Top Herbs to Help You Cope Through Perimenopause Symptoms Before Trying HRT

Perimenopause is a time of significant physiological and psychological changes for women. Many describe feeling like something is ‘off,’ yet they’re often told there’s nothing they can do—unless they opt for hormone replacement therapy (HRT) to manage their symptoms.

If you’re in perimenopause and experiencing frustrating symptoms, I have good news for you. Many herbs can support your body during this time when it needs a little extra TLC.

In this article, we’ll explore perimenopause and its symptoms, highlight lifestyle changes that promote hormonal balance, and introduce the top herbs to help manage your symptoms. Let’s dive in!

Perimenopause and Its Symptoms

Perimenopause is the transitional period marked by changes in a woman’s menstrual cycle, often accompanied by menopause-related symptoms. These signs typically begin in a woman’s 40s, though some may notice changes as early as their mid-30s.

Some symptoms are subtle, and some aren’t so subtle. You may experience symptoms such as:1

• Irregular menstrual cycles, with often increased heaviness
• Worsening premenstrual syndrome (PMS) or period symptoms
• Increased anxiety and risk of depression
• Reduced quality and duration of sleep
• Hot flashes
• Mood changes
• Vaginal and bladder problems
• Changes to cognition
• Fatigue
• Decreased sex drive
• Weight gain
• Insulin resistance
• Bone loss
• Headaches
• Fertility problems
• Uterine bleeding
• Joint pain or stiffness

The average length of perimenopause is about 3 to 4 years, though some women experience symptoms up to 10 years.

Hormone Replacement Therapy – Risks and Benefits

As its name suggests, hormone replacement therapy (HRT) is a treatment that uses synthetic hormones to replace your own natural hormones. Many doctors recommend HRT to women for its well-known potential benefits, including:

• Prevention of osteoporosis2
• Relief or management of symptoms such as mood swings and depression3
• Improvement in sex life and overall quality of life4
• Reduced likelihood of developing diabetes for individuals with prediabetes5

But what about early perimenopause before you’re ready to start hormone replacement is there anything else you can do to support your?

Fortunately, there are many natural alternatives, including herbal remedies, that you can try before turning to HRT. 

Adopt a Whole-Person Approach to a Healthy Lifestyle

As a naturopathic physician with extensive experience in herbal medicine, I believe herbs can be incredibly effective in supporting your health. However, relying on herbs alone without building a healthy lifestyle foundation may not yield the results you’re seeking. Adopting a whole-person approach is essential for making a significant impact on your ovarian responsiveness.

Here are a few things to consider in combination with herbal support:

• Improve insulin resistance with intermittent fasting
• Reduce consumption of highly processed foods
• Build lean muscle mass
• Avoid toxin buildup by promoting detoxification
• Balance inflammation
• Spend time outdoors and support a healthy circadian rhythm (ex: grounding, cold plunging, hiking, forest bathing, getting maximal light exposure during the noon hours)
• Manage stress and mental health
• Regulate and support your nervous system

Now that we’ve established a healthy foundation, let’s explore the top herbs for perimenopause symptoms.

Herbs to Help Manage Perimenopause Symptoms

Vitex

Vitex agnus-castus, also known as chaste tree, chasteberry plant, and Vitex, is a large flowering shrub found throughout Southern Europe, the Mediterranean, and Central Asia.8 Vitex has been used widely since ancient times for female reproductive problems. In fact, there are references to its value for “diseases of the uterus” dating as far back as the 4th century BC!9

Scientists attribute the benefits of Vitex to its:

• Dopaminergic activity, which helps regulate prolactin levels, thereby balancing other hormones10
• Affinity for opioid receptors, which may help relieve PMS symptoms like depression, fatigue, and irritability11
• Ability to increase melatonin secretion, which may help with perimenopause-related sleep disturbances12

One clinical trial showed that participants who took Vitex for 8 weeks had less anxiety and vasomotor dysfunction than those who took the placebo.13 In another study, pre-and postmenopausal women were asked to take an herbal formula consisting of black cohosh, dong quai, milk thistle, red clover, American ginseng, and vitex. The women who received this treatment reported significant decreases in hot flashes and night sweats, accompanied by improved sleep quality.14

It’s important to note that the effects of Vitex are dose-dependent. I encourage you to work with an experienced herbalist to determine the right dose for you.

Maca

If there could be royalty among herbs used for fertility benefits, maca would undoubtedly take the crown. In addition to boosting fertility, maca, also known as Lepidium meyenii or Peruvian ginseng, may have the following potential benefits for women:15,16,17

• Boost in energy
• Increased libido
• Improved mood
• Reduced blood pressure
• Lower inflammation

In one study, perimenopausal women who took maca reported significant improvements in negative physiological and psychological symptoms, including hot flashes, insomnia, depression, and more.18

Maca supports all glandular functions, including your thyroid, adrenals, and ovaries. You can learn more about maca’s benefits for perimenopausal women here.

