Shatavari, Sage & Maca: 3 Herbal Remedies for Perimenopause

Perimenopause or the ‘menopause transition’ is a time when the reproductive system naturally slows, the ovaries start to produce less oestrogen, and physiological and psychological changes first become noticeable. Time in perimenopause is typically apparent for around four years but can last anywhere between a few months to up to ten years for some.

In this blog, our expert Nutritional Therapist, Annie, looks at some of the common symptoms of perimenopause and explores whether herbs and botanicals like shatavari, sage and maca, and other nutrients like magnesium and chromium can help alleviate these.

Changing hormones during perimenopause

During the menopause transition, menstrual cycles become more irregular as ovarian follicle levels decline and the ovaries become less responsive to luteinising hormone (LH) and follicle-stimulating hormone (FSH). The resulting decrease in oestrogen doesn’t occur in a one-way downhill trajectory, instead, levels of oestrogen fluctuate considerably, swinging from high to low across the month, causing subsequent imbalances to the hypothalamic-pituitary-ovarian axis (HPO axis).^1-3

Perimenopause common symptoms

Changing and fluctuating hormone levels throughout this time can cause a wide range of symptoms such as insomnia, hot flushes, anxiety, depression, irritability, mood swings, vaginal dryness, loss of libido, urogenital infections, blood sugar imbalances, weight gain, and cognitive changes, including brain fog and memory issues. Hormonal changes throughout the menopause transition also increase the risk of health issues such as osteoporosis, metabolic syndrome, and heart disease.¹

Depression experienced during perimenopause may be caused, in part, by dysregulation of the monoaminergic pathways in the central nervous system and changing oestrogen levels can lead to alterations in these serotonergic and noradrenergic systems. Furthermore, a drop in oestrogen can reduce nerve function in the brain, as well as reduce acetylcholine and dopamine signalling, all of which can play pivotal roles in mood balance.  Shifts in levels of neurotransmitters can contribute to mood swings, irritability, depression, and anxiety. Alongside this issues such as disturbed sleep, stress, poor nutrition, smoking, and alcohol consumption can further contribute to low mood and mood swings. It has even been suggested that even those with no history of depression or anxiety are more likely to experience this during perimenopause.^4,5

The role of phytoestrogens in perimenopause

Phytoestrogens are oestrogenic plant compounds that resemble the chemical structure of human oestrogen molecules. They are abundant in pulses, seeds, beans, and soya, as well as certain herbs, which we will go more into later in the article. Phytoestrogens can bind with oestrogen receptor sites, which act to mimic oestrogen in the body, producing a mild oestrogenic effect that can help to reduce menopausal symptoms.⁶

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Herbal remedies & nutrients to support perimenopause

The below herbs, botanicals and nutrients can all be helpful in supporting & relieving perimenopause symptoms:

• Magnesium
• Vitamin B6
• Shatavari
• Sage
• Maca
• Ginseng
• Chromium

Below we take a more in depth look at each one:

Magnesium

Magnesium is an essential mineral required for the normal functioning of sex and stress hormones, with low levels often associated with fatigue, poor sleep, blood sugar imbalances, depression, and anxiety. Magnesium can affect the clearing of oestrogen via the conjugation of glucuronic acid to oestrogen, to promote its excretion into the bile and out of the body via the stool. Therefore, low levels can not only contribute to low mood but can also influence hormone detoxification pathways.^5,7

Magnesium can modulate the hypothalamic-pituitary-adrenal axis (HPA axis) and play a role in regulating stress, mood, immunity, and digestion. It is involved in tryptophan metabolism, GABA, serotonin, and melatonin production, and also plays a role in cortisol and progesterone balance. When hormone production from the ovaries begins to decline during perimenopause, the adrenal glands start to take over some production. The adrenals are responsible for making stress hormones, such as cortisol, which is indeed necessary to a point, however, chronic stress can create an increased demand on adrenal health and exacerbate the symptoms of perimenopause. This makes stress management and supporting adrenal function essential to optimal health throughout the menopause transition and beyond.^5,7

B6

In brief, after being metabolised, oestrogen needs to be methylated, ready for excretion out of the body. This process is dependent on catechol-o-methyltransferase (COMT), an enzyme that is dependent on B6 and magnesium as cofactors to work effectively. A deficiency of B vitamins including B12, folate, and B6 can also directly impact methylation, elevate homocysteine, and increase the risk of cardiovascular disease.

