I was recently inspired by a professional Women’s Leadership Group in which I participated. One day, thanks to inspiration from guest speaker Secretary Tisha Edwards from the Maryland Governor’s Office, we had an honest, rich discussion about the challenges women face in managing our crazy lives while in the throes of menopause. As a Clinical Herbalist, I couldn’t help but share a few herbal tips to assist with this important transition in our lives. Suddenly, I knew what my next blog topic would be: herbs for menopause!
Thoughts on Menopause
Before I dive into herbs for menopause, I’d like to talk about menopause as a stage of a woman’s life – one that is to be celebrated. In our Women’s Group we lamented about how there is a stigma associated with it, and we wished it were more acceptable to have conversations around it. Those of us experiencing it (yes, including Yours Truly) shared that the symptoms sometimes make it difficult for us to ‘show up’ as our best selves. We deal with hot flashes, night sweats, emotional roller coasters. Aches and pains in places we never used to get them. Headaches, bloating, vaginal dryness, and unpredictable bleeding. No wonder our culture has deemed menopause a disorder that needs to be cured.
I don’t mean to minimize the devastating symptoms that some women face in menopause. In my herbal practice, I’ve had women come to me with night sweats so bad they were unable to sleep. Other women who would bleed for weeks, or even months, at a time, looking for relief. (Good news – I’ll talk about some herbs that can help further in this article!)
I just mean that I routinely see advertisements for drugs that ‘treat’ hot flashes, or hormone replacement therapy (HRT) to replace our natural hormones that are supposed to decrease as we age. It’s in the messaging – menopause is a disease that must be eradicated. In this country we don’t talk much about menopause as a life stage, a very natural one that does bring with it some interesting experiences. At least for those with manageable symptoms (again, not disparaging those with severe issues), I often wonder that if we talked about it as a normal, safe, albeit a little uncomfortable experience, we would be more tolerant of it. We could celebrate the fact that we’ve arrived at a certain ‘age of wisdom’, not grieve the youth that we lost or try to return to a body that we traded in long ago. We could celebrate the changes our bodies are going through, reflect on our life experiences thus far, and look forward to many more enjoyable years ahead.
At least that’s what I try to do when I get a hot flash or wake up in a sweat. I think, ‘oh, that was interesting’, and then I move on. Attitude is everything.
Menopause Defined
I’ll get off my soapbox, but before I dive into some herbs I want to set the stage for what menopause is and what causes many of the symptoms associated with it.
Strictly speaking, a woman has reached ‘menopause’ after one year of complete absence of menses. When we say a woman is ‘going through menopause’, we typically refer to the time period before complete cessation when reproductive hormone levels naturally start to decline, resulting the menstrual irregularities. This is called ‘perimenopause’.
A StatPearls article succinctly describes menopause as occurring when the number of primary ovarian follicles diminishes such that the ovaries cannot respond to the rise in follicle stimulating hormone (FSH) – i.e., no ovulation. The lack of ovulation results in lower estrogen production, which can trigger the symptoms described above.1
There’s more to it than that, but for the purpose of this article (getting to the herbs for menopause!), the bottom line is that fluctuating hormones set off imbalances in other body systems. These imbalances dysregulate various body functions, resulting in: unpredictable menses, hot flashes/night sweats, mood and memory fluctuations, dry skin, bone loss, headache/migraine, heart palpitations, sleep disturbance, etc.
Herbs for Menopause
Fortunately, there are many herbal partners to help women (us!) dance through menopause with grace. These are just a few to get you started. Your herbalist can help create a targeted herbal strategy customized for your particular situation!
Hormone Modulators
Black cohosh (Actaea racemosa) – Black cohosh root is probably the most common herb cited for menopause. Research has attempted to determine how it works, but there are no definitive conclusions. Some studies suggest that it upregulates estrogen receptors, having the effect of ‘increased estrogen’ without actually containing/being estrogen. Other studies (primarily in vitro) suggest that it also has serotonergic effects. Think about SSRIs (selective serotonergic reuptake inhibitors) – anti-depressants that are used to improve mood and/or reduce anxiety. Regardless, black cohosh is NOT a hormone, and as such can be used by people with estrogen-sensitivity (i.e., breast cancer patients).2
Clinically, there’s good research that suggests black cohosh can assist with hot flashes, night sweats, and thinning vaginal tissue, in particular. In my clinical experience it’s hit-or-miss – worth a try but it doesn’t help everyone. Black cohosh tinctures and capsules/tablets are readily available on the market; just be sure that you buy from a reputable company to ensure quality.
