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Menopause and Perimenopause

This article was written by Dr Arien van der Merwe as an article written for Natural Medicine magazine and an excerpt from Dr Arien’s book: Health and Happiness (also available as an eBook)


Menopause, like puberty, causes dramatic changes in a woman’s body. This life transition process takes place over a period of one to five years, with menstrual periods becoming less frequent (peri-menopause) until they stop altogether, into the postmenopausal years that can last for many years. It is not a disease. Many women do not even realise that they’re going through menopause. Do not expect to get any symptoms. You may be one of the lucky ones!

Click Here for our Female Hormone Health Box.


Perimenopause (the period around menopause), also called the menopausal transition, is the period during which a woman’s body makes a natural shift from mostly regular cycles of ovulation and menstruation, toward permanent cessation of ovulation, or menopause, as the gradually slow down and stop producing oestradiol (the strong oestrogen) and progesterone. The perimenopausal period can start at various ages. Signs can be noticed in your 40’s, or even as early as your 30’s. Signs include irregular periods, which may become shorter, heavier or lighter, with sometimes more and sometimes less than 28 day cycles. Once you’ve had 12 consecutive months without a menstrual period, you’ve officially reached menopause and the perimenopause is over.
Menopausal symptoms such as hot flushes, sleep disturbances, moodiness and vaginal dryness are caused by decreased production of oestrogen and progesterone by the ovaries, but other factors can also affect their severity and duration. Heredity, general health, nutritional status, medication, lack of exercise, stressful events in your life (children leaving home, difficult teenagers, financial problems, marriage problems, looking after elderly parents) and your mental-emotional attitude to life, all play their part. Increased emotional and nutritional demands that put too great a burden on the body and mind can aggravate menopausal symptoms.

As one reader said in a letter to me: ‘We went on holiday, camping by the sea. It was extremely relaxing and although I was not on any hormones at that time and I hardly took any of all the supplements, I had almost no hot flushes. I think a lot has to do with stress.’

Post menopause – 5-20 year period after menopause, when menstrual cycles have ended, but natural management carries on

• Irregular periods
• Hot flushes with night sweats, heart palpitations, nausea and anxiety
• Headaches
• Fluid retention with swelling and oedema
• Tender, painful breasts
• Lowered libido and vaginal dryness
• Insomnia (aggravated by hot flushes)
• Fatigue
• Muscle and joint aches and pains
• Irritability and impatience
• Emotional instability
• Depression
• Loss of short-term memory
• Lack of concentration

While the marked decrease in the amount of oestrogen and progesterone from the main source (the ovaries) will clearly cause dramatic physical changes, the production of oestrogen in the body never stops completely. A woman’s body can compensate for the decline in ovarian oestrogen production, by making more of the weaker oestrogens, namely oestriol and oestrone, in other organs (the adrenal glands, liver, fatty tissue and brain).


• Genital organs (vagina, vulva, uterus) – vaginal dryness, thin atrophied
mucosa and skin, lowered libido, vaginal infections caused by changes in pH change (acid content) in the mucosa.
• Urinary tract (kidneys, ureter, bladder, urethra) – incontinence, infections.
• Breasts – tenderness, nodules.
• Skin – dryness, sensitivity.
• Hair – dryness, hair loss.
• Mucosa – dryness, airway infections, airway allergies, digestive problems.
• Skeleton – osteoporosis.
• Cardiovascular system – hypertension, high low-density lipoprotein (LDL) cholesterol, angina, heart attacks, stroke.
• Pelvic muscles – poor muscle tone in bladder floor with stress incontinence (leakage of urine while laughing, coughing or exercising).
• Brain – depression, emotional instability.

The natural approach to coping with symptoms of perimenopause is geared towards making the process easier for women rather than stopping the natural process. Research has shown that two-thirds of women on prescription hormone replacement therapy (HRT) stop taking it within a year because of the side-effects.

Positive attitude, self-acceptance and self-care
The single most important factor in managing this important life transition is a positive attitude and taking responsibility for your own health and wellbeing. Stress management and daily use of relaxation techniques are essential, as is coming to terms with the fact that you are becoming more mature, and entering a new phase in your life where you will have more time for yourself, your needs and your personal growth and soul development,. It is a time of maturation and wisdom. Your reproductive role is over and you can contribute to the community and your family on a deeper level of wisdom and support.

