Evidence review
Sage for Hot Flashes
Salvia officinalis
The short answer
Early or mixed evidencePossibly a little, but the evidence is thin. Small trials of specific sage leaf extracts report fewer or milder hot flashes over four weeks to three months, yet they were short, used different products, and two were funded by the tablet’s maker; a 2023 meta-analysis found the pooled result imprecise. Hormone therapy and approved nonhormonal medicines work far better, and sage essential oil should never be swallowed.
6 key studies reviewed
Updated October 12, 2026
Key points
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01
Small trials, modest signal
Four placebo-controlled trials of 66 to 100 women each reported that sage extracts eased at least some hot-flash measures over four weeks to three months.
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02
Pooled result is imprecise
A 2023 meta-analysis of four trials (310 women) reported fewer hot flashes, but its confidence interval included no effect, and severity did not clearly improve.
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03
Trial products are not tea
Studies tested extract tablets or capsules, such as a once-daily fresh sage tablet. No trial has tested kitchen sage or sage tea for hot flashes.
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04
Guidelines do not recommend herbs
The Menopause Society’s 2023 statement does not recommend herbal remedies for hot flashes and calls hormone therapy the most effective treatment.
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05
Thujone sets the limits
Sage oil is rich in thujone, which can cause seizures, so never swallow it. Medicinal sage is not recommended in pregnancy or breastfeeding.
Sage may ease hot flashes a little, but the evidence is early and mixed. A handful of small randomized controlled trials (studies in which women are assigned by chance to sage or a dummy pill) have tested specific extracts of sage leaf (Salvia officinalis) for four weeks to three months, and each reported that women taking sage did better on at least some hot-flash measures. Those trials were small and short, used different products and measures, and two of them were funded by the Swiss company that makes the tablet they tested. When reviewers pooled four of them in 2023, the result for hot-flash frequency was imprecise and the result for severity was not significant. Sage is a reasonable thing to discuss with a clinician, not a proven treatment, and its evidence is far weaker than that for hormone therapy or approved nonhormonal medicines.
Hot flashes are sudden waves of heat, usually over the face, neck, and chest, often with sweating, flushing, and a racing heart, sometimes followed by chills. Night sweats are the same thing during sleep. They are the most common symptom of the menopause transition and often last for several years. Sage has a long history as a remedy for sweating: European herbal tradition treated it as a “drying” herb, and the European Medicines Agency (EMA) still accepts sage leaf as a traditional herbal medicine for relief of excessive sweating, on the basis of long use rather than trials. In the UK and Ireland, a once-daily sage tablet is registered as a traditional remedy for menopausal hot flushes on the same basis. Sage is now one of the most common ingredients in menopause supplements: a 2026 survey of 201 UK menopause supplements found it in 42.8% of them.
This page goes through each trial, including the product, the dose, and who paid for it; what regulators and The Menopause Society (formerly the North American Menopause Society) say; how the tested extracts differ from kitchen sage and sage tea; and who should avoid sage. Nothing here is medical advice. Hot flashes are usually menopausal, but sweating and flushing can also come from an overactive thyroid, infections, some cancers, and medicines, so new or unusual symptoms deserve a diagnosis before any remedy, and a clinician can explain treatments with much stronger evidence.
02 The trials
Key studies
The trials and reviews that carry the most weight for this question, with the product and dose each one tested. Results apply to the preparation studied.
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Moradi et al., 2023
Systematic review and meta-analysis of 4 trials
- Who
- 310 postmenopausal women
- What and how much
- Sage extract capsules or tablets, about 100–300 mg a day
- How long
- 4 weeks to 3 months
Reported fewer hot flashes than placebo (effect size −1.12), but the 95% confidence interval (−2.37 to 0.14) included no effect; severity was not significantly reduced (−2.05, −6.53 to 2.43), and the trials disagreed widely (I² 70–71%).
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Kiani Rad et al., 2016
Randomized, double-blind, placebo-controlled
- Who
- 100 postmenopausal women with hot flashes (Shiraz, Iran)
- What and how much
- Sage tablets, 100 mg, three a day
- How long
- 8 weeks
Hot flashes, night sweats, and menopause rating scores fell significantly more than with placebo; estradiol levels did not differ between groups. The abstract gives no effect sizes.
