Botanicals in Perimenopause
By Dr. Briana Lutz, Naturopathic Doctor and Registered Herbalist
When it comes to managing the symptoms of perimenopause, there’s often a feeling of being stuck between two choices: go all in with hormone therapy or “tough it out” without support. But here’s the thing—we don’t have to pick one over the other.
Botanical medicine offers a beautiful, flexible approach to perimenopause. It can complement hormone therapy or serve as a standalone strategy, depending on your unique experience.
Hormone Normalizers: Supporting the Transition
Perimenopause is essentially reverse puberty—an unpredictable shift where hormones rise and fall without much warning. While we can’t stop the transition, we can offer your body tools to stabilize it.
One of those tools? Hormone normalizers like chaste tree (Vitex). This herb works on your brain’s hormone signals—follicle-stimulating hormone (FSH) and luteinizing hormone (LH)—to enhance progesterone production. It’s especially helpful if you’re still ovulating occasionally. For those further along in the journey, the strategy shifts—but support is still possible.
Black Cohosh: A Classic Ally
Black cohosh is another standout for estrogen-related symptoms. It doesn’t act like a plant estrogen but rather stimulates your body’s natural estrogen production. That’s key, because many symptoms like hot flashes or night sweats stem from changes in estrogen levels—not just low levels themselves. Black cohosh also supports dopamine pathways, which can help with brain fog, cravings, and mood changes.
Phytoestrogens: Gentle Balance
Plant-based estrogens, or phytoestrogens, are partial agonists—meaning they bind weakly to estrogen receptors and help smooth out the hormonal rollercoaster. These can be found in:
Flaxseed and milk thistle (lignans)
Soy, red clover, and alfalfa (coumestans)
Hops and licorice root (isoflavones—not the black licorice candy!)
They’re especially helpful post-menopause, when your body’s estrogen is naturally lower.
Adaptogens: Your Hormonal Helpers
Adaptogens are a popular herbal resource. These herbs help your body adapt to stress—an essential task during perimenopause, when hormone shifts can dysregulate your circadian rhythm, impact mood, and challenge sleep quality.
Two favorites:
Rhodiola: Cooling, brain-supportive, and cardioprotective. It even works as a selective estrogen receptor modulator (SERM) and can boost serotonin.
Ashwagandha: Fantastic for early perimenopause, supporting both progesterone and GABA (your calming neurotransmitter). It’s especially helpful for anxiety, sleep disruptions, and that classic 1–3 a.m. wakeup.
*Note: When it comes to adaptogens, form matters. Teas and powders may not extract the active ingredients needed for hormonal support. Tinctures or standardized capsules are your best bet.
Symptom-Specific Botanicals
Sometimes, we need to zoom in and target specific symptoms. Here are a few go-tos we love:
Sage – For hot flashes and night sweats
Saffron – For mood support and libido
Shepherd’s Purse – A uterine tonic that helps manage heavy menstrual bleeding
Lion’s Mane (mushroom) – For brain fog, memory, and cognitive resilience
You Don’t Have to Go It Alone
Whether you're looking for an alternative to hormone therapy, a complement to it, or simply want to explore your options, botanical medicine can meet you where you're at.
At Flow Functional Healthcare, we’re here to help you feel informed, supported, and empowered—every step of the way through perimenopause.
Book a visit with one of our naturopathic doctors to explore a personalized plan that works for you.
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A multidisciplinary functional health care clinic focused on whole family health using natural and complementary therapies. We work on finding the root cause of health issues and help people thrive.
