Last checked September 2026 against 21 sources · Editorial policy
Herbs for menopause
The herbs with the most evidence for menopause are black cohosh, rated moderate certainty for hot flashes in a 2026 International Menopause Society review, and soy and red clover isoflavones, with modest, inconsistent effects. Sage looked promising in a few small studies. Dong quai, red clover's Promensil extract, and vitex with St John's wort didn't beat placebo in trials. The North American Menopause Society doesn't recommend herbal remedies for hot flashes.
Black cohosh, soy and red clover isoflavones, sage, dong quai and vitex rated by evidence for menopause symptoms, with liver and drug-interaction warnings.
Herbs for menopause: expectation vs reality
What people often expect
“Herbs are a gentler, natural alternative to HRT that work just as well”
What the evidence shows
No herb has matched HRT in trials: in a Cochrane review, HRT reduced hot flashes and symptom scores more than black cohosh. Herbs also aren't automatically gentle: black cohosh and ashwagandha have rare liver cases, St John's wort weakens many medicines including birth control pills, and sage contains thujone, which can be toxic in large amounts.
Best herbs for menopause, rated by evidence
Black cohosh
The most studied menopause herb. A 2012 Cochrane review of sixteen trials with 2,027 women found no difference from placebo in hot flash frequency, but a 2023 review of 22 studies and the 2026 IMS review found possible benefit for hot flashes and overall symptoms. Rare, sometimes serious liver damage has been reported with black cohosh products.
Learn more →Red clover and soy
Both contain isoflavones, plant compounds similar in structure to estrogen. Soy isoflavone supplements cut hot flashes by 20.6% in a meta-analysis. Red clover's research hasn't shown conclusive benefit for any condition, and pooled trials of the Promensil extract found no difference from placebo. Red clover extracts appeared safe in studies lasting up to 2 years.
Learn more →Sage
A few small studies suggest common sage might reduce hot flash frequency. Sage is likely safe in food amounts, and larger amounts were used safely for up to 8 weeks in studies. But common sage contains thujone, which can be toxic in large amounts, so high doses or long-term use may be unsafe, and it may be unsafe in pregnancy.
Learn more →Dong quai
Dong quai is often used in traditional Chinese medicine for women's health. In a 24-week placebo-controlled trial in postmenopausal women with hot flashes, it didn't reduce hot flashes or symptom scores and didn't act like estrogen on the uterine lining or vaginal cells. It may interact with the blood thinner warfarin.
Ashwagandha and maca
In one trial of 100 perimenopausal women, ashwagandha root extract reduced menopause symptom scores vs placebo. NCCIH says there isn't enough evidence for menopause and notes rare liver injury; it's not recommended with thyroid or autoimmune conditions. A review of four small maca trials found favorable effects but called the evidence too limited to draw conclusions.
Learn more →Vitex and St John's wort
Vitex, or chasteberry, has some evidence for PMS symptoms and only preliminary data for menopause. A trial combining St John's wort with vitex in late perimenopause found no benefit over placebo. St John's wort alone may help mild to moderate depression but weakens many medicines, including birth control pills, some antidepressants and warfarin.
Learn more →Chinese herbal medicine and valerian
The 2026 IMS review found moderate-certainty evidence that Chinese herbal medicine may improve menopause symptom scores, sleep and blood pressure, though most studies were low quality. Three small studies suggest valerian might help menopause symptoms, but the evidence is too thin; the American Academy of Sleep Medicine recommends against valerian for chronic insomnia.
Herbs for menopause belly fat
No herb has been shown to reduce belly fat in menopause. The FDA warns that many weight loss pills, supplements and teas are likely to be contaminated with dangerous hidden ingredients. Fat gain around the waist in the menopause transition responds to diet, exercise and, where appropriate, medicines, not herbs.
Learn more →Menopause herbs by the numbers
From the studies on this page
fewer hot flashes with soy isoflavone supplements vs placebo
20.6%
2,027
24 weeks
8 weeks
Most herbal trials are small and short, and product strength varies between brands.
Herbal remedies for menopause compared
Black cohosh
Learn more →Good for
Most research of any menopause herb; moderate-certainty evidence for hot flashes in 2026.Watch
Cochrane found no benefit; rare liver damage; mislabeled products.Soy and red clover isoflavones
Learn more →Good for
Soy cut hot flashes by about a fifth.Watch
Red clover didn't beat placebo; may not suit women who shouldn't take estrogen.Sage
Learn more →Good for
Small studies suggest fewer hot flashes.Watch
Thujone makes high doses and long-term use potentially unsafe.Ashwagandha
Learn more →Good for
Reduced symptom scores in one perimenopause trial; may help stress and insomnia.Watch
Rare liver injury; avoid with thyroid or autoimmune conditions.Dong quai, vitex, St John's wort
Good for
Traditional use.Watch
No benefit over placebo in menopause trials; St John's wort interacts with many drugs.
