on the benefits of vitamin A during menopause is mixed, so women who are experiencing menopause should consult with their doctor before taking supplements.

Vitamin B12

During menopause, women may become deficient in vitamin B12, which is linked to insomnia.

Women experiencing menopause could consider stocking up on foods that contain B12, such as liver, mackerel, sardines, salmon, red meat, and milk.

The Office on Women's Health recommends that women over 50 need 2.4 micrograms (mcg) of vitamin B12 each day.

Vitamin B6

This vitamin helps the body to make antibodies, keep the nerves working properly, break down proteins, and keep blood sugar within normal ranges.

Vitamin B6 is found in the following foods:

• avocados
• bananas
• legumes
• beef
• pork
• nuts
• poultry
• whole grains
• fortified cereals
• corn

Vitamin B6 deficiencies have been linked with symptoms of confusion, depression, irritability, sores in the mouth, and damage to the nerves in hands, feet, and arms.

Because women are at increased risk for depression during menopause, it is important to maintain healthy levels of vitamin B6.

The Office on Women's Health recommend that women over 50 need 1.5 milligrams (mg) of vitamin B6 each day.

Supplements

Supplements should be taken as a last resort when the essential vitamins outlined above are not available in someone's diet.

People should be aware that these are not monitored by the U.S. Food and Drug Administration (FDA).

It is important to choose carefully from a reliable source. Start and stop any supplements gradually and do not take over the recommended guidelines.