Index of Herbs

Concern guide

Herbs for Menopause and Hot Flashes

Herbs many women try for hot flashes and night sweats, from black cohosh to sage, with what research shows and how to use them safely.

8 herbs reviewed

Updated October 7, 2026

Menopause is the point when periods stop for good, and the years leading up to it, called perimenopause, are when symptoms usually begin. Hot flashes (hot flushes in the UK) and night sweats are the best known, often alongside broken sleep, mood changes, and vaginal dryness. Every woman’s experience is different: for some it is a mild nuisance, while for others it affects work and sleep for years. Either way, there are good options to explore.

Herbs can be part of that picture. Black cohosh, red clover, and sage are the most-used and most-studied menopause herbs, and many women try them alongside healthy habits and good sleep routines. Hormone therapy is the most effective treatment for hot flashes, and for women who cannot or prefer not to use hormones, the North American Menopause Society highlights cognitive behavioral therapy, clinical hypnosis, and prescription options such as SSRIs or SNRIs, gabapentin, and fezolinetant. These are all worth discussing with a clinician, and herbs can be part of the same conversation.

The herbs below are ordered by strength of evidence, then by how widely they are used. Each is rated as early or mixed evidence: some women find relief, and results vary between studies, partly because menopause trials show large placebo responses that make effects harder to measure. The product matters too, since a European black cohosh extract, a red clover isoflavone tablet, and a kitchen herb are not interchangeable. Each entry ends with the most important caution, and the safety section covers breast cancer history, the liver, and medicine interactions.

02 The shortlist

The herbs, from best studied to time-honored

How to read the ratings

  • Good clinical evidence
  • Promising clinical evidence
  • Early or mixed evidence
  • Long traditional use

Ratings show how much research backs each herb for this particular concern. Every herb links to its full monograph, with preparations, safety notes, and sources.

  1. 01 Black Cohosh

    Early or mixed evidence

    Actaea racemosa

    The best-known and most studied menopause herb, used for hot flashes and night sweats. The EU’s herbal committee accepts three specific extracts as well-established medicines for menopausal complaints, and a 2023 meta-analysis of 22 trials found improvements in hot flashes and overall symptoms, though a 2012 Cochrane review and the year-long HALT trial did not find a clear benefit, and products vary widely in extract and dose. Rarely, products labeled black cohosh have been linked to serious liver injury; dark urine, yellowing skin or eyes, or unusual fatigue mean stopping and seeking care.

    Read the black cohosh monograph →

  2. 02 Red Clover

    Early or mixed evidence

    Trifolium pratense

    Sold as concentrated tablets of isoflavones, plant compounds that resemble estrogen, and one of the most-tried menopause supplements. A 2021 meta-analysis of eight trials found about 1.7 fewer hot flashes a day than placebo, with larger effects in postmenopausal women with frequent flashes, though results vary between studies and a Cochrane review and two US trials did not find a clear benefit. A three-year trial in women with a family history of breast cancer was reassuring on safety. MSKCC advises people with hormone-sensitive cancers to avoid red clover.

    Read the red clover monograph →

  3. 03 Sage

    Early or mixed evidence

    Salvia officinalis

    Garden sage has long been used for excessive sweating, and the EU still lists sage leaf as a traditional remedy for it. Some trials of specific sage extracts report fewer or milder hot flashes over several weeks, and reviewers describe the evidence as promising, though studies are small, extracts differ, and sage in cooking is not the trial product. Sage essential oil contains thujone, which can cause seizures, and should never be swallowed.

    Read the sage monograph →

  4. 04 Maca

    Early or mixed evidence

    Lepidium meyenii

    An Andean root vegetable, eaten as food in Peru and sold as a powder for menopause, mood, and libido. A 2011 review found favorable symptom scores in a handful of small randomized trials, an encouraging start, though the authors felt larger and better trials were needed and safety in supplement doses is not established. Maca is not estrogen replacement. People with hormone-sensitive cancers should talk with their oncology team first, as MSKCC advises, because of estrogen-like signals in laboratory studies.

