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Three Herbs, One Transition: A Naturopathic Guide to Perimenopause
Hiiiii, it’s Dr. Tabitha, your favorite naturopathic doctor, physiologist, and professor! Before we dive in, a quick disclaimer: this blog is for educational purposes only!
Perimenopause is one of the most misunderstood phases of a woman's life. Many people think menopause begins when periods stop, but the truth is that the hormonal transition leading up to menopause, known as perimenopause, can begin as early as your late 30s or early 40s and last up to a decade.5 Often times, women do not realize when perimenopause begins, so let’s review some early signs of perimenopause that women often miss.
The Early Signs of Perimenopause Women Often Miss
One of the biggest misconceptions about perimenopause is that it starts with hot flashes. While hot flashes are common, they're often not the first sign.
In my clinical experience, the earliest symptoms women overlook include:
● Changes in menstrual flow or cycle length (for example, every 21-24 days instead of every 28 days or may skip periods)
● New PMS symptoms
● Mood swings, irritability, or anxiety
● Sleep disturbances (inability to fall asleep or remain asleep)
● Brain fog or forgetfulness
● Fatigue despite adequate rest
● Increased sensitivity to stress
These symptoms can appear years before menopause because estrogen and progesterone begin fluctuating long before they consistently decline.5 From a naturopathic perspective, recognizing these changes early matters because it allows women to support hormone balance, stress resilience, sleep quality, nutrition, and metabolic health before symptoms become disruptive.
As a naturopathic doctor, I often remind my patients that perimenopause is a natural biological transition and our goal is to support our bodies during every phase of life. With the right tools, education, and lifestyle strategies, women can move through this phase feeling informed, empowered, and connected to their changing bodies.
Three botanicals that frequently come up in conversations about perimenopause are black cohosh, red clover, and clary sage. While each herb plays a different role, together they offer a helpful lens into how herbal medicine can support hormonal health during this transition. Let's take a closer look at each one.
Black Cohosh: A Go-To Herb for the Menopause Transition
When it comes to herbal support during perimenopause, black cohosh (Latin names Actea racemosa/Cimicifuga racemosa) is one of the most studied botanicals. Used for generations in women's health traditions, it is best known for its potential role in supporting women experiencing hot flashes and other symptoms of the menopause transition.¹⁻³
What makes black cohosh especially interesting is that it doesn't appear to work like estrogen. Instead, researchers believe it may influence neurotransmitters involved in temperature regulation and mood, which could help explain its effects on common menopausal symptoms.¹,²
Like many herbs, the research is mixed, but certain standardized extracts have shown promising results for reducing hot flashes and improving overall menopausal comfort.¹⁻³ In my practice, I remind patients that quality matters. Most studies have been conducted using specific standardized extracts, not just any black cohosh product on the shelf. That's why it's always worth discussing herbal options with a qualified healthcare provider before adding them to your wellness routine.
Red Clover: Plant-Based Hormonal Support
Red clover (Latin name Trifolium pratense) brings a unique perspective to the perimenopause conversation. It contains naturally occurring compounds called isoflavones, often referred to as phytoestrogens because they can interact with estrogen receptors in the body.⁴
Unlike human estrogen, however, these plant compounds tend to have milder, more tissue-specific effects. That's one reason many women are drawn to red clover as part of an integrative approach to navigating hormonal changes.
The research is mixed, but some studies suggest red clover may offer modest support for hot flashes and other menopausal symptoms. Researchers are also exploring its potential benefits for overall postmenopausal wellness, including heart health.⁴⁻⁶
In my practice, I often see women interested in red clover when they're looking for a more natural way to support their bodies during this transition. As with any herbal approach, it's important to consider your individual health history and talk with a qualified healthcare provider, especially if you have a hormone-sensitive condition.