Energy levels
Energy levels may become lower during this time. Try to get enough sleep – 7 – 8 hours a night, in quiet and darkness. Take a morning or afternoon power nap if you have trouble sleeping at night. Foods that supply plenty of vitamins, minerals and energy include berries, raw honey, red grapes with the pips, spirulina, chlorella, brewer’s yeast, molasses or treacle, lecithin and kelp (or marine algae).

Drink plenty of water (at least 8 glasses a day, or 1 glass for every 10 kg in body weight). Water keeps the body young and energetic, with all the biochemical reactions functioning at peak performance. Water also diminishes cravings for sweet or salt, which often indicate a deficiency of fluids or water in the body.

Eat fresh, wholesome food, including plenty of fruit and vegetables, wholegrain products, seeds and pulses (legumes), especially the various coloured lentils, chick peas and soya beans. Oatmeal porridge with added oat bran is a good tonic – it provides fibre (roughage), lowers LDL cholesterol and contains many vitamins and minerals. Your food can be divided into six or eight small portions to be eaten throughout the day, preventing low blood sugar (hypoglycaemia), which aggravates menopausal symptoms.

Eat foods that are rich in protein, such as fish, poultry, eggs, dairy products (low fat yogurt and cottage cheese) and nuts. Healthy oils include extra-virgin cold-pressed olive oil, canola oil and linseed (flax) oil. Avoid refined sugar, white flour, processed foods, processed meats, fried food, saturated (mainly animal) fat, preservatives and too much alcohol. Good-quality protein and plenty of B-complex vitamins support the pituitary gland and hypothalamus, which in turn control the ovaries and the female hormone cycle, and slow down the onset of menopause. Note that women who are strict vegetarians, with a very low cholesterol level, tend to go through an earlier menopause. Cholesterol is very important for the production of the female hormones.

Foods that contain the B-complex vitamins include green vegetables, wholegrain products, wheatgerm and yeast. Adequate levels of pantothenic acid (vitamin B5), choline and inositol support the adrenal glands as well as the pituitary gland and hypothalamus.

Soya is a rich source of proteins, minerals, vitamins and natural phyto-oestrogens (i.e. oestrogens from plants) that can compensate for the body’s lowered production of oestrogen. These include fermented soya beans, tofu and soy flour. Vegetarian cookery books contain many delicious recipes for tasty soya dishes. Soy flour can also be combined with almond, coconut and complex wholegrain flour. Two of the active ingredients in soya beans, daidzain and genistein, are effective against menopausal symptoms and as antioxidants they protect the body against premature ageing and diseases such as cardiovascular disease, osteoporosis and cancer. Linseed oil (flax oil) contains plenty of these plant oestrogens. Add the seeds to salads, sauces and sandwich spreads, and a tablespoon of ground linseed in a glass of water a good remedy for constipation.

Calcium supplements
Calcium supplements are essential. It is better to prevent osteoporosis than wait until there are signs of it. The body’s minimum daily calcium requirement is 1 200 mg, which is almost impossible to obtain through diet alone. Your supplement should also contain magnesium, vitamin D, which has many important functions in the body (500 – 1 000 IU a day), vitamin C (600 – 1 000 mg a day), boron (2 – 3 mg a day) and potassium (150 mg a day) to ensure optimal calcium absorption and bio-availability. Boron also elevates oestrogen levels naturally.

Women should start to use calcium supplements as early as possible, but it is never too late to start. Calcium and magnesium are involved in many functions in the body. Ensuring an additional daily supply prevents the body from taking it from the bones, thereby accelerating osteoporosis. An adequate supplementation dose during menopause would be 600 – 900 mg of calcium a day and 450 – 500 mg of magnesium a day. The best way to absorb calcium and magnesium is to take them in an amino acid chelated form (amino acids are the building blocks of proteins and therefore familiar to the body). This ensures optimal absorption in the intestinal tract and bio-availability of these nutrients into the cells. Foods rich in calcium and many other nutrients that help to ensure strong bones and a healthy body, include fish, leafy greens, wholegrain products and dairy products such as yoghurt, cottage cheese and milk (choose low-fat or fat-free).

Calcium and magnesium help relieve many of the symptoms associated with menopause, especially headaches, anxiety attacks, hot flushes, insomnia and irritability. They also relieve leg cramps, backache and muscular pain.

Other supplements
Other supplements that delay the onset of menopause and alleviate the symptoms include the following:

Vitamin E and selenium protect against cardiovascular disease by reducing platelet aggregation, which can contribute to heart attacks and stroke. They also alleviate hot flushes and delay the ageing process because of their strong antioxidant action. Use up to 800 IU (660 mg) of vitamin E a day at first, and as the hot flushes improve, reduce the dose to 300 – 400 IU (250 – 330 mg).