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Sadeghi et al., 2013
Randomized, triple-blind, placebo-controlled
- Who
- 84 women aged 45–60 with hot flashes (Lahijan, Iran)
- What and how much
- Sage extract capsule, 100 mg once a day
- How long
- 8 weeks
Hot flashes fell in both groups. The significant result (p = 0.004) is reported as a before-and-after drop within the sage group rather than a direct comparison with placebo.
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Dimpfel et al., 2021
Randomized, double-blind, placebo-controlled; manufacturer-funded
- Who
- 80 women aged 48–65 (48 in the main analysis)
- What and how much
- Menosan tablet (A.Vogel), 280 mg thick extract of fresh sage, once daily
- How long
- 4 weeks
Hot-flush severity halved in 59.1% on sage versus 26.9% on placebo (p = 0.024); among all 78 women with data, 55% versus 32.5% (p = 0.043). Funded by A.Vogel.
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Zeidabadi et al., 2020
Randomized, double-blind, placebo-controlled
- Who
- 66 postmenopausal women (59 finished; Shiraz, Iran)
- What and how much
- Sage extract tablets, 100 mg, three a day
- How long
- 3 months
The flushing score on the Menopause Rating Scale fell 1.6 units more than with placebo (P < 0.001), with better sleep and mood scores. No outside funding.
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Bommer et al., 2011
Open-label, no placebo group; manufacturer-funded
- Who
- 71 postmenopausal women with at least 5 hot flashes a day (69 analyzed)
- What and how much
- Once-daily tablet, 280 mg thujone-free thick extract of fresh sage leaves (A.Vogel Bioforce)
- How long
- 8 weeks
A score combining hot-flash number and intensity fell 50% by week 4 and 64% by week 8, but without a placebo group part of this reflects the placebo response.
03 Evidence
What the research shows
Our rating for Sage for Hot Flashes, based on the studies below.
The only meta-analysis (a study that pools the results of several trials) devoted to sage and hot flashes is by Moradi and colleagues at Mashhad University of Medical Sciences (International Journal of Community Based Nursing and Midwifery 2023). It included four randomized trials with 310 women, three from Iran and one from Germany. All four reported benefits, but the pooled numbers were less convincing. For hot-flash frequency the authors reported an effect size of −1.12 and called it significant, yet the 95% confidence interval (the range in which the true effect probably lies) ran from −2.37 to 0.14, which includes no effect at all. For severity the pooled result (−2.05; −6.53 to 2.43) was not significant. Heterogeneity was high (I² of 71% and 70%), meaning the trials disagreed more than chance would explain. One included trial, of 80 women, compared sage with black cohosh rather than placebo and did not report blinding; the paper contains reporting errors, such as naming yarrow instead of sage in its research question; and it did not include the 100-woman Iranian trial described below. The authors, who declared no conflicts of interest, concluded that sage can reduce hot-flash frequency but that wider use should wait for confirmation.
The Iranian trials tested 100 mg sage extract capsules or tablets. The largest, by Kiani Rad and colleagues at Shiraz University of Medical Sciences (International Journal of Medical Research & Health Sciences 2016), gave 100 postmenopausal women three 100 mg sage tablets or placebo a day for eight weeks. Hot flashes, night sweats, and scores on the Menopause Rating Scale (a standard questionnaire of menopausal symptoms) fell significantly more with sage, while blood estradiol (the main estrogen) did not differ between groups. Sadeghi and colleagues (Complementary Medicine Journal 2013) gave 84 women aged 45 to 60 one 100 mg capsule or placebo daily for eight weeks; hot flashes fell in both groups, and the abstract reports its significant result (p = 0.004) as a before-and-after drop within the sage group rather than a direct comparison with placebo. Zeidabadi and colleagues (Journal of Family Medicine and Primary Care 2020) randomized 66 women to three 100 mg tablets a day, made by Gol Daroo in Isfahan, or placebo for three months, and 59 finished. The flushing score fell 1.6 units more with sage (P < 0.001), alongside better sleep and mood scores. Zeidabadi’s team declared no outside funding, and the other two abstracts do not mention funding; none of the three describes how its extract was standardized, and the abstracts give few effect sizes.
