stop. An additional 10 percent of menstruating women suffer from a mild iron deficiency. Heavier periods, common in perimenopause, can further deplete iron levels.
B Vitamins
Broadly speaking, B vitamins are involved in releasing energy from food. A severe deficiency in vitamin B12 can cause periods to become irregular, a symptom that may be confused with perimenopause among women in their early forties. A lack of vitamin B12, which is found in red meat and other foods, can occur in vegans and in older people who lose the ability to absorb this vitamin. Symptoms include weight loss, fatigue, tingling in the feet, and balance problems.
Vitamin B6 deficiency, which is often linked with premenstrual syndrome, is surprisingly common, and it is associated with anxiety and depression in both men and women. It is involved in the response of tissues to estrogen and seems to be needed by the part of a cell’s surface that interacts with estrogen receptors. So increased amounts of vitamin B6 may be necessary if you take relatively large amounts of estrogen — for example if you take oral contraceptives.
Vitamin B1 deficiency is also associated with anxiety and depression.
A lack of vitamin B3 (niacin, nicotinic acid, or niacinamide) usually develops only in heavy drinkers, those on very poor, low-protein diets, and those with serious digestive problems. Symptoms include depression, diarrhea, and a red, scaly rash on the face, the back of the hands, or other areas exposed to light. In women who are deficient in vitamin B3, menstrual irregularities are common, and this deficiency may aggravate symptoms in perimenopausal women who drink heavily.
Vitamin D
Vitamin D deficiency is now known to have many serious health implications. Dietary sources of vitamin D include egg yolks, fortified milk and cereals, cheese, and oily fish. The vitamin can also be synthesized in our skin from sunlight, but people who spend most of their time indoors, and those who always cover or protect their skin while outdoors, rarely receive enough sun exposure to maintain healthy levels of vitamin D — particularly in the winter, when days are shorter and sunlight is weaker. US health guidelines recommend taking a vitamin D3 supplement of 600 international units (IU) daily in the winter. Those who are housebound or always cover their skin should take vitamin D throughout the year.
Vitamin D plays a role in calcium metabolism, so it is crucial to bone growth and health, helping to prevent the bone-thinning disease osteoporosis. There is also mounting evidence that low levels of vitamin D are associated with an increased risk of type 1 diabetes, bone and muscle pain, hypertension, and cancers of the breast, ovaries, colon, esophagus, lymphatic system, and prostate.
Symptoms of deficiency include excessive sweating — which is obviously a key issue for women already suffering from hot flashes at midlife — along with low mood, aching joints, muscles and bones, and recurrent urinary tract infections, all common symptoms as we age.
During the summer at most latitudes, about twenty minutes’ exposure of the face and arms a day, early in the day or evening, without heavy sunscreen, should provide you with enough vitamin D for the health of your bones. If you have fair skin, it’s probably best to restrict exposure to sunlight to ten minutes without sunscreen. The ultraviolet radiation that damages our skin is strongest between 10 a.m. and 4 p.m. If you have to go outdoors during the middle of the day, be sure to protect your skin from damage and signs of aging with a good sunscreen.
Vitamin E
Scientists discovered long ago that a deficiency of vitamin E in rats caused pregnant females to lose their offspring. In fact, the chemical name for vitamin E is tocopherol, which is derived from the Greek words for “childbearing.” Vitamin E is an antioxidant, helping to repair the effects of free radicals (unstable chemical molecules that can damage cells). It is also thought to help reduce inflammation.
In women with premenstrual syndrome, supplements of vitamin E have been found to raise estrogen levels, but its effect on hormone chemistry in perimenopausal and post-menopausal women has not been studied to any great degree. Its effect on hot flashes, however, has been known since 1949. In one of the first studies, a positive response, with over 50 percent fewer hot flashes, was recorded when high doses were given (in the region of 1,000 IU per day), although this small, early trial was not sufficiently robust to convince today’s doctors.
Low vitamin E levels have been associated with an elevated risk of breast cancer, so supplementation might help some women, perhaps those in perimenopause rather than those who are postmenopausal.
Good sources of vitamin E include almonds, hazelnuts, Brazil and pine nuts, sweet potato, and sunflower and rapeseed oils.
Magnesium
Magnesium is necessary for normal bone, muscle, and nerve function and for the production of energy in cells. Like potassium, it controls energy functions within cells. Good sources include fresh fruit and vegetables, especially green ones. But magnesium deficiency is common: the National Health and Nutrition Examination Survey (NHANES) of 2013–16 found that 48 percent of Americans ingest less magnesium from food and beverages than the estimated average requirement for their age group.
Magnesium is also involved in reproductive hormone function. Experiments have shown that the ovaries need it to respond to the stimulatory effect of the pituitary hormones FSH and LH. A failure by the ovaries to respond is exactly what happens at menopause. Since magnesium supplementation can reduce PMS symptoms, it’s not surprising that it has also been shown to alleviate some menopausal problems, including mood swings, anxiety, insomnia, and bladder problems.
Women experiencing an early menopause, erratic menstrual cycles, fatigue, anxiety, depression, or aches and pains may benefit from magnesium supplementation. A diet naturally high in magnesium is also rich in other nutrients, and supplements are harmless enough. The only likely side effect is diarrhea, and the laxative effect could actually help if you are constipated.
At last studies are beginning to look at the relationship between magnesium and the timing of menopausal symptoms. This is great news, because magnesium levels are known to be low in at least 50 percent of women with PMS and in some women with menopausal problems.
Zinc
Only 0.003 percent of our body is made up of zinc, but without it we wouldn’t be able to live. The average intake of zinc has decreased over the last sixty years (to below World War II levels in the United Kingdom), mainly because we now eat less red meat. Zinc intake in many Western countries, including the US, the UK, and Australia, is fairly close to the minimum recommended amounts. In addition, absorption of zinc is reduced by consumption of alcohol, whole grains, and many other foods. Zinc is involved in a wide range of metabolic processes. More than 85 percent of our total body zinc is found in our muscles and bones. We require it to make insulin, for the catalytic activity of about one hundred enzymes, and for normal mental, immune system, and sex hormone function. It is also involved in the absorption of other key nutrients.
The best dietary source of zinc is oysters, followed by beef and most other meats. Vegetarian sources include Brazil nuts, almonds, muesli, lentils, and eggs.
Calcium
Calcium intake is important in the prevention of osteoporosis, but that is only part of the story. On average we carry approximately three pounds (1.4 kg) of calcium in our bodies, 99 percent of it in our bones and the rest circulating in our bloodstream. Blood calcium is necessary for blood clotting, optimum muscle and cardiac function, and neurotransmission.
Calcium is essential for growing strong bones
