A Perimenopause Resource

Herbal & Traditional Approaches

Plant medicines, traditional systems, and what women have done across cultures and centuries

Women have been navigating this transition for as long as there have been women. Long before clinical trials, there were grandmothers, midwives, herbalists, and healers passing down knowledge about what helped.

This page explores plant-based and traditional approaches—not just through the lens of “what does the research say,” but also “what have people done, and why might it matter?”

The Limits of Evidence-Based Framing

Modern evidence-based medicine values randomized controlled trials (RCTs). This approach has real strengths—it helps distinguish what works from what we wish worked, or what happens to coincide with natural improvement.

But it also has blind spots:

  • Traditional knowledge is rarely funded for study—there’s no profit motive
  • Whole-system approaches don’t fit the single-intervention model—Chinese medicine, for instance, is individualized and combines herbs
  • Subjective experience is hard to measure—feeling “more balanced” may matter even if hot flash counts don’t change
  • The placebo effect is real healing—ritual, belief, and care have physiological effects

This doesn’t mean everything traditional “works” in the pharmacological sense. But absence of RCT evidence isn’t the same as evidence of absence—and there may be value in these approaches that our measurement tools miss.

Traditional Chinese Medicine (TCM)

TCM views menopause through the lens of yin, yang, and qi—not as a disease but as a natural transition requiring rebalancing.

Common TCM Approaches

Kidney Yin Deficiency (common pattern for hot flashes, night sweats):

  • Herbs: Rehmannia (shu di huang), Cornus (shan zhu yu), Dioscorea (shan yao)
  • Classic formula: Liu Wei Di Huang Wan (Six Ingredient Pill with Rehmannia)

Kidney Yang Deficiency (cold signs, fatigue, low libido):

  • Herbs: Cinnamon bark (rou gui), Aconite (fu zi—processed), Eucommia (du zhong)
  • Classic formula: Jin Gui Shen Qi Wan (Kidney Qi Pill)

Qi and Blood Deficiency (fatigue, weakness, poor digestion):

  • Si Jun Zi Tang (Four Gentlemen Decoction)—ginseng, atractylodes, poria, licorice
  • Ba Zhen Tang (Eight Treasure Decoction)—combines qi and blood tonics

Liver Qi Stagnation (mood swings, irritability, breast tenderness):

  • Xiao Yao San (Free and Easy Wanderer)—one of the most commonly prescribed formulas for women

What the Research Shows

Working with TCM

TCM is a whole-system approach—diagnosis involves pulse, tongue, symptoms, and constitution. Off-the-shelf formulas may or may not match your pattern. If you’re drawn to this approach, consider working with a licensed acupuncturist or TCM practitioner who can individualize treatment.

Ayurveda

The traditional medicine of India, Ayurveda views menopause as a transition from the pitta (fire) life stage to vata (air/ether). Symptoms arise from imbalances in these doshas.

Common Ayurvedic Approaches

Shatavari (Asparagus racemosus):

Ashwagandha (Withania somnifera):

Brahmi (Bacopa monnieri):

Triphala:

  • Three-fruit formula for digestion and elimination
  • Considered foundational for overall health

Lifestyle Practices

Ayurveda emphasizes:

  • Daily routines (dinacharya)—regularity calms vata
  • Warm, cooked, grounding foods
  • Oil massage (abhyanga)—particularly with sesame oil
  • Specific yoga practices for this life stage

Western Herbalism

European and American herbal traditions have their own approaches to supporting women through menopause.

Commonly Used Herbs

Black Cohosh (Actaea racemosa):

Vitex/Chaste Tree Berry (Vitex agnus-castus):

  • Traditional European use for women’s complaints
  • May affect prolactin and progesterone
  • Sometimes used for PMS-like perimenopausal symptoms

Red Clover (Trifolium pratense):

Hops (Humulus lupulus):

Sage (Salvia officinalis):

Motherwort (Leonurus cardiaca):

  • Traditional “women’s herb” for anxiety, heart palpitations
  • Calming without sedation
  • Limited formal research

St. John’s Wort (Hypericum perforatum):

Valerian (Valeriana officinalis):

Nervines and Adaptogens

Beyond specific menopause herbs, many herbalists emphasize:

