Although the average age in the U.K. for the menopause – defined as the time when periods have stopped for 12 months – is 52, 1 percent of British women go through it before they reach 40.

Research carried out at Versailles University which looked at the health and lifestyle of more than 1,500 women in their 50s suggests that working long hours in a stressful job can hasten the onset of the menopause by at least a year. Experts believe that the strain of long hours or a demanding job can affect a woman’s reproductive health.

The Versailles study found that those who worked at least 48 hours a week were more likely than those doing shorter hours to go through the menopause before the average age of 52. For those with stressful jobs in which they felt constant pressure to rush, do several things at once and were frequently interrupted when carrying out tasks, menopause tended to hit at 51. In women who were suffering from depression, the effects of long working days were even greater. They were twice as likely to go through the menopause before they reached 52.

This warning comes just a few weeks after another study showed that pregnant women who work for long hours increase their risk of miscarriage. The study of more than 7,000 expectant nurses found that those who worked more than 40 hours a week were 50 percent more likely to miscarry. Additional research indicates that work related stress can also lead to irregular periods or periods stopping earlier than normal. On the other hand a good education and having a less stressful repetitive job delayed the onset of the menopause.

All these findings come as more and more women delay motherhood, with almost half of the 720,000 births each year in Britain being to women aged 30-plus. Smoking has also been found to have a big effect, with those who smoked more than 10 cigarettes a day going through the menopause at the age of 50, according to a recent report in the American Journal of Epidemiology. It is thought that long hours and stress affect levels of hormones key to a woman’s reproductive cycle, while smoking causes the eggs to deteriorate more quickly than normal. Genetics also play a large role in the timing of the menopause, with many women experiencing it at a similar age to their mother and sisters.

Black cohosh (Cimicifuga racemosa), a member of the buttercup family, is a perennial plant that is native to North America. Other common names include black snakeroot, bugbane, bugwort, rattle root, rattle top, rattle weed, and macrotys. Insects avoid it, which accounts for some of these common names.

Black cohosh was used in North American Indian medicine for malaise, gynaecological disorders, kidney disorders, malaria, rheumatism, and sore throat. It was also used for colds, cough, constipation, hives, and backache and to induce lactation for breast feeding. In 19th-century America, black cohosh was a home remedy used for rheumatism and fever, as a diuretic, and to bring on menstruation. It was extremely popular among a group of alternative practitioners who called black cohosh “macrotys” and prescribed it for rheumatism, lung conditions, neurological conditions, and conditions that affected women’s reproductive organs (including menstrual problems, inflammation of the womb or ovaries, infertility, threatened miscarriage, and relief of labour pains)

Today black cohosh is known primarily as an herbal treatment for hot flushes and other menopausal symptoms, but does it work and is it safe?

The possibility that black cohosh exhibits hormone balancing estrogenic activity has been studied but the evidence is contradictory. Let’s examine the research on how well it works for menopausal symptoms. In a study of 704 women, 49% of the women who took the preparation experienced complete relief of menopausal symptoms (hot flushes, sweating, headache, vertigo, heart palpitation, and ringing in the ears.) An additional 37.8% reported significant improvement. According to the physicians who participated in the study, 72% of the women who took the black cohosh treatment experienced advantages over those given hormonal treatment.

In another controlled study, of 629 women with menopausal complaints who took a black cohosh twice a day, 76 to 93% had an overall improvement in hot flushes, headache, irritability, heart palpitations, mild depression and sleep disturbances. The reduction in headache, sleep disturbances and heart palpitations is understandable because black cohosh also contains a small amount of salicylic acid (used to make aspirin) that has anti-inflammatory and pain-relieving qualities.

You may have read some recent negative information on black cohosh.  In 2006, The Medicines and Healthcare products Regulatory Agency’s (MHRA) cited 14 cases of women with liver problems that were “possibly” or “probably” linked to black cohosh.  When the European Medicines Agency (EMEA), reviewed all the evidence worldwide, it concluded that, in fact, there were only two “possible” and two “probable” cases and that it is not clear whether black cohosh caused the problem.  These four cases are such a small number when weighed up against an estimated 9 million treatment days of black cohosh used each year. 