Research has found that B6 supplementation has been shown to improve mood, fatigue, cognitive function, and cardiovascular health.^8,9 Low levels of this nutrient have been reported in women of various ages, including those experiencing premenstrual syndrome (PMS) and premenstrual dysmorphic disorder (PMDD). A recent systematic review concluded that treatment with vitamin B6 demonstrated a significant improvement in various symptoms of PMS, further highlighting its role in hormone regulation.¹⁰

B6 as pyridoxal-5-phosphate (P5P) may support hormone-related depression via its role in the synthesis and metabolism of various neurotransmitters such as serotonin and dopamine, which play a role in mood regulation and cognition. Studies have indeed found low levels of plasma pyridoxal phosphate in those exhibiting depressive symptoms⁸ and that B6 supplementation has been found to reduce anxiety in many.^11,12

Shatavari

Shatavari (asparagus racemosus) also known as wild asparagus, is an adaptogenic herb with a long history of traditional use in Ayurvedic practice for its ability to support hormonal balance.

Shatavari’s main constituents are steroidal saponins called shatavarins alongside other bioactive compounds including asparagamine, racemosol, polysaccharides, mucilage, sarsasapogenin, flavonoids, and polyphenols. These compounds are thought to influence hormone balance across a woman’s cycle, specifically during perimenopause and menopause due to their phytoestrogenic properties. Shatavari, being an adaptogen can also help the body respond to stress and support mood regulation, helping to ‘Revitalise Vigor and Vitality’. ¹³ Shatavari is thought to influence monoaminergic neurotransmission, influence the HPA axis, and increase brain-derived neurotrophic factor (BDNF), which may all work to reduce the risk of depression and low mood.¹³

Shatavari can help nourish the female reproductive system both before and during perimenopause. Research highlights its potential use in regulating menstruation and reducing the symptoms of PMS, such as bloating and cramps, as well as offering support to menopausal symptoms such as hot flushes, and sleep disturbances. Often touted as an aphrodisiac, it is thought to reduce vagina dryness, support lubrication, and enhance sexual sensation by increasing blood flow to the genital area.

Shatavari is high in antioxidants and has anti-inflammatory, anti-aging, neuroprotective, and nootropic properties. It may also offer immune-stimulating actions, with research indicating that it can upregulate Th1 and Th2 cytokines, activating the immune response and suppressing pro-inflammatory cytokines such as IL-6 and TNF. ^13,14

A randomised double-blind placebo-controlled study with menopausal women found that after eight weeks of supplementation with Shatavari, participants reported significant reductions in their menopausal symptoms. They reported reduced incidences of insomnia, anxiety, nervousness, hot flushes, vaginal dryness, and low libido, alongside feeling overall improvements in their quality of life. Laboratory results of serum oestradiol and progesterone had also significantly improved since baseline in the active group. The researchers discussed how the phytoestrogenic and adaptogenic properties of Shatavari may modulate hormonal balance and support the regulation of the HPO axis.¹

Lastly, oestrogen decline can play a huge role in age-related muscle weakness as oestrogen is known to improve myosin binding function and muscle force production. Shatavari has been found to increase skeletal muscle strength in postmenopausal women, an important contributing factor in supporting bone health and reducing the risk of osteoporosis and muscle weakness. Research has found that after six weeks of Shatavari supplementation, postmenopausal participants showed marked improvements in their hand grip strength. It was suggested that Shatavari may be able to support muscle adaptation responses to exercise, muscle protein synthesis, and myosin function.¹⁵

Sage

Hot flushes and night sweats are extremely common symptoms occurring in over 55% of women in perimenopause and 85% of women during menopause. This has a significant effect on both sleep duration and quality as well as energy and well-being the following day. The causes of this are thought to be multifactorial but are associated in part with a dysregulation of the hypothalamic regulatory system, due to the fluctuations and eventual decline in oestrogen. Hot flushes may also be linked to disrupted neurotransmitter levels as reduced serotonin increases levels of noradrenaline, which disturbs the hypothalamic thermostat.¹⁶ Noradrenaline plays an important role in thermoregulation, acting through the α2-adrenergic receptors, therefore stress and subsequent HPA dysregulation can contribute to adrenergic receptor activation which influences the set point of temperature.^16,19

Sage (salvia officinalis), from the Lamiaceae family, is a phytoestrogen that may support both peri and menopausal symptoms in women. Research has found that sage can reduce the severity of night sweats and hot flushes, alongside improving fatigue, anxiety, and concentration,¹⁷ which mirrors other research in this area.¹⁸

In one three-month study with postmenopausal women, the intervention group supplementing with sage reported a range of beneficial outcomes. They saw improvements in nighttime sweats, flushing, heart palpitations, muscle and joint pain, depression and anxiety, sleep disruptions, brain fog, mental exhaustion, and libido.¹⁹ Another four-week clinical trial found similar results after sage supplementation. In addition, they also measured brainwave patterns using an electroencephalogram (EEG) during cognitive and memory tests and found a significant change in electrical brain activity. Participants exhibited an enhanced ability to cope with cognitive challenges, whilst also eliciting a lower stress response compared to baseline.²⁰

Maca

Maca (Lepidium meyenii), also known as Peruvian ginseng, is packed full of nutrients, fibre, amino acids, and plant compounds such as glucosinolates. It has been traditionally used for many years to support energy, stamina, fertility, PMS, menopausal symptoms, and sexual function.

