Herbal Remedies for Perimenopause: A Complete Guide
Explore herbal remedies used during perimenopause, from black cohosh to ashwagandha. What the evidence says and how to use them safely.
Why Women Turn to Herbal Remedies
Perimenopause brings symptoms that can feel relentless: hot flashes, disrupted sleep, mood swings, brain fog, and joint aches. Many women look beyond conventional medicine, either because they want to avoid or delay hormone therapy, or because they want to support it with something more natural. Herbal remedies have been used across cultures for centuries to ease hormonal transitions, and today there is a growing body of research examining whether they work, how they work, and how safe they are. This guide walks through the most commonly used herbs, what the evidence currently shows, and what to keep in mind before trying any of them alongside your existing health care.
Black Cohosh
Black cohosh is the most studied herb for perimenopause symptoms, particularly hot flashes and night sweats. It does not appear to act as a phytoestrogen; instead, it seems to influence serotonin pathways, which may explain its effect on temperature regulation and mood. Clinical trials have shown mixed results, with some women experiencing significant reduction in hot flash frequency and intensity, while others report little change. It is generally considered safe for up to six months of use. Women with liver conditions are advised to avoid it, and anyone on blood-thinning medication should check with their doctor first.
Phytoestrogen-Rich Herbs and Foods
Phytoestrogens are plant compounds that bind weakly to oestrogen receptors. Red clover and soy isoflavones are among the most discussed. Red clover supplements have shown some benefit for hot flashes in trials, particularly for women who metabolise isoflavones effectively. Soy-based isoflavone supplements are similarly studied, with evidence pointing to modest reductions in vasomotor symptoms. These herbs are thought to be most helpful when oestrogen levels are low, which matches the perimenopause stage. Women with oestrogen-receptor-positive cancers should discuss phytoestrogen use carefully with their oncologist before starting.
Ashwagandha and Adaptogens
Adaptogens are herbs believed to help the body respond better to stress. Ashwagandha is the best-researched adaptogen for hormonal health, with studies suggesting it can reduce cortisol, improve thyroid function, and support sleep quality. During perimenopause, chronically elevated cortisol can worsen hot flashes, disrupt sleep, and contribute to weight gain around the abdomen. Rhodiola rosea is another adaptogen used for mental fatigue and low mood. While the evidence base is not as strong as for conventional treatments, many women report that adaptogens help them feel more resilient through the hormonal fluctuations of this life stage.
Valerian Root and Sleep Support
Valerian root has a long history of use as a sleep aid and mild anxiolytic. Some research suggests it can help reduce the time it takes to fall asleep and improve sleep quality, both of which are common concerns during perimenopause. It appears to work by increasing GABA activity in the brain, promoting a calmer state before sleep. It is often combined with hops or passionflower in commercial sleep supplements. Valerian can cause vivid dreams in some women and may interact with sedative medications, so it is worth checking with a pharmacist if you take anything regularly.
Sage, Maca, and Other Commonly Used Herbs
Sage has traditional use for reducing excessive sweating and hot flashes. Small studies suggest fresh sage or sage extract may reduce the frequency of hot flashes over several weeks. Maca root is used to support libido, energy, and mood during perimenopause. It does not appear to change oestrogen levels, but may act through the hypothalamic-pituitary axis. St John's Wort is sometimes used for low mood, though it has significant drug interactions and is not suitable alongside antidepressants, contraceptives, or thyroid medications. Dong quai is used in traditional Chinese medicine but lacks strong clinical evidence and should be avoided by women on blood thinners.
How to Use Herbal Remedies Safely
Herbal remedies are not automatically safe because they are natural. They can interact with prescription medications, have side effects, and vary widely in quality between brands. A few principles help: always tell your doctor what you are taking, choose products from reputable manufacturers with third-party testing, start with a low dose to see how your body responds, and give any herb at least six to eight weeks before deciding if it is helping. Tracking your symptoms over time is one of the most useful things you can do. Apps like PeriPlan let you log symptoms and monitor patterns, which makes it easier to see whether something is genuinely making a difference or just feeling that way.
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