Sage Advice – An Herb for Hot Flashes

Medicinally-speaking,”common sage” is anything but!

Having worked with a number of menopausal or peri-menopausal women in my clinical practice, hot flashes and night sweats are among the most uncomfortable symptoms these women are dealing with.  A quick Google search for “herb for hot flashes” generally yields discussions about hormone modulators such as black cohosh, vitex (chaste tree berry), and others.  These herbs are great for general menopausal support and may alleviate hot flashes and night sweats over time, but for my money the unassuming and oft overlooked sage leaf is the champion of symptom relief in the short term.

Salvia officinalis is a native Mediterranean plant in the mint (Lamiaceae) family.  Perhaps it is best known for its culinary value through its slightly sweet, slightly bitter with overtones of pine taste.  Herbalist Bevin Clare, in her new book Spice Apothecary cautions that its strong flavor can “take some getting used to”.  Personally, I think we all could use “more spice in our lives”.  Sage is a healthy, calorie-free, and phytochemical-rich flavoring that pairs well with other Mediterranean herbs such as rosemary and thyme in cooking.  Use a mixture of these herbs as a dry rub on pork before grilling or sauteeing.

Back to sage as an herb for hot flashes.  Sage has traditionally been used to “dry secretions”, the most dramatic of which is to halt lactation.  In fact, sage in medicinal doses is contra-indicated in lactating women unless cessation is the objective.  Similarly, sage has proven useful in reducing sweating that accompanies hot flashes or wakes women up at night.  To be honest, there is not a lot of clinical trial evidence that supports this claim. However, I can personally attest that several of my clients have reported substantial improvement in their hot flash and/or night sweat symptoms after drinking sage tea.  Some of them “swear by it” and would not want to go without.

Sage is most easily administered in a tea.  To make a hot infusion, steep 1-2 tsp dried (3-4 tsp fresh) in 2-3 cups of boiling water for 15 minutes.  There are differences in opinions as to whether the tea should be drunk hot or cold (room temperature), so try both and see what works for you.  To my clients I recommend drinking sage tea about 30 – 60 minutes before bed and also keeping some bedside should they awaken in the middle of the night.

Since sage is a common herb, it’s readily available in grocery and health-food stores.  I recommend buying sage in bulk (a few ounces at a time) because the small jars available in the baking section will only provide a couple of medicinal doses. A good mail-order source of bulk herbs is Mountain Rose Herbs in Oregon.

For the gardening-inclined, sage is also quite easy to grow.  In mild to temperate climates, this bushy shrub is a perennial.  Start with a healthy plant from the nursery and find a sunny-to-partial-shade spot with good drainage.  Sage, unlike most other mints, is not invasive so find a nice place where it can live happily for seasons to come.  Over the years it can get woody so it’s important to prune out the deadwood annually (typically in late spring) to make room for new growth.  Harvest the leaves just before or when the plant begins to flower, and “dead head” (prune off the flower buds) to encourage bushiness and more leaf production.

For a tea you can use the leaves fresh or dry in a single layer on a cookie sheet in a 200F oven for a few hours.  You can also put the cooled tea in a spray bottle for a topical spritzer to immediately help cool down in the midst of a hot flash.

As with all herbs, sage isn’t a “one-trick-pony”.  In addition to being useful for diminishing sweating, its high essential oil content also makes it a useful anti-septic/anti-microbial.  Along with thyme, sage is sometimes used as a gargle to disinfect the mouth, especially in the presence of ulcers or sores as it also soothes inflamed tissues.  It is a mild anxiolytic, which provides additional support to menopausal women whose hormonal fluctuations also create nervousness.  Finally, since ancient times sage has been used for cognitive enhancement.  Braun & Cohen (2015) summarize several more recent studies (within the last 20 years) that demonstrate improvement in cognitive performance after taking various preparations of sage over time.

With all these potential benefits, and its zingy taste, what are you waiting for?  If you’re suffering from uncomfortable hot flashes or night sweats, take this “sage advice”:

It’s easy to grow and abundantly available, inexpensive, and extremely safe, so what do you have to lose by trying sage?

If you do try this herb for hot flashes, let me know how it goes!  And if you are suffering from more complex and frustrating menopausal challenges, please inquire about how I can help you with a personal, custom-formulated herbal strategy.

Braun & Cohen (2015).  Herbs and Natural Supplements.  An Evidence-Based Guide. 4th Ed.  Elsevier.