Sage, Black Cohosh, Saffron… Which plants are effective for a serene menopause?

Hormonal changes in the premenopause

The menopause corresponds to the permanent cessation of ovarian function, generally around the age of 51 [1]. It is accompanied by a significant drop in oestrogen, hormones that are essential to the balance of the female body.

Before this, a phase called perimenopause or premenopause can last up to 7 to 14 years [2], with significant hormonal fluctuations. This period is often the most difficult, as symptoms appear gradually. A woman can therefore be in perimenopause as early as 35–40 years of age. 

The most common symptoms and their impact

They are numerous and can significantly affect daily life. According to one study, the most common are [3]: 

• Hot flushes in 78% of cases and up to 85% [4] 
• Persistent increased sweating (84%)
• Sleep disturbances (67%)
• Increased irritability (79%)
• Low mood (64%) or even depression [5]
• Brain fog [6]
• Joint pain (69%)
• Palpitations (65%)
• Weight gain, raised cholesterol, etc. [7]
• Genitourinary problems [8]
• Osteoporosis [9]

Other manifestations are also found, such as hair loss, headaches, increased facial or body hair growth (hirsutism), palpitations, increased urinary frequency, changes in breast size or shape, as well as irritability, fatigue and memory disturbances such as frequent forgetfulness. It can also lead to unpredictable mood swings, anxiety, a decrease in sexual desire (libido), pain during sexual intercourse (dyspareunia), breast tenderness or pain, as well as vulvovaginal atrophy which can cause vaginal dryness.

These manifestations are not trivial: they can last several years and impact daily, professional and emotional life. Every woman is different and may experience just one or several of these signs. 

The World Health Organization (WHO) considers complementary medicine to be a method of prevention and improvement of menopausal symptoms [10].

In this context, a menopause food supplement based on herbal medicine represents a relevant natural approach, particularly for women who do not wish to use or cannot use hormonal treatments.

Hormone replacement therapy (HRT) is an effective solution for rapidly relieving clinical symptoms. It acts on so-called "climacteric" complaints, particularly those linked to hormonal changes associated with the cessation of ovarian function, such as hot flushes, night sweats, vaginal dryness and mood disturbances. It also contributes to the prevention of osteoporosis by reducing the risk of bone fractures by 30 to 40%.

Across all age groups, hormone therapy is not associated with an increase in overall mortality in women, nor with mortality related to cardiovascular disease or breast cancer. When initiated within the first 10 years following the end of periods, it may even have a protective effect on mortality [11].

The decision to initiate hormone therapy is individualised for each woman. Its use is governed by medical advice, as it may be associated with certain risks, particularly cardiovascular, thromboembolic or related to hormone-dependent cancers. This is why it is not systematically recommended for all women, and the prescription of medication requires a personalised medical assessment by a doctor or gynaecologist.

In this context, natural solutions such as medicinal plants represent an interesting alternative: they allow for a gentler approach whilst limiting side effects, provided that effective and safe active ingredients are chosen.

Scientific research now makes it possible to clearly identify which plants are genuinely effective during this transition. Some stand out for their robust and reproducible clinical results. It is important to note that these are not medicines. 

Sage: proven efficacy on hot flushes

It is one of the best-documented plants. Several clinical trials show a significant effect from the first few weeks.

One study observed a reduction of 50% at 4 weeks and up to 64% at 8 weeks [12].

 

Another analysis shows that it leads to a significant and overall improvement in the following areas after 10 to 12 weeks of supplementation [13]: 

• Hot flushes and night sweats: up to −75%
• Sleep disturbances: improvement of −64%
• Muscle and joint pain: reduction of −52%
• Depressive mood: reduction of −50%
• Irritability: reduction of −49%
• Anxiety: reduction of −47%
• Cardiac discomfort (palpitations): reduction of −49%
• Urinary incontinence: improvement of −38%
• Sexual problems: improvement of −19%

Its mechanism is based in particular on modulation of neurotransmitters such as serotonin, which contributes to regulating the disrupted thermoregulation during this hormonal transition [14].

Shatavari: a comprehensive action on hormonal balance

Shatavari stands out for its comprehensive action on physical complaints, emotional wellbeing and hormonal imbalance.

In 60 days, shatavari helped to significantly improve the following areas [15]:

• -93% of hot flushes
• -92% of night sweats
• -41% on the overall insomnia score
• +35% overall quality of life
• -55% anxiety
• -53% stress
• +43% sleep quality

This efficacy is explained by its richness in natural phytoestrogens, which help to gently compensate for the decline in oestrogen levels.

Saffron: a demonstrated impact on mood and sleep

Saffron is particularly interesting for the emotional difficulties associated with the menopause, but not only that!

Its efficacy has been demonstrated in particular on [16]:

• -50% impact of hot flushes compared to baseline, and 60 to 65% additional reduction versus placebo on associated discomfort
• 50% improvement in depressive indicators from 2 weeks, and 73% improvement at 4 weeks
• 40 to 60% additional benefit versus placebo for depression associated with the menopause

It acts on neurotransmitters (particularly serotonin), making it a valuable ally for stabilising mood.

Milk thistle: essential metabolic support

Less well known in the context of the menopause, milk thistle nonetheless plays a key role.

