The Herbal Guide to Menopause

Perimenopause and menopause mark a profound shift in a woman’s life. Hormone levels fluctuate, cycles become irregular, and the body begins its natural transition into a new phase. While this stage is normal and healthy, it often brings challenges: hot flashes, mood swings, sleep problems, brain fog, changes in skin and hair, and shifts in metabolism.

Pharmaceutical options like hormone replacement therapy (HRT) are available, but many women prefer to first explore natural ways to support their bodies. Herbs have been used across cultures for centuries to ease this transition, nourish the body, and restore balance. Below, we’ll explore some of the most respected herbs for perimenopause and menopause, how they work, and which symptoms they best address.

1. Black Cohosh (Actaea racemosa)

Best for: Hot flashes, night sweats, mood swings

Black cohosh is one of the most well-researched herbs for menopause. Native to North America, it has long been used by Indigenous peoples and later adopted in Western herbal medicine.

Studies suggest that black cohosh works by influencing serotonin receptors and possibly mimicking some estrogen-like activity, though it’s not a phytoestrogen. This makes it especially useful for vasomotor symptoms—the hot flashes and night sweats that can disturb sleep and daily life. Many women also find it helps smooth out irritability and mild anxiety that come with hormonal shifts.

2. Red Clover (Trifolium pratense)

Best for: Gentle hormone support, bone health, cardiovascular support

Red clover blossoms are rich in isoflavones, a type of phytoestrogen. These plant compounds can bind to estrogen receptors in the body and provide mild estrogenic activity, which may ease symptoms like hot flashes, vaginal dryness, and bone density loss.

While results vary between individuals, red clover is considered safe and gentle, making it a good option for women who want ongoing nourishment rather than fast relief. It’s also traditionally used as a blood purifier and to support circulation, which can be helpful during this phase of life when cardiovascular health becomes increasingly important.

3. Sage (Salvia officinalis)

Best for: Hot flashes, excessive sweating, cognitive clarity

Sage is a culinary herb with powerful medicinal effects. Herbalists often recommend sage tea or tincture for women struggling with excessive sweating—especially night sweats. Clinical trials confirm its effectiveness in reducing both the frequency and intensity of hot flashes.

Beyond its cooling effect, sage also has a reputation for supporting memory and mental clarity. During perimenopause, when “brain fog” and forgetfulness are common, sage can help sharpen focus.

4. Maca Root (Lepidium meyenii)

Best for: Energy, libido, mood, stamina

Maca is a root vegetable native to the Andes, often referred to as “Peruvian ginseng.” While it doesn’t contain phytoestrogens, maca nourishes the endocrine system, helping the body adapt to stress and restore balance.

Many women find maca improves energy levels, stabilizes mood, and supports sexual vitality—a concern that often arises as hormones shift. It is also rich in minerals like calcium and magnesium, adding nutritional value for bone support.

5. Dong Quai (Angelica sinensis)

Best for: Circulation, hormonal balance, menstrual irregularities in perimenopause

Dong quai, often called “female ginseng,” is a staple of Traditional Chinese Medicine. It is used to move and nourish the blood, ease cramps, and regulate cycles. For women in perimenopause, when cycles may become irregular and heavy, dong quai can bring balance.

It is less often recommended once menstruation has completely ceased, but it can still support circulation and vitality in menopause. Women who are prone to heavy bleeding, however, should consult a practitioner before use.

6. Ashwagandha (Withania somnifera)

Best for: Stress resilience, sleep, anxiety, fatigue

Ashwagandha is a revered adaptogen from Ayurvedic medicine. Adaptogens help the body manage stress and restore equilibrium. Perimenopause and menopause often bring sleep disturbances, irritability, and a sense of being “wired but tired.”

Ashwagandha has calming, restorative qualities. It reduces cortisol (the stress hormone), supports restful sleep, and helps rebuild energy reserves. It’s especially useful for women who feel burned out or struggle with anxiety during this life stage.

7. St. John’s Wort (Hypericum perforatum)

Best for: Mood swings, mild to moderate depression

Hormonal changes often impact neurotransmitters, leading to mood dips, anxiety, or irritability. St. John’s wort is one of the most studied herbs for mild to moderate depression. It supports serotonin and dopamine activity in the brain, lifting mood and reducing emotional turbulence.

Because it interacts with many medications, it should be used cautiously under professional guidance, but for those who can take it safely, it can be a powerful ally for emotional well-being.

8. Licorice Root (Glycyrrhiza glabra)

Best for: Mild estrogenic support, adrenal nourishment

Licorice root contains phytoestrogenic compounds that may gently ease hot flashes and mood swings. Beyond its hormonal effects, it supports the adrenal glands, which take on a larger role in hormone production after menopause.

Licorice is naturally sweet and often included in herbal blends. However, it should be avoided in women with high blood pressure unless using deglycyrrhizinated licorice (DGL).

9. Vitex / Chaste Tree Berry (Vitex agnus-castus)

Best for: Hormonal rhythm, perimenopausal cycle irregularity

Vitex is best known for supporting the pituitary gland, which regulates reproductive hormones. In perimenopause, when cycles may be irregular, vitex can help normalize progesterone production, easing PMS-like symptoms, breast tenderness, and mood swings.

Its benefits are strongest during the transition years rather than post-menopause, when menstruation has fully ceased.

How to Use These Herbs

• Teas and infusions: Sage, red clover, and licorice make pleasant teas.

• Tinctures: Black cohosh, dong quai, and vitex are often taken in liquid extract form for more concentrated effects.

• Capsules and powders: Maca and ashwagandha are commonly available in capsule or powder form to blend into smoothies.

• Combinations: Many women benefit from blends that combine several herbs targeting multiple symptoms.

  Safety Considerations

  While herbs are natural, they are still potent. Always consider:

  • Interactions: Some herbs (like St. John’s wort or dong quai) may interact with medications.

  • Individual constitution: What works for one woman may not work for another.

  • Professional guidance: Consulting a qualified herbalist or healthcare provider ensures safety, especially if you have underlying conditions.