The other two trials tested a once-daily tablet from the Swiss herbal company A.Vogel (Bioforce), and both were sponsored by it. Bommer, Klein, and Suter (Advances in Therapy 2011), two of whom worked for the company, gave 71 women who had been postmenopausal for at least a year and had at least five hot flashes a day one tablet daily for eight weeks, with no placebo group. Each tablet held 280 mg of a thick (spissum) extract of fresh sage leaves with thujone below 10 parts per million. A score combining the number and intensity of hot flashes fell 50% by four weeks and 64% by eight, and the daily number of hot flashes fell 59%. Because everyone knew they were taking sage, these figures include the placebo response, and the authors themselves noted that placebo had reduced hot flashes by 11% to 40% in other trials. The later placebo-controlled trial, by Dimpfel, Nina, and Bommer (Heliyon 2021), randomized 80 women aged 48 to 65 to the same tablet, sold in Switzerland as Menosan, or placebo for four weeks. In the main analysis, limited by the study plan to 48 women aged 48 to 56, 59.1% on sage versus 26.9% on placebo halved their hot-flush severity score (p = 0.024); among all 78 women with data the figures were 55% and 32.5% (p = 0.043). Bommer is a company employee, and four weeks is too short to show whether the effect lasts.
Regulators have accepted sage only on the basis of tradition. EMA’s herbal committee (HMPC) lists sage leaf as a traditional herbal medicine for relief of excessive sweating, with no specific menopause indication; its assessment report cites the Bommer trial as supporting traditional use. National traditional registrations allow A.Vogel’s Menoforce tablet to be sold in the UK and Ireland for menopausal hot flushes, again “based exclusively on long-standing use.” In the United States, sage products are sold as dietary supplements, which the Food and Drug Administration does not approve before sale. The US National Center for Complementary and Integrative Health (NCCIH) says a few small studies suggest common sage might help reduce the frequency of hot flashes, and that there is too little research for firm conclusions. The Menopause Society’s 2023 nonhormone therapy position statement does not recommend supplements or herbal remedies for hot flashes, though sage is not among the herbs it lists. It recommends cognitive behavioral therapy, clinical hypnosis, SSRIs and SNRIs (antidepressants that also reduce hot flashes), gabapentin, and fezolinetant on its strongest level of evidence, and calls hormone therapy the most effective treatment.
Big questions remain. None of the trials found ran longer than three months, none compared sage with a proven treatment, and none tested sage tea. How sage might work is unknown. In laboratory tests by Rahte and colleagues (Planta Medica 2013), a sage tincture showed no estrogen-like activity as a whole, though one fraction did, traced to common plant flavonoids, and it did not act like an SSRI. Products also differ: Maggini and colleagues (Molecules 2023) found no detectable thujone in four commercial sage supplements labeled for menopause, but one had 1.8 to 3.2 times the polyphenols of the others. Menopause trials show large placebo responses, so small, briefly reported, or unblinded studies can easily overstate a benefit. A larger, independently funded, placebo-controlled trial using hot-flash diaries over at least three months is the obvious next step.
04 In practice
How it was taken in studies
Studies used concentrated extracts, not kitchen sage. The Iranian trials gave 100 mg sage extract capsules or tablets once a day (Sadeghi) or three times a day (Kiani Rad and Zeidabadi) for eight weeks to three months. The two A.Vogel trials used one tablet a day containing 280 mg of a thick extract of fresh sage leaf, which the papers equate to 3,400 mg of fresh-sage tincture, with thujone below 10 parts per million. The Irish leaflet for Menoforce, the version registered in Ireland, lists 51 mg of dry extract from fresh sage leaves per tablet (equivalent to 795–1,370 mg of fresh herb, extracted with 68% ethanol), one tablet daily for adults. The labels describe the extract differently from the trial papers, so whether the products are identical is not clear from them alone. In the trials that found a benefit, changes appeared within the first few weeks, and the difference from placebo in the four-week A.Vogel trial was significant from week 3.
EMA’s monograph gives traditional doses of several sage leaf preparations for excessive sweating, such as a tea of 2 g of dried leaf in 150 ml of boiling water, 80–160 mg of a dry water extract three times a day, or 0.5–1 ml of a liquid extract three times a day, with 1.5 ml an hour before bed for night sweats. It advises seeing a doctor if sweating has not improved within six weeks and does not recommend sage for anyone under 18. The Irish Menoforce leaflet says to talk to a doctor if symptoms worsen or have not improved within 12 weeks, and that long-term safety has not been established. These are label directions, not proof that a given dose works for hot flashes.