Its active compound, silymarin, has the following properties:

• Powerful antioxidant properties [17]
• Hepatoprotective [18]
• Beneficial for blood sugar levels [19]

As the liver is involved in hormonal regulation, its proper functioning is essential for navigating this period more comfortably.

Evening primrose oil: a useful support

Evening primrose oil has shown interesting results in menopausal women.

In a first study, an increase in oestradiol, a reduction in total cholesterol and an overall improvement were observed [20].

In a second study, evening primrose oil reduced hot flushes by 73%, sleep disturbances by 51% and musculoskeletal symptoms by 76%. The overall physical score also improved by 57% [21].

As it comes in oil form, it is less commonly found in supplements containing multiple active ingredients. 

Ashwagandha: be aware of contraindications

Ashwagandha has shown interesting results in women in perimenopause and menopause.

In a first study, it reduced the overall MRS score (menopause rating scale) by 23.5%, improved psychological domain scores by 25% and urogenital scores by 27%, whilst significantly reducing hot flushes. It was also associated with an increase in oestradiol and a reduction in FSH and LH [22].

In a second study [23], it reduced the overall MRS score by 40.9%, improved psychological symptoms by 44.6%, somatic symptoms by 42.1% and urogenital symptoms by 31.5%. Hot flushes decreased by 26.9%, with an increase in oestradiol and progesterone, a reduction in FSH and LH, as well as an improvement in quality of life and a 47% reduction in perceived stress.

In addition to its benefits on commonly experienced clinical symptoms, ashwagandha is also particularly useful for helping to reduce cortisol levels and better manage stress.

Although effective, this plant is not recommended in cases of:

• Endocrine disorders (thyroid, hyperandrogenism)
• Liver or heart conditions
• Treatments affecting the nervous system

Black cohosh: caution required

It is often used as it may be effective [24], particularly for hot flushes, but its use requires caution:

• Not recommended in cases of hormone-dependent cancer
• Hepatic risk

Soy: controversial phytoestrogens

Isoflavones may be useful and are well documented [25], but they should also be used with caution:

• Not recommended in cases of a history of breast cancer

It is an extract best chosen organic. 

Herbal teas, capsules or standardised extracts

Not all forms of plants offer the same effectiveness. Standardised extracts and capsules are the most recommended, as they provide a precise, concentrated dose of active ingredients, in line with what is used in scientific studies.

Herbal teas and infusions, on the other hand, are generally less concentrated. They can be pleasant to enjoy daily, but their effectiveness tends to be milder and less consistent.

Dosages and duration of use

Plants act gradually. The first effects are often felt after 2 to 4 weeks, with more noticeable results after 1 to 3 months of regular use.

The key is consistency and a sufficient dosage in order to achieve visible results.

Even though plants are natural compounds, they are not always risk-free. It is essential to understand the precautions to take before any use.

Drug interactions

Some plants may interact with medications, which can alter their efficacy or cause unwanted side effects: 

• Antidepressants: some that act on serotonin (such as saffron or ashwagandha) may potentiate their effect.
• Anticoagulants: some may influence blood clotting.
• Hormonal treatments: those containing phytoestrogens may interact.

It is therefore recommended to seek the advice of a healthcare professional (doctor, gynaecologist) if you are currently undergoing any treatment.

At-risk profiles

Certain situations require particular vigilance:

• Personal or family history of hormone-dependent cancers
• Thyroid or endocrine system dysfunction
• Hepatic or cardiac conditions

These limitations explain why certain formulations favour actives without major contraindications, in order to ensure greater safety of use.

Not all plants work in the same way, and that is precisely where the value of combined formulations lies. During menopause, symptoms are multiple and interconnected: hot flushes, sleep difficulties, fatigue, mood changes, metabolic imbalances… No single plant can address all of these needs.

This is why certain combinations of active ingredients are particularly relevant. For example, sage acts primarily on vasomotor indicators such as hot flushes, while shatavari works more on overall hormonal regulation. Saffron targets the emotional sphere and relaxation, while milk thistle supports the liver and metabolism.

This complementary approach allows for a much more comprehensive and effective response. Rather than addressing a single symptom, several mechanisms are targeted simultaneously, which significantly improves day-to-day wellbeing.

Furthermore, certain formulations have been designed to avoid ingredients with known contraindications. This makes it possible to create a product that is both effective and suitable for the widest range of women, including those with sensitive profiles.

With this in mind, Péri Support has been formulated to offer a plant-based, targeted and complementary response to the various discomforts of perimenopause. Its combination of sage, shatavari, saffron and milk thistle works on vasomotor comfort, feminine wellbeing, mood and metabolic support all at once. Hormone-free and 100% plant-based, it can easily be incorporated into a holistic routine and combined with our premenopause multivitamin food supplement Péri Essentials, which supports nutritional needs, vitality and cognitive function, notably through its patented bacopa extract.

If you are wondering which plant to use for the menopause, the most relevant answer is grounded in science and safety.

The most effective are:

• Sage: hot flushes
• Shatavari: hormonal balance
• Saffron: mood
• Milk thistle: metabolism and liver health

Some popular plants carry risks, which makes formulations with no particular contraindications especially valuable.

The ideal approach remains a holistic, natural and scientifically validated one, combining efficacy and safety. It is also important not to overlook the impact of a healthy diet and regular physical activity. It has been shown that exercise also helps to reduce clinical signs.