The Powerful Plants of Menopause

Plants have occupied many different places in women's lives for generations. They have been food, medicine, ritual and comfort—and across cultures, women have drawn on their knowledge of plants to support sleep, mood, reproductive health, digestion and many of the concerns we now associate with the menopause transition.

Some are familiar. Sage has a long history of use for sweating and hot flashes, while chamomile has traditionally been used to calm the body. Others, including ashwagandha, shatavari and black cohosh, come from much older traditions of botanical medicine and are now being studied specifically in menopausal women.

At the same time, botanicals have become big business. Americans spent more than $13 billion on herbal supplements in 2024, and women can now choose from herbs marketed for hot flashes, sleep, stress, “hormone balance,” energy and just about every other menopause concern.

Behind all that marketing, though, is a much more interesting story: traditional women's knowledge is beginning to meet modern menopause research.

And that opens up a more useful question than whether botanicals are a “natural alternative” to hormone therapy or conventional medicine:

What might a particular plant contribute?

Menopause care doesn't have to be about finding the one thing that will “fix” us. It can be about building a collection of tools that support us through this transition. Nutrition, movement, sleep, breath and mindfulness, hormone therapy and conventional medical care may all have a place. Botanicals can be one of those tools, too.

Five Botanicals Being Studied for Menopause

Many of the plants now appearing in menopause research have been used medicinally for generations. Modern research gives us another way to explore what they might offer women today.

Black cohosh

Black cohosh is a North American plant with a long history of medicinal use by Native peoples, including for reproductive concerns. Today, it has one of the larger bodies of research among botanicals studied for menopause.

A 2023 review of 22 studies involving more than 2,300 women found that black cohosh preparations may improve hot flashes and overall menopause-related concerns. An important detail: much of the research has involved specific preparations made from the plant's root or rhizome. That matters when trying to apply the research to the products women actually encounter.

Ashwagandha

Ashwagandha has been used for centuries in Ayurveda as a rasayana, or restorative herb, traditionally associated with resilience and stress.

Researchers are now studying it specifically during the menopause transition. In a randomized trial of 100 perimenopausal women, a standardized ashwagandha root extract taken for eight weeks improved menopause-related concerns and quality of life compared with placebo.

This is particularly interesting during a life stage when sleep, mood, stress and our response to everyday demands can all feel different.

Shatavari

Shatavari has perhaps the most distinctly female history of this group. It has long been used in Ayurveda in connection with women's reproductive health, and modern researchers are beginning to investigate its potential role during menopause.

Recent randomized trials using standardized root extracts have reported improvements in hot flashes and other menopause-related changes. In one study of 80 perimenopausal women, 300 mg of a standardized shatavari root extract taken daily for eight weeks produced significant improvements compared with placebo.

The research is still emerging, but shatavari is a good reminder that a relatively small modern evidence base doesn't mean a plant has no history behind it. Sometimes science is beginning to ask questions that traditional systems of medicine have been exploring for a very long time.

Red clover

Red clover offers a fascinating window into phytoestrogens—plant compounds that can interact with estrogen receptors in the body.

Its isoflavones have been studied in menopausal women, particularly for hot flashes. A recent analysis of nine randomized trials found a modest reduction in hot-flash frequency.

But here's where the details become important: these studies generally used preparations that provided measured amounts of red-clover isoflavones. Drinking a cup of red-clover tea isn't necessarily equivalent to taking the concentrated preparation used in a clinical trial.

Sage

And then there's sage, Salvia officinalis, which beautifully blurs the line between food and medicine.

Sage has a long traditional history of use for sweating, and researchers have begun investigating it for menopausal hot flashes. A review of four studies involving 310 postmenopausal women found promising evidence that sage may help reduce hot-flash frequency.

The sage growing in the garden—or simmering in tonight's soup—isn't a therapeutic dose. But I love knowing that such a familiar culinary herb can have both a culinary and medicinal story.

With Botanicals, Form Matters

One of the most useful things to understand about botanical medicine is that the name of the plant doesn't tell us everything we need to know.

A tea, tincture, powder and standardized extract may all begin with the same plant, but they aren't necessarily equivalent. A tea extracts certain plant compounds into water. Tinctures use alcohol, glycerin or another solvent. Powders contain more of the whole plant material. Standardized extracts are prepared to provide a consistent concentration of particular compounds or a defined extract—which is one reason they are commonly used in clinical research.

Even a capsule doesn't tell you much on its own: it may contain powdered whole plant material or a concentrated standardized extract.

So when research suggests that a botanical may be useful during menopause, one of the first questions I ask is:

What form was actually studied?

The same principle applies to botanical blends. Combining plants is an important part of many traditional healing systems, and some combinations are now being studied directly. But evidence for an individual herb doesn't automatically transfer to a formula that contains a much smaller amount of that herb alongside several others.

How Do You Know if a Botanical Is Right for You?

Rather than asking whether an herb is simply “good for menopause,” start with what you actually want it to support.

Are you thinking about hot flashes? Sleep? Stress? Mood? Those are different concerns, and the botanical with the strongest evidence for one may not be the most relevant for another.

Then look beyond the name on the front of the bottle. What plant part was used in the research? Was it a tea, powder, tincture or standardized extract? How much was studied, and for how long?

Traditional use and modern clinical research also offer different kinds of information. I find value in understanding both rather than assuming one has to invalidate the other.

And, importantly, consider the rest of your own health picture. Medications, hormone therapy, health conditions and other supplements can all affect whether a botanical is an appropriate choice. A physician, pharmacist or qualified practitioner with botanical training can help you evaluate those pieces together.

Finally, give yourself a way to know whether it's actually doing what you hoped it would do. Start with a purpose, allow an appropriate amount of time and pay attention to what changes. It's much easier to learn from one thoughtful addition than from adding five new supplements at once.

Plants as Part of the Menopause Toolbox

Botanicals don't have to replace hormone therapy, nutrition, movement or conventional medicine to have value. Natural and conventional aren't opposing teams.

What interests me much more is what happens when we take plants seriously enough to understand both their long history of use and the emerging science around them.

For women navigating menopause, botanicals may be one thoughtful—and potentially powerful—part of a much larger picture of care.