Vitamin C (1 000 – 2 000 mg in divided doses) also helps relieve hot flushes.

Essential fatty acids such as evening primrose oil (1 000 mg a day), cod liver oil and salmon oil (500 mg a day) alleviate almost all the symptoms of menopause and prevent the bad LDL cholesterol levels from increasing. They ensure that the good high-density lipoprotein (HDL) cholesterol levels remain high, thereby preventing atherosclerosis (thickening of the arteries).

Chromium (200 μg a day) ensures that blood sugar levels remain constant, lowers LDL cholesterol and increases HDL cholesterol. It also reduces sweet cravings.

Vitamin A supports the mucosa and skin. It is a potent antioxidant. Also take mixed carotene.

B-complex vitamins (40 mg each of B1-6; 50 μg of B12 and 400 μg of folic acid) support the pituitary gland, the nervous system (depression, irritability and tension) and the female urogenital system.

Iron (take 15 mg a day in amino acid chelated form) remains important until menstruation stops completely, and even for a while afterwards.

Iodine and kelp (marine algae) are important for supporting the thyroid gland that, in turn, improves female hormone function.

Zinc (15 mg a day) helps with depression and supports the female urogenital system.

Herbal Remedies

Herbal remedies
• Dong quai (Angelica sinensis), or simply angelica, is regarded as the most important herbal remedy for keeping the female urogenital system in balance.
• Wild yam (Dioscorea villosa) and fenugreek have a progesterone effect (also preventing osteoporosis. Progesterone is the most important hormone to supplement during and after menopause, as oestrogen is still made in other organs.
• Fennel contains natural plant oestrogen and progesterone. Use it in salads, meat marinades and sauces.
• Sage helps for hot flushes. Refer to ‘Menopause managing tea’
• Black cohosh (Cimicifuga racemosa), unicorn root (contains natural oestrogens) and liquorice root are excellent tonics for the female urogenital system. Black cohosh lowers the levels of the luteinising hormone which is secreted by the pituitary gland, the chief cause of hot flushes. Unlike conventional oestrogen replacement therapy, black cohosh does not interfere with the secretion of the other hormones from the pituitary gland.
Always get your herbs from a reputable source, or herbal practitioner.
It takes a while before herbs and supplements start to work (usually two to three months). Give them a fair chance – be patient!

Aromatherapy oils are very helpful to alleviate the symptoms of menopause. Essential oils of sage, cypress and geranium improve the physical symptoms. Keep a mixture at hand to inhale when necessary. You could also add six to eight drops to your bathwater. For massaging add 15 drops of each of the essential oils to 100 ml of a carrier oil (almond, coconut, olive or grape seed). Geranium, lavender, grapefruit, camomile, bergamot, neroli, clary sage, vertivert and benzoin are effective for depression and stress. Add them to your bath water and massage them into the temples, neck or abdomen. Dilute them as described above.


Exercise is one of the most important and best ways of alleviating symptoms of menopause and stress. Any form of exercise is good for you, but the best exercises are those that improve bone density as well. Walking is the best example. Every woman can find the time in her busy daily schedule to walk for 20 minutes! Other good exercises include swimming, aerobic exercise, cycling and dancing. Pelvic floor exercises prevent or retard pelvic muscular degeneration. It is important to do these activities regularly – for half an hour five times a week. Exercise also improves symptoms of depression, stress, anxiety and the development of atherosclerosis. It ensures a general improvement in health and wellbeing.

Stop smoking

Besides all the other consequences of smoking, it leads to early symptoms of menopause and accelerates ageing. Please give up smoking! It also increases the risk of developing osteoporosis and cardiovascular disease.

Hormone replacement therapy
HRT is a very controversial subject. Some women are in favour of it, but the number who are reluctant to commit themselves is even greater, especially in light of the research showing an increased risk of breast cancer, embolism and even endometrial cancer.


There are many steps you can take to manage the onset of peri- and menopausal symptoms and ease the transition period. At the same time they will improve your general health and wellbeing, ensuring that your life after menopause will be a vital and joyful one! Click Here for our Female Hormone Health Box.

This article is based on an excerpt from Health and Happiness by Dr Arien van der Merwe, the newly revised edition of which was published by HSM Publishers in 2013. Visit for more information.