The National Institutes of Health in the US believes there’s no case to answer and their website states that black cohosh has few side effects and that ‘liver damage has been reported in a few individuals using black cohosh, but millions of people have taken the herb without apparent adverse health effects.  There is no scientific evidence to show that the herb causes liver damage.’ 

Also worryingly, researchers have found that some black cohosh products on the market contain an Asian species of black cohosh which is cheaper than the North American black cohosh.  Compared with the species cultivated in North America, the Asian variety has different chemical properties and may have different effects on the body.  So I would still recommend that you use black cohosh as the herb of choice for the menopause symptoms but make sure that you buy from reputable companies so that you know you are getting the best quality herb and preferably buy organic. (for a good organic black cohosh formula – see Resources Page).

If you have hot flushes, night sweats, vaginal dryness or itching, depression, or bone loss due to natural or surgically-induced menopause, black cohosh is an herb that you may want to consider. We know that black cohosh is effective for the symptoms of the menopause and a recent study (April 2007) in the International Journal of Cancer has shown that black cohosh may halve the risk of breast cancer.  So this herb can be doubly beneficial for women around the menopause.

Sometime in your 40s or late 30s you may experience irregular menstrual irregularities that signal the perimenopause, or the beginning of the menopause. Your menstrual cycle may become irregular or erratic, large clots may be passed during menstruation and spotting or heavier than normal bleeding may occur.

All these ‘abnormalities’ are typical of the menopause but if you are concerned in any way or not sure if this is the perimenopause or really unnatural bleeding that needs attention and treatment talk to your doctor immediately. Heavy bleeding (flooding) is one irregularity that is typical among menopausal and perimenopausal women.

Flooding is a response to changing hormonal levels, most notably progesterone levels. Excessive bleeding may, however, be linked to other medical conditions such as fibroids or ovarian cysts so it is wise to consult your doctor if a period lasts more than twice as long as it ever did or if there is a persistent low back/pelvic pain.

Bear in mind to that irregular or absent periods are also a symptom of a very common hormonal imbalance in women (it affects as many as one in ten) called polycystic ovaries or PCOS. If you suspect PCOS, other symptoms include acne, excess body  hair and weight gain, see your doctor to confirm the diagnosis and put into place the nutritional recommendations in my ‘Nutritional Health Handbook for Women’ or you can download the ebook on PCOS from www.naturalhealthpractice.com. Over the last few years, research into the nutritional approach to PCOS has revolutionised the treatment of this problem so it is important to put these recommendations into place.

To ease the discomfort of menstrual irregularities first and foremost make sure you eat a diet that is rich in fruits and vegetables, whole foods, oily fish, legumes, nuts and seeds and as fresh and natural, preferably organic as possible, as this will give your body the antioxidants and nutrients it needs to boost your overall health and well being. The following tips should also help:

• Balance your blood sugar levels: Never leave more than two or three hours between  meals as skipping meals will trigger blood sugar and hormone imbalances which can impact your periods. Aim to start the day with breakfast, then have a mid morning snack, followed by lunch a tea time snack and a light supper. Other blood sugar balancing tips include: avoiding sugar, refined carbs, caffeine and alcohol and eating some quality protien, such as nuts, seeds or oily fish, with every meal or snack.
• Stock up on phytoestrogens: Phytoestrogens are substances found in certain foods that can have a hormone balancing effect and help ease menstrual irregularities. Foods rich in phytoestrogens can ease heavy bleeding because they can help to keep oestrogen under control and prevent excessive build up in the lining of the womb Phytoestrogens mainly fall into the class of isoflavones – found in legumes such as lentils, soya beans and chickpeas; lignans found in nearly all grains and vegetables, the best source being flaxseeds (linseeds) and coumestans found in alfalfa and mung bean sprouts.
• Take a multivitamin and mineral that includes B vitamins, zinc, vitamin C, beta carotene and vitamin E (MenoPlus is the one I use in the clinic see Resources Page). You might also want to take a vitamin B6 and zinc supplement as studies have linked vitamin B6 and zinc deficiency to irregular periods. (You can take extra B6 and zinc separately or have them in a combination supplement such as BioCare’s P-5-P Complex see Resources Page).  
• Essential fatty acids have been proven to help regulate the cycle: supplementing with Omega 3 a day is strongly advised (e.g. Mega EPA). Oily fish, nuts, seeds, eggs and avocado are a source of essential fats and beneficial prostaglandins which are anti-inflammatory and anti-cramping and will help to encourage light, pain free periods.
• Constipation is bad news for periods as excess hormones are excreted through the intestines. The longer the bowel transit time the more likely old hormones will get reabsorbed so to avoid this happening increase the amount of fibre in your diet in wholegrains, fruits and vegetables. If you also get bloating reduce salt – diruetics aren’t advised as they deplete magnesium levels and lead to increased cramping.
• If you suffer from heavy bleeding it is especially important to make sure you are getting enough iron. Ask your doctor to confirm whether or not you are anaemic. You might also consider including more iron rich foods in your diet such as green leafy vegetable, egg yolk and nuts and some iron rich herbs in your diet. Try dandelion leaves, milk thistle,  echinacea and peppermint. Eating them on the day you are bleeding heavily is best.  Having a cup of nettle tea with food can increase the absorption of minerals including iron.  
• Avoid coffee which increase menstrual flow and avoid drinking black tea with meals which reduces the amount of iron that is absorbed.
• Agnus castus is the single best herb for regulating the menstrual cycle. When taken regularly it regulates the timing of the menstrual cycle by acting on the pituitary gland which in turn releases the hormones that regular ovarian function. Lady’s mantle is another herb often recommended for heavy bleeding or flooding.
• Herbalists often recommend cinnamon for keeping menstrual cycles regular and stemming heavy bleeding. If you are bleeding heavily sip a cup of cinnamon infusion, chew a cinnamon stick or take five to ten drops of tincture once or twice a day.
• If your periods have stopped completely or your ovulation pattern is irregular agnus castus can be helpful but other useful herbs include false unicorn root, siberian ginseng and milk thistle.  Raspberry leaf tea can also help tone the pelvic area and improve circulation.
• Progesterone-producing and hormone-balancing herbs to choose when perimenopausal periods become too frequent include: agnus castus, sarsaparilla, wild yam and yarrow.  
• Oestrogen-producing and hormone-balancing herbs to choose when menstruation is scanty, early, or irregular include alfalfa, red clover, hops, sage and milk thistle.
• Exerting pressure on acupressure points for one minute of every fifteen is believed to be an effective sedative for flooding. One point is located above the centre of the upper lip (under the nose), and the other is at the top of the head.
• Probiotics such as Lactobacillus Aciophilus help to regulate hormones by helping to remove unwanted visitors such as yeast that can unsettle hormones further.  (The one I use in the clinic is called BioKult which does not need to be kept in the fridge – see Resources Page.)
• Maintain a healthy body weight as being too thin or carrying excess weight has been shown to trigger irregular periods
• For aromatherapy, massage your abdomen with lavender or melissa oil if periods are irregular, rose or cypress oil if periods are heavy, marjoram oil or a warm compress placed on your abdomen if your periods are painful. Use a total of 2 drops of essential oil in a teaspoon of carrier oil (like almond oil) or massage and up to 4 drops for a bath.
• If you suffer from period pains try a warm bath with a couple of drops of geranium (mood lifting), chamomile (painkilling) and clary sage (muscle relaxant) oils to ease cramping and soothe pain. You could also try the good old hot water bottle.
• Avoid stress as much as possible as this can unsettle your hormones and trigger menstural problems. Try pampering yourself with araomatherapy oils. Studies have shown that acupuncture can be very effective at relieving pain and regulating the hormonal system. Yoga can also restore hormonal balance and there are specific exercises to ease tension in the lower abdomen. Deep breathing and stretching can help relax your muscles and your mind and increase the blood low to the pelvic region.