Shatavari

Known to many as the “queen of herbs,” Shatavari (Asparagus racemosus) is an amazing adaptogenic herb used for centuries by Ayurvedic practitioners as a rejuvenating female reproductive tonic.19 In fact, Shatavari can be translated as “100 spouses,” implying its ability to boost fertility.

The roots of Shatavari may benefit women experiencing perimenopause in the following ways:20,21,22,23

• Slowing down signs of aging
• Increasing longevity
• Improving immune function
• Boosting vigor and vitality
• Enhancing cognitive function
• Supporting increases in muscle size and strength gained by strength training
• Maintaining bone density
• Reducing vaginal dryness that is a result of declining estrogen levels
• Regulating inflammation
• Alleviating depression

One recently published study explored the effects of Shatavari for women experiencing menopausal symptoms. The women who took shatavari showed significant improvements in hot flashes, night sweats, sleep disturbances, anxiety, nervousness, vaginal dryness, and loss of libido.24 Notably, there were no significant adverse events reported in the treatment group, which suggests that shatavari may be a safe herbal remedy for perimenopausal women.

Dong Quai

Angelica sinensis, commonly known as dong quai, is a perennial herb with a long history of use in traditional Chinese medicine. Some practitioners refer to dong quai as the “female ginseng” because of its use for various health conditions affecting women, including painful menstrual cramps or menopausal symptoms.25

Research data on the effects of dong quai alone for menopausal symptoms are inconclusive. Herbalists often use dong quai in formulations with other herbs. However, dong quai stands out for its high polyphenol content. Polyphenols are natural compounds found in plants that exhibit various biological activities. There are over 8000 known polyphenols, though the main types include:26

• Flavonoids
• Phenolic acids
• Chalcones
• Lignans
• Anthocyanins
• Tannins

Among them, ferulic acid and Z-ligustilide are believed to be the most important for the biological activities of dong quai.27

So why are polyphenols important? Decades of research have shown that polyphenols have antioxidant and anti-inflammatory properties. Perimenopause is a pro-inflammatory stage of a woman’s life that increases her risk of osteoarthritis, accumulation of plaque in blood vessels, and other chronic diseases later in life.28 That’s why supporting your body early on with the right herbs is so important.

Green Tea

Green tea (Camellia seinensis, Theaceae) is a delicious, popular beverage with numerous, wide-ranging purported health benefits.

But did you know green tea may also help you during perimenopause?

That’s because green tea is full of antioxidants that scavenge free radicals, bringing down inflammation. Drinking green tea during perimenopause may also help increase your bone mineral density.29 Many women also experience weight gain or develop insulin resistance during perimenopause. Fortunately, compounds (namely epigallocatechin-3-gallate or EGCG) found in green tea have been demonstrated to alleviate both symptoms.30,31

One study found that long-term consumption of green tea could reduce the risk of depression in postmenopausal women by increasing estradiol.32

It’s important to check the source of your green tea. Studies have shown that some green tea can be contaminated with heavy metals due to the soil in the region where the plants are grown.33 I recommend only high-quality matcha tested and confirmed to be free of heavy metals and pesticides.

Turmeric/Curcumin

Turmeric (Curcuma longa L.) has been a staple in many Indian dishes for centuries. But this colorful spice isn’t just for cooking – it has a long history of medicinal use as well. Some people call it the “Golden Goddess,” a fitting name for women approaching their golden years.

Scientists have identified at least 235 compounds in turmeric, the most well-known of which is curcumin. Studies have found that curcumin, along with the other hundreds of compounds in turmeric, possesses various properties that may benefit our health, a few of which include:34,35,36,37,38,39

• Anti-inflammatory
• Anti-arthritis
• Anti-microbial
• Analgesic (pain-relieving)
• Hepatoprotective (liver)
• Cognitive
• Digestive
• Anti-anxiety
• Cardioprotective
• Nephroprotective (kidneys)
• Immunomodulatory

One study also reported that curcumin may help reduce hot flashes.40 Although this study involved postmenopausal women, perimenopausal women may experience similar benefits.

Support Your Body Naturally With a Perimenopause Specialist in Boston

Herbs are potent and powerful. And while they’re natural, using them incorrectly can lead to unwanted effects. That’s why it’s essential to collaborate with an experienced herbalist and women’s health specialist to achieve the best results.

I offer personalized consultations to women nationwide. We’ll begin with an in-depth case review and work together to identify the most effective solutions for your unique health concerns. Schedule a free 15-minute introductory call to learn more.