Research with postmenopausal women found that after six weeks of supplementing maca, participants experienced positive effects on markers of anxiety, depression, and low libido. However, no differences were found in serum concentrations of oestrogen, FSH, LH, or sex hormone binding globulin (SHBG) between baseline, placebo, and maca supplementation.²¹

However, other research with perimenopausal women supplementing with maca did find increases in markers of oestrogen (E2), FSH, progesterone, and adrenocorticotropic hormones (ACTH) compared to baseline, as well as reductions in weight, blood pressure, and cholesterol. Furthermore, they found significant reductions in depression, hot flushes, night sweats, disrupted sleep, and anxiety.²²

Ginseng

Ginseng is an adaptogenic herb that has a history of traditional use in promoting longevity, supporting energy, and building resilience to stress.

A decline in libido is extremely common during the menopause transition and beyond. Research with menopausal women found that ginseng had a significantly positive effect on sexual function and quality of life after a four-week intervention, as assessed through the Female Sexual Function Index, the Menopause-Specific Quality of Life Scale, and the Greene Menopausal Symptom Scale.²³ This is supported by other research that found improvements in sexual functioning and arousal after eight weeks of Korean ginseng supplementation.²⁴

Bone health and reducing the risk of osteoporosis is an important concern as a woman enters perimenopause. Oestrogen is important for healthy bones, including the absorption and utilization of calcium. After menopause, women experience up to 30% bone loss due to an imbalance between the rates of formation and resorption, resulting in a negative remodelling balance.

A recent study looking at post-menopausal women with osteopenia found that high intakes of ginseng (3g a day) taken by the intervention group for twelve weeks resulted in increased bone formation indices, and improved serum osteocalcin and blood calcium levels. Osteocalcin is produced by osteoblasts and plays a role in bone mineralisation, and calcium ion homeostasis. It is often used as a biomarker of osteoblast function when evaluating bone formation rate in conditions such as osteoporosis (although it may not be enough alone to predict bone quality and quantity). Overall, the study concluded that ginseng had positive effects on indices of bone formation and therefore may play a beneficial role in bone health.^{25, 26}

Ginseng may also support cardiovascular and overall health due to the presence of ginsenosides, such as triterpene saponins. These compounds are thought to play a protective role due to their antioxidant capabilities and their ability to modulate energy metabolism, inflammation, and autophagy.²⁷

Ginseng is often supplemented during times of fatigue due to its adaptogenic and energy-providing properties. As perimenopause can be a time of disturbed sleep, mood imbalances, and low energy, ginseng could potentially be used to help reduce these symptoms through its effects on cortisol, the nervous system, and antioxidant and anti-inflammatory pathways.²⁸

Chromium

During the menopause transition, many women feel like they have a harder time managing a healthy weight, with 60-70% of women experiencing weight gain during this time.²⁹

Oestrogen plays a role in metabolic health by improving pancreatic beta-cell insulin secretion, increasing insulin sensitivity, and facilitating glucose uptake. Therefore, during the fluctuations and decline of oestrogen during perimenopause and menopause, there is an increased risk of blood sugar dysregulation, obesity, and Type 2 Diabetes. During this time basal metabolic rate (BMR) reduces, while appetite may increase, potentially leading to higher calorie intake and resulting in weight gain and visceral fat accumulation.²⁹

Along with nutrition, exercise, and lifestyle factors, maintaining optimal nutrient status can support weight management and blood glucose control.

Chromium is an essential trace element that is closely associated with glucose tolerance factor which helps to support blood sugar balance, carbohydrate and fat metabolism, bone health, weight management, cardiovascular health, and immunity. Chromium plays a vital role in insulin signalling and activating insulin receptors, therefore enhancing insulin action by bringing glucose into cells where it can be used for energy. Many studies have reported positive effects after chromium supplementation on markers of blood glucose control such as HbA1c, fasting insulin, and fasting blood glucose levels.^30,31

Furthermore, chromium may support bone health through its effects on bone mineral density and bone tissue structure. This mineral has been found to slow calcium loss, increase osteoblasts, and reduce osteoclasts.³²

 

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References

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Last updated on 13th March 2025 by cytoffice