Red clover (Trifolium pratense) – Red clover is also often used for menopausal symptoms due to it containing phytoestrogenic substances. That is, this herb contains plant-based versions of estrogen, which may or may not act as estrogen would in the body (research is conflicting). Still, like black cohosh, red clover (makes a nice tea) may be helpful in the reduction of hot flashes, etc. NOTE: use caution in patients with estrogen-positive cancers – consult your herbalist or doctor first.3
Menstruation regulation
Dong quai (Angelica sinensis) – Dong quai root is another important herb that’s used in Traditional Chinese Medicine (TCM) to regulate menstrual bleeding. Considered a uterine tonic, it can be used for younger women experiencing abnormal, unpredictable bleeding as well as for menopausal women. Care must be taken, though, in that when used chronically, sometimes dong quai can end up causing more bleeding. Therefore, often it’s recommended to stop taking while active menstruation is occurring.3 Dong quai can be taken as a capsule/tablet; it also works very well as a powder to be added in food.
Shepherd’s purse (Capsella bursa-pastoris) – Unlike dong quai, shepherd’s purse can and should be taken as soon as bleeding starts in cases of extreme blood loss. This plant is a hemostatic, meaning that it stops, or slows, down bleeding directly by affecting blood and blood vessels. A tincture (or tea) of shepherd’s purse can be used daily when menstruation starts and until it ends. There is no need to continue to take it throughout the entire menstrual cycle. Clinically, my clients have had good luck with shepherd’s purse.
Adjunct Herbs for Menopause
Sage (Salvia officinalis) – Sage is one of my favorite herbs to suggest for hot flashes, and particularly, night sweats. In fact, I wrote a whole, separate blog post about it! But in short, sage has a long history of “drying secretions”, having a relatively immediate effect when the hot flashes start. For menopausal women, I recommend preparing a sage tea and either drinking before bed, or keeping by the bedside to drink when you wake in a sweat. I have had several clients swear by this – offering much welcome relief. For more details, including how to prepare the tea, see my sage post.
Motherwort (Leonarus cardiaca) – I love motherwort as a concept – the very name elicits an affinity for women. Motherwort is ambiguously used as a ‘women’s tonic’ in herbal medicine. More specifically, motherwort can have a calming effect, and is often used in cases of stress or anxiety that manifest themselves via cardiovascular symptoms – i.e., heart palpitations, increased blood pressure. Motherwort also made my list of Herbs for Anxiety. It is best used in a tincture or capsule/tablet, as it is VERY bitter.
Ginkgo (Ginkgo biloba) – I include ginkgo here as a memory supporter/enhancer. A common complaint of menopausal women is mental fogginess or sluggishness. Ginkgo is primarily used – and is currently very popular on the market – for improving brain function and memory. As it is presumed to operate by increasing oxygen to the brain via blood circulation, ginkgo also has some general cardiovascular benefits.
Ginkgo is best taken in concentrated formulas. In a tincture, look for a ratio of “2:1”, meaning that 1 ml of the tincture is equivalent to 2g of ginkgo. Concentrated tablets as much as 50:1 are also available.
Summing It All Up
I’d like to thank the Women’s Leadership Group who inspired me, as well as inspired this post about herbs for menopause. As with most medicinal herbs, these are often most effective when used in combination. Just consider whether you are looking for a systemic solution such as the hormone modulators, or whether you have acute symptoms that you’d like to target with more specific options. As your herbalist (and fellow perimenopausal woman), I can help you navigate this experience with grace, comfort, and (hopefully) fewer hot flashes!
Please reach out to me if I can be of assistance.
- Peacock, K., Carlson, K., Ketvertis, K. (2023), “Menopause“, StatPearls. Retrieved 2/17/2024.
- Braun, L., Cohen, M. (2015) “Herbs and Natural Supplements, An Evidence-Based Guide”, 4th edition.
- Romm, A. (2018) “Botanical Medicine for Women’s Health”.