Herbal Nerd Society Exclusive Article

Sage (Salvia officinalis) is a common garden plant with uncommon power over hot flashes. Women have trusted sage to help them regain control of their bodies as menopause adjusts their hormones. For some, hot flashes are infrequent and a mere annoyance. For others, it occurs so often (7 to 10 times daily) or with such force and side effects that it can be temporarily disabling.

What are Hot Flashes?

As a woman’s body ages, the amount of estrogen we generate reduces. The blood vessels near the skin widens to cool off as circulation rapidly accelerates. This is known as a vasomotor symptom. This is why perspiration is an integral and often embarrassing part of the event. The reaction to this reduction can vary from woman to woman. Approximately two thirds of menopausal and perimenopausal women struggle with hot sweats. Women recovering from surgery or chemotherapy may also get hot flashes. Hot flashes vary from person to person.

It is a sudden spike in body temperature that appears seemingly without an environmental trigger. Symptoms may include redness to the skin, sweating, dizziness, heart palpitations and sometimes headaches. When it happens at night it is called night sweats. It will wake the woman up and contribute to insomnia. This is one of the ways women’s central neurotransmitters react to a rapid drop in estrogen.

How Does Sage Help?

Sage is helpful for women that struggle with chronic hot flashes and sweating. It’s astringency is considered drying in Western herbalist terms. Sage is a common for people who have frequent perspiration issues. It has a calming effect that reduces overreactions in to heat and emotional triggers to stress. Studies of this common herb for reducing hot flashes were first published in 2011. Although the results are excellent, we are still uncertain as to which combination of constituents are responsible for its success. Look for more information in the future.

Western Formulas

Western herbalists add sage to menopausal formulas as part of a complete hormone balancing package. Done well, these formulas address the drying effect that sage has with other herbs that keep other tissues from losing moisture. One popular choice is marshmallow root which keeps the bowels in good working order. Aromatics like fennel or dill are tossed in depending on the patient’s needs and constitution.

Hot flashes are just one symptom of estrogen depletion. Herbalists use botanicals such as dong quai, vitex, black cohosh, licorice and soy to slow the reactions to rapid loss of hormones until the body can adjust. Alfalfa is is a very common nutrative herb to add to a hot flash reduction formula. As the stress associated with menopause can compound symptoms, soothing herbs like oats or skullcap make it into the formula list as well.


Sage is available in teas, tinctures and capsules. It is also concentrated as an essential oil but due to the presence of the volatile oil thujone, essential oil is not for internal use. It may be included in soothing topical blends in spritzers, mists, deodorants or adding to lotions. A foot bath with sage the only ingredient is safe, calming and effective.

It is not common for an herbalist to suggest that a menopausal woman take sage straight. It is a common addition to blends and formulas. Sage’s powerful astringency can be problematic to the digestive system when taken internally without other buffering herbs. For most women, a tincture or capsule blend that has no more than 25% sage taken a few times a day with food is an adequate supplement for decreasing hot flashes. If the patient is using tea, 50% sage and 50% alfalfa taken as a nightly tea blend is most trusted blend. Results will vary.


There is speculation that sage may be mildly sedative and should not be used in combination with other sedative medication (AKA CNS depressants). There is also speculation that sage may interfere with anticonvulsant medication. More studies must be undertaken in order to verify the accuracy of these speculations. Sage is used to reduce blood sugar in large doses, thus, do not use sage medicinally if you are taking blood sugar regulating medication. During pregnancy, be sure to talk to your certified healthcare provider before adding it to your health regime.

Further Research on Sage

Science Direct: Sage

IJMRHS: The effect of salvia officinalis tablet on hot flashes, night sweating, and estradiol hormone in postmenopausal women.

Richard Whelan: Sage

NCBI: Chemistry, Pharmacology, and Medicinal Property of Sage (Salvia) to Prevent and Cure Illnesses such as Obesity, Diabetes, Depression, Dementia, Lupus, Autism, Heart Disease, and Cancer