Can sage help with menopause symptoms?

You probably know sage as a fragrant herb that can add a savoury kick to your cooking – but you may also be wondering whether it deserves its reputation as a remedy for menopause symptoms.

As we’ll explain, there’s good evidence that common sage – Latin name Salvia officinalis – can improve at least some aspects of hot flushes and night sweats. Studies also suggest it could help with a number of other menopause symptoms, although that research is less clear-cut.

We’ll also consider the chemical compounds that might be behind these benefits, and look at safety, the different ways you can take sage, how much to take and what the numbers on sage tablets actually mean.

Finally, we’ll touch on clary sage (Salvia sclarea), a less-researched cousin of common sage, as well as some other supplements that can help with menopause symptoms.

Potential benefits of sage for menopause

Research into the potential benefits of sage for treating menopause symptoms has mostly focused on hot flushes and night sweats. A review of multiple studies found that tablets or capsules containing sage extract significantly reduced the frequency of hot flushes, although not necessarily their severity.

US government body the National Center for Complementary and Integrative Health (NCCIH) agrees that although there has only been a relatively limited amount of research, sage could be helpful in reducing the frequency of hot flashes.

When it comes to the potential benefits of sage for other menopause symptoms, more research is needed, but small clinical trials have found improvements in:

• hot flushes and night sweats
• physical fatigue
• brain fog
• sleep quality
• muscle and joint aches
• anxiety
• libido

The NCCIH also says that a handful of studies suggest that taking sage supplements may improve memory and brain function in the general population.

Overall, it seems there’s good evidence that sage supplements can improve hot flushes but not yet enough to say for sure whether they can help with other menopause symptoms.

How might sage work for menopause symptoms?

Most menopause symptoms are the result of changing levels of reproductive hormones, particularly oestrogen.

Sage contains phytoestrogens – chemical compounds with a structure similar to oestrogen. They can mimic some of its effects by binding with the oestrogen receptors around your body.

Although phytoestrogens have a much weaker effect than oestrogen itself, it’s possible that at the right dosage the phytoestrogens in sage could contribute to its apparent benefits for menopause symptoms.

Sage also contains a range of polyphenols – plant compounds with antioxidant and anti-inflammatory properties. One of these is rosmarinic acid, which you’ll see mentioned as the active ingredient on the labels of many supplements.

Rosmarinic acid has been linked to improved brain function, but this has currently only been demonstrated in animal studies.

Different ways to take sage

Apart from using it in cooking, there are a number of ways you can take sage in a more concentrated form:

• Sage tablets, pills and capsules: These usually contain sage extract, made by processing sage leaves to isolate the active ingredients. Some capsules contain a combination of sage extract and powdered leaves. Choose supplements labelled ‘thujone-free’ (see section on safety below).
• Sage tinctures: Tinctures are sage extract dissolved in alcohol and then usually mixed with water. You add drops of the tincture to water or other drinks.
• Sage tea: Sage tea is a traditional herbal remedy. You can buy packets of dried sage leaves to make tea, although it’s hard to know how much of the active ingredients you’re actually consuming.
• Sage essential oils: Sage essential oils are used for aromatherapy, with a few drops added to an oil burner or to bathwater, or diluted for use in massage. One small study found that aromatherapy using sage oil improved sexual function in postmenopausal women.

Sage dosage and how long it takes to work

Here, we’ll look at what scientific studies can tell us about how much sage might be effective for treating menopause symptoms, and how long it might take to work. We’ll focus on sage tablets and capsules, as these are the most popular form of sage supplement and the most commonly used in studies.

Understanding the labels

Before we consider how much sage to take, it’s worth explaining what some of the numbers and terms on the supplement labels actually mean.

Confusingly, supplement manufacturers may use either or both of two different numbers to describe the amount of sage a product contains.

For example, you may see something like:

• ‘2500mg of sage as 500mg sage leaf extract’

This means the manufacturer has processed 2500 milligrams (mg) of sage leaf to produce 500mg of sage extract.

The extraction process gets rid of some of the fibrous raw materials but keeps the important plant compounds. In this case, the actual tablet or capsule you take will be 500mg not 2500mg.

You may also see this:

• On the front of the packet: ‘1000mg’
• On the back: ‘Each tablet provides the equivalent of 1000mg of sage, provided by a 5:1 sage extract’

This means the contents of each tablet started out as 1000mg of sage leaf and has been reduced in weight by five times to create the extract. So despite saying 1000mg on the front, each tablet will actually contain only one fifth of that in sage extract: 200mg.

