The 5 Best Herbs for Hot Flashes and Other Menopause Symptoms, According to Herbalists

If you’re dealing with menopause—a natural, biological occurrence that marks the end of your menstrual cycle—you’ve likely encountered some less-than-pleasant symptoms. Typically, menopause is diagnosed after a full 12 months without a period. Still, you can deal with a bunch of other interesting bodily changes beforehand (think: irregular periods, anxiety, hot flashes, and brain fog). So if you're looking for a bit of relief, no one can blame you.

Before you reach for anything herbal or otherwise, Jolene Caufield, M.S, a senior advisor at Healthy Howard, a non-profit community healthcare organization that advocates for healthy lifestyle choices, says to make sure you chat with your doctor. Menopause typically doesn’t require any particular medical treatment (remember: it’s a natural part of life), but talking through your concerns with a doctor is necessary if you want to alleviate symptoms. 

Additionally, it's worth noting that the American College of Obstetrics and Gynecology (ACOG) says, while people have used herbs to treat symptoms for many years, these substances remain under-researched and aren’t proven effective. So before you prepare to brew teas or take tinctures, talk to your provider to make “sure that there are no interactions with any existing condition or medications,” Caufield says. Below, you’ll find five herbs that herbalists recommend if you’re dealing with menopause symptoms.

1. Black cohosh

During menopause, your estrogen levels begin to decline naturally. Black cohosh is a perennial plant native to North America that's often used for its estrogen-like effects. Native Americans have employed it to treat conditions like sluggish labor and menstrual irregularities, and settlers adopted it for the same reasons, according to the National Institute of Health (NIH). 

The German Commission E, a body like the United States Food and Drug Administration, has approved black cohosh as a treatment for menopause. However, there are conflicting reports of adverse effects, specifically on the liver. In a study with over 3,000 subjects, about 1,200 people were given black cohosh, but there weren’t any reports of serious liver problems in any of these trials. Still, you should discuss risks with your provider and exercise caution when introducing black cohosh.

“Not all black cohosh is the same,”  says Stephanie Redmond, PharmD, CDCES, BC-ADM, Co-Founder of DiabetesDoctor and SkyPharm, adding, “The potency can be varied among manufacturers, which may affect the effectiveness.” Meaghan Price, an Afro-Indigenous herbalist based in Baltimore, say, in her experience, people find relief if they’re dealing with mood swings related to menopause or PMS. But she was careful to mention minor side effects like headaches she’s noticed among people who take it. 

2. Sage

Bevin Clare, a professor of clinical herbalism at the Maryland University of Integrative Health and the president of the American Herbalists Guild, says sage is beneficial. In her book, Spice Apothecary: Blending and Using Common Spices for Everyday Health, she discusses a 2015 study of menopausal women aged 50 to 65 who were experiencing at least five hot flashes per day. The researchers gave the subjects 250 mg of sage each day (equal to 3.4 grams of fresh sage leaf), Clare says. “Results showed an average 50 percent decrease in the number of flashes within the first four weeks and a 64 percent decrease by the end of eight weeks. Also, the intensity of hot flashes decreased,” she says.  A small 2019 study published in the International Journal of BioMedicine builds on earlier research. It suggests that taking 100 mg of sage extract daily for four weeks reduces symptoms of menopause, including hot flashes, night sweats, and sleep problems. 

3. Valerian root

Valarian is an herb that grows in Europe, parts of Asia, and North America. Monisha Bhanote, MD, Founder & CEO of Holistic Wellbeing Collective, recommends valerian root for people “who are experiencing sleep issues while they are transitioning from menopause to post-menopause.”  A 2013 study published in Complementary Therapies in Clinical Practice discussed the effectiveness of valerian with sleep disorders, specifically related to menopause, and suggests that it might facilitate rest.  Though more research is needed, a literature review published in the American Journal of Medicine suggests very little harm in trying it. So it might be worthwhile to sip some valerian tea, though Bhanote mentions that “sometimes, the odor can be distinct.”

4. Red clover

Another possible herb for anxiety is red clover, which contains high amounts of genistein and daidzein. Genistein is a soy-derived compound that's been extensively studied for hormone-related purposes, while Daidzein-rich isoflavone compounds are mainly linked to helping with hot flashes.

Dr. Redmond says this herb is especially helpful with psychological symptoms like mood swings, anxiety, and depression. But it might also help with symptoms like vaginal pain, soreness, and irritation. But—before you reach for red clover—Dr. Redmond says that anyone with a history of breast cancer, active breast cancer, or other hormone-dependent cancers should discuss possible implications with their healthcare provider. 

5. Dong Quai

A key player in Traditional Chinese Medicine (TCM) is Dong Quai, an herb under the parsley family indigenous in China and Japan. TCM practitioners often use it for issues like helping women’s issues. The NIH says that the scientific evidence is insufficient, but Redmond says there might be enough anecdotal evidence to explore it.

Price says the reason people find relief is because “Dong Quai contains phytoestrogen, which helps to balance estrogen and hormone levels during menopause or a monthly cycle.” But Price says that you should exercise caution when you’re working with the herb: “It can be a blood thinner, so it is not recommended to use this herb with Tylenol or similar medicines,” she says, adding that she recommends getting dried root and brewing your own tea. “Dong Quai is in the celery family, and the tea has a taste that is reminiscent of celery.”

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