Kitchen sage, sage tea, and trial extracts are different exposures. A pinch of sage in a recipe is food. Sage tea matches EMA’s traditional preparation for sweating, but no trial has tested tea for hot flashes, and the strength of a home brew varies with the leaf and the steeping time. Extracts deliver a measured dose, and the better-made ones limit thujone; EMA requires sage leaf medicines to state their thujone content and keep daily intake below 6.0 mg. Supplements sold outside these licensing schemes may not state the extract, ratio, or thujone content at all. Anyone who decides to try sage is best served by a single-herb product that names its extract and dose, ideally like one that was tested, and by keeping a simple hot-flash diary to judge whether it helps.
05 Caution
Before you try sage
Side effects in the trials were few and mild. In the open A.Vogel trial, 10 adverse events occurred in six of 71 women, and only mild abdominal pain and mild diarrhea in one woman were judged related to sage; blood tests, including liver enzymes, did not change meaningfully. The placebo-controlled A.Vogel trial recorded three adverse events in total, none judged related to treatment, and two of the Iranian trials reported no side effects. These trials lasted three months at most. EMA lists no known side effects for sage leaf at its traditional doses. NCCIH says sage is likely safe in food amounts and that larger amounts have been used safely for up to eight weeks in studies, but that it may be unsafe in high doses or over long periods because of thujone.
Thujone, a compound concentrated in sage essential oil, can cause seizures. EMA’s assessment report describes convulsions after people swallowed sage oil, including a 5-year-old who had a 10-minute seizure after taking about 5 ml for colic, and notes that oil equal to more than 15 g of sage leaf can cause a sense of heat, a racing heart, dizziness, and seizures. Sage essential oil should never be swallowed, added to drinks, or given to children. People with epilepsy or another seizure disorder should avoid sage oil and talk to a doctor before using medicinal sage at all; the placebo-controlled trial excluded women with epilepsy. EMA does not recommend medicinal sage in pregnancy or while breastfeeding because safety has not been established, NCCIH warns it may be unsafe in pregnancy, and EMA’s report notes sage’s folk use to reduce milk supply during weaning. Pregnancy is still possible in perimenopause. Sage medicines are not recommended for anyone under 18, and anyone allergic to sage should avoid it.
EMA lists no drug interactions for sage leaf, which mostly reflects a lack of study. The Irish Menoforce leaflet says not to take it with barbiturates or benzodiazepines (sedatives such as diazepam) and warns that it may affect the ability to drive. Because thujone can trigger seizures, anyone taking anti-seizure medicine should ask their doctor first. In laboratory work one fraction of a sage extract showed weak estrogen-like activity, and what that means in people is unknown, so women with a history of breast cancer or another hormone-sensitive cancer, or who take tamoxifen or an aromatase inhibitor, should discuss sage with their oncology team. As with any herbal product, tell your doctor and pharmacist that you are taking it.
Some symptoms need a doctor rather than a herb. Hot flashes or night sweats with fever, unexplained weight loss, swollen glands, or drenching sweats can signal infection, lymphoma, or another illness. Flushing outside the usual menopausal pattern also needs checking: starting before 40, without any change in periods, returning years after menopause symptoms settled, in men not on hormone-lowering treatment, or with diarrhea, wheezing, palpitations, tremor, or heat intolerance, which can point to thyroid disease or rarer hormone-secreting tumors. Any bleeding after menopause needs prompt investigation. When hot flashes disrupt sleep or work, see a clinician: hormone therapy, which The Menopause Society calls the most effective treatment, and nonhormonal options such as SSRIs, SNRIs, gabapentin, and fezolinetant have far stronger evidence than sage.
06 Questions
Frequently Asked Questions
Nobody knows, because no trial has tested sage tea for hot flashes. The studies used concentrated extract tablets or capsules. Europe’s herbal committee accepts a tea of 2 g of dried sage leaf in 150 ml of boiling water as a traditional remedy for excessive sweating, based on long use rather than trials. Occasional cups are unlikely to cause harm for most adults outside pregnancy and breastfeeding, but the strength of home-brewed tea varies, and tea should not replace a medical assessment if hot flashes are disrupting your sleep or work.
