Five Herbs for Perimenopause

Perimenopause—the transition phase leading up to menopause—can last several years and is often marked by a wide range of symptoms. Fluctuating and declining hormone levels may bring irregular periods, hot flashes, night sweats, sleep disturbances, anxiety, low mood, and even brain fog that affects concentration and memory. While hormone replacement therapy (HRT) can be an option for some, many women seek more complementary approaches to support this stage of life. Certain herbs, backed by both traditional use and growing scientific research, have shown potential in supporting the body through perimenopause—helping to balance hormones, calm the nervous system, support symptoms and improve overall quality of life.

*Herbs are powerful plants with medicinal properties – please always consult a professional before using herbs to understand the right dose for you. Do not use if you are pregnant or breastfeeding.

**If you are on any medication or have any health issues, always consult a professional to check for contra-indications before using herbs.

**1. Sage (Salvia officinalis)**

What is sage used for:
Sage has a long history of use for hot flashes, excessive sweating, cognitive support and mood.

How sage may help perimenopause symptoms:

Hot flashes, night sweats: Multiple clinical studies show that sage extract reduces the frequency, severity, and duration of hot flashes and night sweats.
Cognitive issues, brain fog, fatigue: Studies also report that sage improves mental exhaustion, concentration and alertness. In randomised trials, sage improved cognitive scores, reduced fatigue and mental-psychological menopausal symptoms.
Sleep & mood: Because hot flashes/night sweats often disrupt sleep, reducing them via sage helps with sleep. Also, sage has effects on neurotransmitter systems which likely contribute to mood stabilisation and reduce anxiety and psychological symptoms.

2. Vitex agnus castus (Chasteberry)

What it is agnus castus used for:
Vitex agnus castus (often called “vitex” or chasteberry) is used traditionally to regulate the menstrual cycle, PMS symptoms, and hormone-related symptoms via its effects on pituitary hormones.

How agnus castus may help perimenopause symptoms:

Irregular/painful periods, breast tenderness: A recent large retrospective longitudinal cohort study (1700 women) over 3 months of vitex extract showed a major decrease in the percentage of women with irregular cycles (from 9.1% to 0.1%), as well as improvements in bleeding intensity, frequency and pain, and breast tenderness.
Hot flashes, menopause symptoms, anxiety: Another randomised, double-blind, placebo-controlled trial compared vitex agnus castus extract vs placebo for menopausal symptoms and found significant improvements.
Mood, anxiety, brain fog: By helping balance progesterone and oestrogen via pituitary modulators, vitex may reduce mood swings and anxiety. Also, its hormonal balancing effects indirectly may help with cognitive clarity by reducing hormonal fluctuations.

**3. Ashwagandha (Withania somnifera)**

What is ashwagandha used for:
An adaptogenic herb used in Ayurvedic medicine. Known for reducing stress, improving sleep, supporting mood and cognition.

How ashwagandha may help perimenopause symptoms:

Sleep issues & anxiety: Studies show that ashwagandha reduces stress and anxiety, and improves sleep quality.
Hot flashes: Some preliminary studies suggest ashwagandha may reduce the frequency/intensity of hot flashes and night sweats. However, evidence here is less strong compared to sleep/anxiety.
Mood & brain fog: Participants in ashwagandha trials often report improved mood, reduced irritability, improved mental clarity. In some studies, improvements in mental exhaustion, focus, overall well-being, were noted.

**4. Passion flower (Passiflora)**

What is passion flower used for:
Passion flower is used mainly for its calming, sedative, anxiolytic properties. Traditionally used for insomnia, nervousness, and sometimes mild depression.

How passion flower may help perimenopause symptoms:

Sleep issues, stress: A clinical trial of passionflower given over 12 weeks showed improvements in sleep and stress levels due to its effects on increasing GABA (an inhibitory/calming neurotransmitter) in the brain (which increases relaxation and sleep).
Anxiety: Several trials suggest passionflower reduces anxiety and other menopause symptoms including insomnia and depression.
Hot flashes & night sweats: The same menopause symptoms study found that passion flower helped to reduce vasomotor symptoms like hot flashes and night sweats.

**5. Maca (Lepidium meyenii)**

What it is Maca used for:
Maca is a root plant native to the Peruvian Andes. It's often used as an adaptogen, thought to help the body adapt to stress, balance hormones, improve energy, mood, libido. It works by promoting optimal functioning of the hypothalamus and pituitary (which control a lot of our hormones), so the downstream effects are improved functioning of the thyroid, ovaries and adrenal glands.

How maca may help perimenopause symptoms:

Hot flashes, sleep issues, mood and brain fog: A systematic review found that maca may reduce some menopausal symptoms (using measures like the Kupperman Menopausal Index or Greene Climacteric Score), including hot flashes.
Irregular periods/hormonal balance: In a specific study using a maca preparation in perimenopausal women, researchers observed changes in hormone levels - lower follicle stimulating hormone (FSH), higher oestrogen and progesterone, as well as improvement in symptoms like hot flashes and night sweats after 2 months.

References:

https://pubmed.ncbi.nlm.nih.gov/21840656/

https://pmc.ncbi.nlm.nih.gov/articles/PMC3614596/

https://pubmed.ncbi.nlm.nih.gov/38393671/

https://pmc.ncbi.nlm.nih.gov/articles/PMC6887765/

https://pubmed.ncbi.nlm.nih.gov/23439798/

https://pmc.ncbi.nlm.nih.gov/articles/PMC8462692/

https://www.academia.edu/79048966/

https://www.cureus.com/articles/238136-randomized-double-blind-placebo-controlled-clinical-study-of-passiflora-incarnata-in-participants-with-stress-and-sleep-problems

https://pmc.ncbi.nlm.nih.gov/articles/PMC3203277/

https://pubmed.ncbi.nlm.nih.gov/37489230/

https://www.sciencedirect.com/science/article/pii/S2405844021000153