    Read the maca monograph →

  5. 05 Hops

    Early or mixed evidence

    Humulus lupulus

    Best known for flavoring beer, hop cones contain 8-prenylnaringenin (8-PN), one of the strongest plant estrogens identified, though much less active than the body’s own estradiol, and extracts standardized to 8-PN are sold for hot flashes. In a trial of 67 women, the lower 8-PN dose eased symptoms more than placebo at six weeks, though not at 12, and EMA concluded that the small trials so far do not show a clear effect and a larger one is needed. Hops can cause drowsiness and should not be used after a hormone-sensitive cancer without medical advice.

    Read the hops monograph →

  6. 06 Evening Primrose

    Early or mixed evidence

    Oenothera biennis

    Evening primrose oil is a popular menopause supplement and is generally well tolerated. In a six-week trial of 56 women, hot flashes became less severe with the oil than with placebo, though not less frequent, and NCCIH says more evidence is needed. The oil itself is not estrogenic, but some products add phytoestrogens, so labels are worth checking. Its main caution is bleeding: it may add to the effect of blood thinners and antiplatelet drugs.

    Read the evening primrose monograph →

  7. 07 St. John’s Wort

    Early or mixed evidence

    Hypericum perforatum

    Studied mainly for mild to moderate depression, St. John’s wort also has small studies suggesting help for hot flashes, according to NCCIH, and some European trials have combined it with black cohosh. Its key caution is interactions: it lowers blood levels of many medicines, including hormonal contraceptives still used in perimenopause, warfarin, and several cancer drugs, and with SSRIs or SNRIs, which are also prescribed for hot flashes, it can contribute to serotonin syndrome.

    Read the st. john’s wort monograph →

  8. 08 Valerian

    Early or mixed evidence

    Valeriana officinalis

    Used for the broken sleep that often comes with night sweats. NCCIH reports three small studies suggesting help with menopausal symptoms, and some people taking valerian report sleeping better, though it tends to work gradually and NCCIH says more evidence is needed. It may cause next-day grogginess and should not be combined with alcohol or sedatives; liver injury has been reported in very rare cases, most often with multi-herb products.

    Read the valerian monograph →

03 Caution

Using these herbs safely

Most of these herbs are well tolerated in clinical trials, and a few sensible precautions make them easier to use safely. Some symptoms deserve a clinician’s attention before any remedy: vaginal bleeding after menopause needs prompt investigation, as do very heavy or irregular bleeding during perimenopause, a new breast lump, severe mood changes, and night sweats with fever or weight loss, which can have causes other than menopause. Hot flashes that disrupt sleep or work are worth raising too. Hormone therapy, which NAMS says should be considered within 10 years of the final period, and non-hormonal prescriptions such as SSRIs, SNRIs, gabapentin, and fezolinetant have stronger trial evidence than any herb so far, and are good options to discuss alongside herbs.

A history of breast cancer or another hormone-sensitive condition changes the picture. Red clover and hops contain phytoestrogens; MSKCC advises people with hormone-sensitive cancers to avoid red clover and to consult their doctors before using hops, and neither has been well studied alongside tamoxifen or aromatase inhibitors. Black cohosh does not appear to act as an estrogen, but EMA advises against it after breast or other hormone-dependent cancers without medical advice, and it weakly inhibits CYP2D6, the enzyme that activates tamoxifen. In a trial of 132 patients with breast cancer, black cohosh did not ease hot flashes more than placebo. MSKCC also advises talking with the oncology team before using maca. The same caution about phytoestrogens applies to endometriosis, fibroids, and endometrial cancer.

Two herbs on this page call for particular care. Products labeled black cohosh have been linked to acute liver injury, occasionally needing a transplant; people with liver disease should avoid it, and dark urine, yellow skin or eyes, loss of appetite, or unusual fatigue mean stopping and seeking care. St. John’s wort speeds the clearance of many drugs, and its effect lasts about a week after stopping, so it is worth asking a pharmacist to check every medicine before it is started or stopped. Red clover and evening primrose oil may add to anticoagulants and antiplatelet drugs and are best stopped before surgery, and valerian and hops add to the drowsiness of sedatives and alcohol.

Pregnancy is still possible during perimenopause, and black cohosh, red clover, hops, St. John’s wort, valerian, and medicinal-strength sage are not recommended in pregnancy or while breastfeeding. Product quality matters: EU-licensed black cohosh uses defined extracts, while US supplements vary widely in extract, dose, and quality, and some liver cases may have involved contaminants or the wrong plant. Single-herb products from reputable makers make it easier to tell what is helping; with multi-herb menopause blends that is impossible, and in the HALT trial a multi-herb product did not outperform placebo.