In trials that found a benefit, changes began within the first few weeks. In a four-week placebo-controlled trial of a Swiss sage tablet, the difference from placebo became significant from week 3, and in an open trial of the same tablet hot flashes fell week by week over eight weeks. The Iranian trials measured results after eight weeks or three months. Europe’s herbal committee advises seeing a doctor if excessive sweating has not improved within six weeks of using sage, and the Irish Menoforce leaflet says 12 weeks. If nothing has changed by then, it makes sense to stop and discuss other options.
No. The Menopause Society calls hormone therapy the most effective treatment for hot flashes, and it recommends nonhormonal medicines such as SSRIs, SNRIs, gabapentin, and fezolinetant, plus cognitive behavioral therapy and clinical hypnosis, on its strongest level of evidence. Those treatments have been tested in large trials. Sage has a few small, short trials, and no study has compared it directly with any of them. The society’s 2023 statement does not recommend herbal remedies for hot flashes. Sage may suit someone with mild symptoms who prefers to try a herb after talking options through with a clinician.
It is hard to say. One small Iranian trial of 80 women compared sage with black cohosh and reported faster improvements with sage, but it did not report blinding. Black cohosh has far more trials, with mixed results: The Menopause Society cites a 2012 Cochrane review of 16 trials (2,027 women) that found no significant difference from placebo in hot-flash frequency. Red clover is the other common herbal choice. None of these herbs has evidence close to that of hormone therapy or approved nonhormonal medicines.
Few interactions are known, but they have barely been studied, and Europe’s herbal committee lists none for sage leaf. The Irish leaflet for the Menoforce sage tablet says not to combine it with barbiturates or benzodiazepines, such as diazepam, and warns that it may affect driving. Because the thujone in sage can trigger seizures, ask your doctor first if you take anti-seizure medicine. If you have had breast cancer or take tamoxifen or an aromatase inhibitor, check with your oncology team. Always tell your pharmacist about any herbal product you use.
Do not swallow it. Sage essential oil is concentrated in thujone, which can cause seizures; Europe’s herbal committee describes young children who had seizures after being given sage oil, and notes that oil equal to more than 15 g of leaf can cause a racing heart, dizziness, and convulsions. None of the hot-flash trials used the oil. They used leaf extracts, and the Swiss tablet tested in two of them was made with thujone below 10 parts per million. Keep sage oil away from children, and avoid it entirely if you have a seizure disorder or are pregnant.
07 References
Sources
These references support the claims on this page. They are not an endorsement of any product. The sage monograph carries its own full source list.
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The Effect of Salvia Officinalis on Hot Flashes in Postmenopausal Women: A Systematic Review and Meta-Analysis
International Journal of Community Based Nursing and Midwifery (PubMed 37489230), 2023
Moradi et al.: 4 trials, 310 women (Sadeghi, Masoumi, Zeidabadi, Dimpfel); frequency ES −1.12 (95% CI −2.37 to 0.14, I² 71%); severity ES −2.05 (−6.53 to 2.43, I² 70%); one trial used black cohosh as comparator; no conflicts declared.
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The effect of salvia officinalis tablet on hot flashes, night sweating, and estradiol hormone in postmenopausal women
International Journal of Medical Research & Health Sciences 5(8):257–263, 2016
Kiani Rad et al.: double-blind RCT, 100 postmenopausal women in Shiraz, three 100 mg sage or placebo tablets daily for 8 weeks; hot flashes, night sweats, and MRS fell significantly more with sage; estradiol did not differ between groups.
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Effect of sage extract on hot flashes in postmenopausal women
Complementary Medicine Journal, Arak University of Medical Sciences 2(4):324–335, 2013
Sadeghi et al.: triple-blind RCT, 84 women aged 45–60, 100 mg sage extract or placebo capsule daily for 8 weeks; hot flashes fell in both groups; significant pre–post drop in the sage group (p = 0.004).