Just to complicate things further, some products contain a combination of sage leaf extract and powdered sage leaf.

So if you want to know how much sage you are getting, and in what form, make sure to read the label carefully – and don’t assume that the biggest number has the largest amount of the active ingredients.

Whatever the numbers, each product should tell you how many tablets or capsules to take each day. You shouldn’t exceed the recommended dose.

Sage supplements in scientific studies

In most of the studies referred to in this article, participants took around 300mg per day of sage extract. In one, they took just 100mg.

In all of these studies, participants found that the frequency of their hot flushes was significantly reduced. In two of the studies that used the higher dosages, participants also reported improvements in other menopause symptoms, including fatigue, anxiety, muscle and joint pain, sleep problems and libido.

What’s a little confusing – and demonstrates the need for more research in this area – is that in one of these studies the improvements were seen after just one week, while in others they weren’t seen until 10 or even 12 weeks.

This could be due to differences between the products used in the studies, as well as between the groups of participants, but it suggests that for some women, sage supplements may take a while to have an impact or that a higher dose might work better.

Safety and side effects

Studies using sage capsules or tablets have found that daily doses of up to 300mg taken for as long as 3 months were safe for postmenopausal women and caused no side effects.

While the NCCIH backs up these findings, it also points out that sage contains a chemical compound called thujone that can be toxic in large amounts. There are a number of sage supplements on the market that are thujone-free so if you’re interested in trying sage, it’s a good idea to choose one of these.

The NHS doesn’t have anything specific to say about sage as a supplement but does recommend talking to your doctor or a pharmacist if you're thinking about taking a herbal remedy for menopause symptoms, particularly if you’re already on a prescription medicine.

It’s important to remember that sage essential oils are for external use only. You should also keep them away from your eyes and should not apply them to your skin without diluting them first. To be safe, make sure to read the instructions on the packet before use.

Clary sage oil

Clary sage (Salvia sclarea) is a different species to common sage but it also contains rosmarinic acid. It’s generally sold as an essential oil for use in aromatherapy.

There’s some evidence that clary oil used as an aromatherapy treatment – inhaled as a vapour or in massage – may help with menopause symptoms including hot flushes, anxiety and poor sleep.

However, full details of the research are hard to come by, and it seems that many studies may involve very small numbers of participants and may not be proper clinical trials, so it’s unclear whether positive results are based on more than the placebo effect.

Other supplements to help with menopause symptoms

The following natural supplements are formulated by doctors and can help with menopause symptoms, or provide support for the different changes your body is going through during this time.

To see the maximum benefits, these supplements are generally best taken for at least 12 weeks.

• Gut health: The friendly bacteria in Better Gut probiotics help maintain the balance of your gut microbiome and the gut-hormone connection during menopause, improving symptoms including bloating, hot flushes, anxiety and fatigue.
• Sleep: The blend of ashwagandha, saffron, magnesium glycinate and vitamins B6, B12 and D3 in Better Night is formulated to support relaxation, nervous system function and night time balance as part of your evening routine.
• Metabolism: The key nutrients and plant extracts – including berberine, myo-inositol, chromium picolinate and cinnamon extract – in Better Metabolism can help with increased food cravings, dips in energy and changes in blood sugar balance during menopause.
• Libido: The essential minerals and vitamins, including zinc, vitamin E and niacin, in Better Libido contribute to normal hormone function, energy metabolism and psychological function, while botanicals like maca root, cordyceps, ginseng and gingko support vitality and sexual wellbeing.

Summary

There’s good evidence that taking a daily sage extract supplement can reduce the frequency of hot flushes for menopausal women. It may also help with other menopause symptoms, but more research is needed before scientists can say.

Sage contains phytoestrogens that mimic some of the effects of oestrogen around your body. It also contains the active ingredient rosmarinic acid.

Sage supplements include tablets, capsules and tinctures containing sage extract, sage leaf tea, and sage essential oils used in aromatherapy. In most studies involving menopausal women, participants took tablets or capsules delivering daily amounts of between 100mg and 300mg of sage extract.

The time it took for participants to see significant benefits varied between studies. Some report immediate improvements while others took up to 12 weeks.

Research suggests that sage supplements are generally safe and without side effects for menopausal women when taken in the amounts and for the lengths of time studied. However, if you’re on a prescription medicine, it’s important to talk to your doctor before taking a herbal remedy.