How to use herbs for menopause safely
- Talk to a doctor before taking herbal supplements, as the NHS advises, especially if you take any medicine.
- Avoid St John's wort if you take birth control pills, antidepressants or warfarin.
- Skip black cohosh and ashwagandha if you have liver disease.
- Choose products that name the plant species and dose; some black cohosh products contained the wrong herb.
When to talk to a doctor about herbal remedies
Dark urine, yellow skin or belly pain on an herbal remedy
Stop it and see a doctor; several herbs have been linked to liver damage.
You take prescription medicines
Check interactions first; St John's wort can weaken birth control, antidepressants and blood thinners.
Hormone-sensitive cancer
Talk to your oncology team; vitex and phytoestrogens may not be safe.
Symptoms affecting daily life
Ask about HRT or proven non-hormonal treatments.
Herbs for menopause: questions women ask
What is the best herb for menopause?
Black cohosh has the most research and was rated moderate certainty for hot flashes in a 2026 review, though a Cochrane review found no benefit over placebo. No herb matches HRT.
What herbs help with menopause hot flashes?
Black cohosh and soy isoflavones have the most supporting evidence, and sage looks promising in small studies. Dong quai and red clover's Promensil extract didn't beat placebo.
Are herbal remedies for menopause safe?
Many are well tolerated short term, but not all: black cohosh and ashwagandha have rare liver cases, kava is linked to severe liver disease, and St John's wort interacts with many drugs.
Do herbs for menopause really work?
Some show modest benefit, but most studies are small and low quality. NCCIH says no dietary supplement has clearly been shown to relieve menopause symptoms.
What herbs are good for menopause mood and sleep?
Ashwagandha may help stress and insomnia, and Chinese herbal medicine showed moderate-certainty benefit for sleep. St John's wort helps mild to moderate depression but interacts with many medicines.
Can herbs replace HRT?
No. In the Cochrane review, HRT reduced hot flashes and symptom scores more than black cohosh, and no herb protects bones or treats vaginal dryness like estrogen.
Related →Are there herbs for menopause belly fat?
No herb has been shown to reduce belly fat. The FDA warns that many weight loss pills, supplements and teas are likely to contain dangerous hidden ingredients, so be cautious with anything sold for that purpose.
Related →How long should I try an herbal remedy?
Trials typically ran up to 12 weeks, and some herbs, such as sage and ashwagandha, have safety data only for short use. If there's no benefit after a few months, stop.
Sources
- Maunder A, Mardon AK, Rao V, et al. Complementary therapies for management of menopausal symptoms: a systematic review to inform the update of the International Menopause Society recommendations on women's midlife health. Climacteric. 2026;29(2):165-209.
- Taku K, Melby MK, Kronenberg F, et al. Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: systematic review and meta-analysis of randomized controlled trials. Menopause. 2012;19(7):776-90.
- NCCIH. Sage: usefulness and safety.
- Hirata JD, Swiersz LM, Zell B, et al. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril. 1997;68(6):981-6.
- Lethaby A, Marjoribanks J, Kronenberg F, et al. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Syst Rev. 2013;2013(12):CD001395.
- van Die MD, Burger HG, Bone KM, et al. Hypericum perforatum with Vitex agnus-castus in menopausal symptoms: a randomized, controlled trial. Menopause. 2009;16(1):156-63.
- The North American Menopause Society. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590.
- Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012;2012(9):CD007244.
- National Center for Complementary and Integrative Health. Black cohosh: usefulness and safety.
- NCCIH. Ashwagandha: usefulness and safety.
- NCCIH. St. John’s wort: usefulness and safety.
- National Center for Complementary and Integrative Health. Red clover: usefulness and safety.
- National Center for Complementary and Integrative Health. Menopausal symptoms: in depth.
- Gopal S, Ajgaonkar A, Kanchi P, et al. Effect of an ashwagandha (Withania Somnifera) root extract on climacteric symptoms in women during perimenopause: A randomized, double-blind, placebo-controlled study. J Obstet Gynaecol Res. 2021;47(12):4414-4425.
- Lee MS, Shin BC, Yang EJ, et al. Maca (Lepidium meyenii) for treatment of menopausal symptoms: A systematic review. Maturitas. 2011;70(3):227-33.
- NCCIH. Chasteberry: usefulness and safety.
- NCCIH. Valerian: usefulness and safety.
- US Food and Drug Administration. Tainted weight loss products (weight loss product notifications).
- Greendale GA, Sternfeld B, Huang M, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5):e124865.
- NHS. Things you can do to help menopause and perimenopause symptoms.
- Heger M, Ventskovskiy BM, Borzenko I, et al. Efficacy and safety of a special extract of Rheum rhaponticum (ERr 731) in perimenopausal women with climacteric complaints: a 12-week randomized, double-blind, placebo-controlled trial. Menopause. 2006;13(5):744-59.
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