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Effectiveness of Menosan® Salvia officinalis in the treatment of a wide spectrum of menopausal complaints. A double-blind, randomized, placebo-controlled, clinical trial
Heliyon (PubMed 33615001), 2021
Dimpfel, Nina, Bommer: 80 women, 280 mg fresh sage extract tablet or placebo for 4 weeks; ≥50% hot-flush severity reduction 59.1% vs 26.9% (PP, n = 48) and 55% vs 32.5% (ITT, n = 78); epilepsy excluded; sponsored by A.Vogel, Bommer an employee.
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The effect of Salvia officinalis extract on symptoms of flushing, night sweat, sleep disorders, and score of forgetfulness in postmenopausal women
Journal of Family Medicine and Primary Care (PubMed 32318472), 2020
Zeidabadi et al.: double-blind RCT, 66 women (59 completed), 100 mg Gol Daroo sage tablets three times daily for 3 months; flushing score fell 1.6 units more than placebo (P < 0.001); no financial support declared.
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First time proof of sage’s tolerability and efficacy in menopausal women with hot flushes
Advances in Therapy (PubMed 21630133), 2011
Bommer, Klein, Suter: open, uncontrolled trial in 71 women (ITT 69); once-daily 280 mg thujone-free fresh sage tablet; TSIRHF −50% at 4 and −64% at 8 weeks; 2 related mild GI events; sponsored by A.Vogel Bioforce, which employed two authors.
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European Union herbal monograph on Salvia officinalis L., folium (Revision 1)
European Medicines Agency (EMA/HMPC/277152/2015), 2016
Traditional use for excessive sweating; posology (tea 2 g in 150 ml, dry extract 80–160 mg three times daily, night-sweat dose); see a doctor after 6 weeks; not under 18; not in pregnancy or lactation; no known interactions; thujone below 6.0 mg a day.
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Assessment report on Salvia officinalis L., folium and Salvia officinalis L., aetheroleum (Revision 1)
European Medicines Agency (EMA/HMPC/150801/2015), 2016
Summarizes Bommer as supporting traditional use; UK and Irish registrations for menopausal hot flushes; seizures from sage oil, including a 5-year-old after about 5 ml; overdose above 15 g leaf equivalent; folk antilactagogue use; 6 mg thujone limit.
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Sage: Usefulness and Safety
National Center for Complementary and Integrative Health (NIH), 2025
A few small studies suggest common sage might reduce hot-flash frequency; likely safe in food amounts and used safely up to 8 weeks in studies; thujone makes high doses, long-term use, and pregnancy use potentially unsafe; FDA does not approve supplements before sale.
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The 2023 nonhormone therapy position statement of The North American Menopause Society
Menopause (PubMed 37252752), 2023
Recommends CBT, clinical hypnosis, SSRIs/SNRIs, gabapentin, and fezolinetant (Level I); does not recommend supplements/herbal remedies, a list that omits sage; hormone therapy most effective; cites a 2012 Cochrane review of black cohosh (16 RCTs, 2,027 women) showing no benefit.
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Package Leaflet: Information for the User — Menoforce Sage tablets
A.Vogel Ireland, via Health Products Regulatory Authority (TR 2309/004/001), 2021
Traditional use for menopausal hot flushes and excessive sweating; 51 mg dry extract of fresh sage leaves, one tablet daily for adults; not in pregnancy, breastfeeding, or under 18; avoid with barbiturates or benzodiazepines; see a doctor after 12 weeks.
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Salvia officinalis for hot flushes: towards determination of mechanism of activity and active principles
Planta Medica (PubMed 23670626), 2013
Rahte et al.: in vitro, the whole tincture was not estrogenic and showed no serotonin reuptake inhibition; an aqueous ethanolic subextract was estrogenic, traced to luteolin glycosides.
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The Different Phytochemical Profiles of Salvia officinalis Dietary Supplements Labelled for Menopause Symptoms
Molecules (PubMed 38202677), 2023
Maggini et al.: four commercial sage products had no detectable thujones or isoflavones, but one had 1.8–3.2 times the polyphenols of the others; authors stress quality control.
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What is in the bottle? An analysis of the ingredients in menopause supplements
Climacteric (PubMed 42722014), 2026
Sullivan et al.: of 201 UK menopause supplements, sage was the most common herb (42.8%); ingredients and doses varied widely despite limited evidence.
Other herbs reviewed for menopause & hot flashes
- Black Cohosh for Hot Flashes Early or mixed evidence