Clary Sage: Finding Calm Amid Change
One of the most overlooked aspects of perimenopause is its impact on mood! Many women notice increased irritability, anxiety, overwhelm, or emotional ups and downs, and it's often dismissed as "just stress” or a woman being overly emotional (eww 🙁). In reality, shifting hormones, disrupted sleep, and changes in neurotransmitter activity can all influence how we feel during this transition.⁵
While black cohosh and red clover are often discussed for their potential hormonal effects, clary sage offers a different kind of support. Long used in herbal traditions and aromatherapy, it's known for its calming aroma and association with relaxation and emotional wellbeing.⁷
Clary sage (Latin name Salvia sclarea) contains naturally occurring aromatic compounds, including linalool and linalyl acetate, that contribute to its distinctive scent.⁷ It is a part of the “mint” family. Although we don't have strong evidence that it directly influences hormones or menopause symptoms, many women find its grounding fragrance to be a welcome addition to their self-care routine.⁸
Sometimes, supporting yourself through perimenopause looks as simple as creating small moments of calm, comfort, and connection throughout the day.
Why Perimenopausal Bleeding Can Feel So Unpredictable
One of the most common frustrations women experience during perimenopause is not knowing what to expect from their cycle. One month may bring a lighter period, while the next may bring heavy bleeding, spotting, surprise gushes, or even occasional bladder leaks.
This unpredictability is often driven by fluctuating estrogen and progesterone levels. As ovulation becomes less consistent, the hormonal signals that regulate the uterine lining can shift, leading to changes in flow and cycle patterns.⁵
As a women's health doctor, I encourage women to view these changes as information rather than a sign that something is wrong. Your body is adapting to a new hormonal rhythm, and that transition often calls for additional support.
Having practical solutions to support yourself during perimenopause matters just as much as nutrition, lifestyle, and herbal medicine. That's why I appreciate that The Honey Pot Company offers a variety of menstrual and leak protection products designed for real life, helping women feel comfortable, prepared, and confident through all the unexpected twists and turns of perimenopause.
The Bottom Line
Perimenopause is a new chapter, and one that deserves support, understanding, and self-compassion. Whether it's black cohosh, red clover, clary sage, lifestyle changes, or simply having the right products on hand, there are many ways to support your body through this transition. The key is remembering that there's no one-size-fits-all approach. Every woman's experience with perimenopause is unique.
If you're navigating perimenopause, know that you're not alone. This transition may bring changes, but it can also be an opportunity to reconnect with your body, advocate for your needs, and redefine what wellness looks like for you. With the right knowledge, tools, and support, you can feel empowered to care for your body and embrace this next phase with confidence.
Ready to learn more? Explore The Honey Pot Co.'s Reclaiming Wellness resources for expert guidance, practical tools, and conversations designed to support you through every stage of your hormonal journey.
References
- National Institutes of Health Office of Dietary Supplements. Black Cohosh Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/Blackcohosh-HealthProfessional/
- National Cancer Institute. Black Cohosh (PDQ®)–Health Professional Version.https://www.cancer.gov/about-cancer/treatment/cam/hp/black-cohosh-pdq
- National Center for Complementary and Integrative Health. Black Cohosh.https://www.nccih.nih.gov/health/black-cohosh
- National Center for Complementary and Integrative Health. Red Clover.https://www.nccih.nih.gov/health/red-clover
- National Center for Complementary and Integrative Health. Menopausal Symptoms and Complementary Health Approaches. https://www.nccih.nih.gov/health/menopausal-symptoms-in-depth
- Kanadys W, Barańska A, Jedrych M, et al. Effects of Red Clover Isoflavones on Lipid Profile in Postmenopausal Women: A Systematic Review and Meta-analysis. Complement Ther Med. 2022.
- North Carolina State Extension. Salvia sclarea (Clary Sage). https://plants.ces.ncsu.edu/plants/salvia-sclarea/
- U.S. Food and Drug Administration. Is It a Cosmetic, a Drug, or Both? (Or Is It Soap?)https://www.fda.gov/cosmetics/cosmetics-laws-regulations/it-cosmetic-drug-or-both-or-it-soap
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