04 Questions

Frequently Asked Questions

Black cohosh is the most popular and most studied choice. The EU licenses specific extracts for menopausal complaints, and a 2023 meta-analysis of 22 trials found it eased hot flashes, though a Cochrane review and the year-long HALT trial did not find a clear benefit. Red clover and sage are the other most-tried options: a 2021 meta-analysis found red clover modestly reduced hot flashes, and small trials of sage extracts report fewer or milder flashes. Results vary from study to study, so it helps to choose a product like the one tested, and EMA advises not taking black cohosh for more than six months without medical advice.

Hormone therapy is more effective, and herbs can still be worth discussing as part of the plan. In a 12-month NIH-funded trial, hot flashes fell by 94% with combined hormone therapy, 57% with red clover, 34% with black cohosh, and 63% with placebo; only hormone therapy did significantly better than placebo. That large placebo response is common in menopause studies, and the North American Menopause Society does not currently recommend herbal remedies for hot flashes. Hormone therapy is not right for everyone, so non-hormonal prescriptions are worth discussing too. If you use herbs alongside any treatment, tell your prescriber: EMA advises combining black cohosh with estrogen only on a doctor’s advice.

Your oncology team is the best guide, because several popular menopause herbs need extra care after breast cancer, and prescription non-hormonal options are worth discussing with them first. EMA advises people treated for breast cancer not to use black cohosh without medical advice, and trials in breast cancer patients did not show it relieved hot flashes more than placebo. Red clover and hops contain phytoestrogens, and MSKCC advises people with hormone-sensitive cancers to avoid red clover; neither should be combined with tamoxifen or aromatase inhibitors unless the oncologist agrees.

Some European products and trials pair the two, but it is worth a pharmacist’s check first. St. John’s wort lowers blood levels of many medicines, including hormonal contraceptives, warfarin, and several cancer drugs, and with SSRIs or SNRIs it can contribute to serotonin syndrome. Single-herb products also make it easier to tell what is helping; in the HALT trial, a multi-herb product containing black cohosh did not outperform placebo.

Liver problems are rare, but they can be serious, so it pays to know the warning signs. Products labeled black cohosh have been linked to acute liver injury, some severe enough to need a liver transplant, although it is often unclear whether the herb, a contaminant, or the wrong plant was responsible. A US Pharmacopeia review rated 30 cases as possible and none as probable, but still recommended a cautionary label. People with liver disease should avoid it, and anyone taking it should stop and see a doctor promptly for dark urine, yellow skin or eyes, loss of appetite, unusual fatigue, or upper abdominal pain.

05 References

Sources

These references support the claims in this guide. Each herb’s monograph carries its own full source list.

  1. The 2023 nonhormone therapy position statement of The North American Menopause Society

    Menopause (PubMed 37252752), 2023

    Supports the non-hormonal options named on this page and the society’s current position that herbal remedies are not recommended for hot flashes.

  2. Black cohosh (Cimicifuga spp.) for menopausal symptoms

    Cochrane Database of Systematic Reviews (PubMed 22972105), 2012

    Supports the finding that black cohosh did not differ clearly from placebo across 16 trials.

  3. Black cohosh extracts in women with menopausal symptoms: an updated pairwise meta-analysis

    Menopause (PubMed 37192826), 2023

    Supports the encouraging black cohosh finding, pooling 22 trials that favored black cohosh for hot flashes.

  4. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial

    Menopause (PubMed 19609225), 2009

    Supports the head-to-head comparison in which only hormone therapy did significantly better than placebo and placebo cut hot flashes by 63%.

  5. Phytoestrogens for menopausal vasomotor symptoms

    Cochrane Database of Systematic Reviews (PubMed 24323914), 2013

    Supports the finding that the red clover extract Promensil did not significantly reduce hot flashes compared with placebo.

  6. Red clover

    Memorial Sloan Kettering Cancer Center, About Herbs, 2022

    Supports the advice that people with hormone-sensitive cancers avoid red clover, and its bleeding cautions.

  7. Black cohosh

    LiverTox, National Institute of Diabetes and Digestive and Kidney Diseases (NIH), 2025

    Supports the warning that products labeled black cohosh have been implicated in acute liver injury, rarely needing transplant.

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