Nervines (support nervous system):

  • Oat straw, skullcap, lemon balm, passionflower
  • For anxiety, irritability, sleep

Adaptogens (support stress response):

  • Ashwagandha, rhodiola, eleuthero, holy basil
  • For fatigue, resilience, overwhelm

Indigenous and Folk Traditions

Across cultures, menopause has been marked by traditional practices:

Native American traditions:

  • Black cohosh, dong quai (though originally Chinese), red raspberry leaf
  • Many tribes honored menopause as entry into “wise woman” status
  • Sweat lodges and ceremony for life transitions

Latin American traditions:

  • Maca root (Peruvian)—traditional use for energy, libido, fertility
  • Damiana—traditional aphrodisiac
  • Various regional herbs depending on geography

African traditions:

  • Varied by region and culture
  • Often integrated with spiritual practices
  • Many traditional remedies not well documented in Western sources

European folk traditions:

  • “Change of life” teas with sage, red clover, hops
  • Elder flower for sweating
  • Integration with food as medicine

Modern Herbal Blends

The supplement market is full of menopause formulas. Some observations:

What to look for:

  • Transparent ingredient lists with amounts
  • Reputable companies with third-party testing
  • Realistic claims (not miracle cures)
  • Herbs that make sense together

What to be cautious about:

  • Proprietary blends that hide amounts
  • Extravagant claims
  • Very cheap products (quality costs money)
  • Products with many ingredients at low doses (“fairy dusting”)

Finding what works for you:

  • Individual response varies enormously
  • What helps your friend may not help you
  • Give things adequate trial (often 2-3 months)
  • Pay attention to your body’s response

Some women find products like herbal “menopause support” blends helpful. Others don’t. The only way to know is to try—thoughtfully, one thing at a time, paying attention.

How to Think About All This

A Framework for Exploration

  1. Start with safety: Some herbs interact with medications or have contraindications. Research before trying, especially if you’re on other medications.

  2. Consider your constitution: What works for someone else may not work for you. Traditional systems account for individual variation.

  3. Give adequate trials: Herbs often work gradually. Unless you have an adverse reaction, give things 6-8 weeks before deciding.

  4. One thing at a time: Hard to know what’s helping if you change everything at once.

  5. Quality matters: Herbs vary in potency, purity, and preparation. Cheap supplements may be ineffective or contaminated.

  6. Work with practitioners: Herbalists, TCM practitioners, naturopaths, and Ayurvedic doctors can individualize approaches.

  7. Trust your experience: If something helps you feel better, that matters—even if studies are inconclusive.

The Grandmother Test

One herbalist’s framework: “Would my grandmother have used this? Would she have given it to her daughter?”

Traditional remedies that have been used for generations have a track record of at least not causing obvious harm. Novel, concentrated, or isolated compounds are less tested by time.

This isn’t foolproof—some traditional remedies are genuinely dangerous—but it’s one lens for thinking about relative safety.

Safety Considerations

Drug interactions:

  • St. John’s Wort interacts with MANY medications
  • Some herbs affect liver enzymes (CYP450 system)
  • Always disclose herbs to your healthcare providers

Hormone-sensitive conditions:

  • Phytoestrogens (soy, red clover, hops) may affect hormone-sensitive cancers
  • Discuss with oncologist if you have history of breast cancer

Quality and contamination:

  • Herbs can be contaminated with heavy metals, pesticides, or incorrect species
  • Look for third-party testing (USP, NSF, ConsumerLab)
  • Buy from reputable sources

Pregnancy and breastfeeding:

  • Many herbs are contraindicated
  • Some traditional “women’s herbs” are specifically dangerous in pregnancy

“Natural” doesn’t mean safe:

  • Kava: traditional Pacific use, but associated with liver damage
  • Comfrey: traditional use, but contains liver-toxic compounds
  • Traditional ≠ automatically safe

Resources for Further Exploration

Books:

Web:

Finding practitioners:

Quality verification:

The absence of extensive clinical trials doesn’t mean these approaches are worthless—it often means they haven’t been profitable enough to study. Your grandmother’s remedies may hold wisdom that our measurement tools can’t capture. Pay attention to your own body. It knows things.

More paths forward await.

Mind-Body Practices