I have had Nina as a patient for ten years; I first saw her when she was in her mid-thirties, when she came to me for help with premenstrual syndrome. At that time we devised a program for her then that included, along with balancing her diet and increasing her exercise, the occasional use of natural progesterone. I hadn’t seen her in more than a year when she came in again recently. She looked very troubled as she said, “I don’t know what’s going on. My PMS has gotten really bad, even worse than it was ten years ago. I’m so anxious, I literally feel like I’m jumping out of my skin. Nothing is working anymore.”

Nina is 44 now, and the grade-school children she had when she first came to my office are in college. She and I talked about how fluctuating hormone levels in the forties can manifest themselves as worsening PMS, particularly if a woman still has a regular cycle.

When Nina said “nothing is working,” she meant that she was avoiding sweets, alcohol, salt, and caffeine as much as possible and still maintaining a regular exercise routine. (She and her husband spend many weekends mountain biking, and she rides during the week.) Yet in spite of her efforts, she said, “I get this terrible feeling in the pit of my stomach. Sometimes I almost feel like I’m going to get sick. I’ve tried deep breathing, but I can’t seem to calm down.”

Nina shook her head when I asked if there were any unusual stresses or pressures in her life. “Not really. Nothing that hasn’t been there before. Money is really tight with two kids in college, but we’re managing.”

Since Nina’s primary goal was to get a handle on her anxiety, I suggested that she might want to try black cohosh to bring her moods more into balance. Black cohosh is used for a variety of symptoms during perimenopause, including hot flashes and insomnia, but it has also been shown to be useful in relieving anxiety. Nina had the option of taking black cohosh in several forms, either as a tea, as a fluid or powdered extract, or as a standardized product, Remifemin, which my patient Janice is also taking. Black cohosh is believed to suppress luteinizing hormone levels in the body, which may spike irregularly as estrogen levels fall.

I am comfortable recommending Remifemin to my patients who are interested in using black cohosh for several reasons. First, it is a standardized formula that has been studied for four decades in Germany.

Second, it has been shown to help alleviate a variety of menopausal symptoms, and some women prefer to take one preparation for broad symptom relief rather than individual herbs or vitamins targeted at specific symptoms. Also, with Remifemin it is easier for patients to monitor exactly how much black cohosh they are taking. I suggested that Nina begin with a dose of 40 mg per day and keep a chart of her symptoms to evaluate its effect on her symptoms for one month.

It usually takes about two weeks to begin to experience relief from perimenopausal symptoms with Remifemin. Dosage amounts range from 40 to 80 mg per day. I generally suggest that women begin at the low end of the dosage range and increase the amount if their symptoms are not relieved within two weeks. I do not recommend taking above 80 mg per day. When I saw Nina one month later she said 40 mg daily seemed to be adequate for her. She was experiencing less anxiety.

Use also found that black cohosh was very helpful in controlling palpitations that made her feel as if she were having a panic attack or, worse, a heart attack. A successful real estate saleswoman, Use almost left her job because she was having increasing episodes where her heart would race without warning. “I had appointment after appointment with this specialist and that specialist,” she told me. “I didn’t have heart disease, they told me. Someone finally called it anxiety disorder or something like that. I still have a prescription for an anti-anxiety medication, but I put it in my drawer and never filled it. It’s not that I didn’t want to take it, but I had this gut feeling that something else was going on besides anxiety.”

She found out about black cohosh from a friend of hers and tried it on her own. After using 160 mg daily (two 40 mg tablets morning and evening) for six months, she said that “black cohosh took care of the palpitations almost a hundred percent. I felt much better after using it for only two weeks.”

Related posts:

1. The Basics of Mood Swings During Perimenopause – Depression

2. The Basics of HRT alternative perimenopause treatment – black cohosh

3. The Basics of Dueling Mood Swings During Perimenopause

4. The Basics of Perimenopause – Progesterone and Mood

5. The Basics of More PMS During Perimenopause

6. The Basics of Treating Sleep Disturbances During Perimenopause

7. The Basics of Perimenopause – The Health Changes When The Mood Is Right

8. The Basics of Herbs for Hot Flashes During Perimenopause

9. The Basics of Perimenopause – Working with Your Health Care Provider

10. The Basics of Perimenopause – HRT and Your Heart