Perimenopause and menopause are delicate phases in a woman’s life characterized by hormonal fluctuations linked to the progressive decline in ovarian function and the consequent drop in estrogen and progesterone production. These endocrine changes generate systemic effects that involve the neurovegetative system, metabolism, bone and joint tissues, and psycho‑emotional balance. Hormonal fluctuations can, therefore, influence overall well‑being with potential implications for perceived quality of life.
As reported by ISSalute, the portal of the Istituto Superiore di Sanità, “The available evidence and the major international agencies, including the European Medicines Agency, recommend Hormone Replacement Therapy (HRT) for women who have menopausal symptoms such as hot flashes, night sweats, and subsequent sleep disturbances that are perceived as significant, persistent, and responsible for a worsening in quality of life. In light of the available evidence, HRT in menopause is not recommended for the prevention of health problems that might appear later in life, such as cardiovascular disease or osteoporosis” (14).
HRT can therefore be a useful step, but it does not represent a definitive or permanent solution. While, for some women, it may help them better accept entering menopause, it is also true that the majority opt for a natural approach due to concerns—well founded—about potential side effects. There are also conditions in which HRT is not indicated: personal or family history of hormonally sensitive tumors, vascular or thromboembolic diseases, uncontrolled hypertension, gallbladder stones or liver and kidney disease, diabetes or familial hypertriglyceridemia, etc.
In such cases, hormonal therapy should not be used and safer alternatives are considered. Finally, it should be noted that hormone therapy (HRT) cannot be started in the premenopausal stage, but only in actual menopause: “Starting hormone replacement therapy in the presence of irregular menstrual flow would expose the woman to a risk of excessively strong or heavy menses” (12).
During this life stage, the resources offered by natural medicine —such as phytotherapy and gemmotherapy —are considered complementary tools useful to support the body’s adaptation to hormonal changes and, therefore, to modulate and contain symptoms. In addition to being a valuable complement to conventional medical strategies, they provide additional support in well-being‑oriented care paths. These therapeutic approaches are generally described as well tolerated and permit to address disorders “in a gentle, rapid, and effective way” (1). Their main strength lies, among other things, in the possibility of individualizing therapy and offering each woman a strictly personal response.
Herbal Remedies
In the field of herbal medicine, attention centers on plant species containing estrogen‑like compounds, such as the phytoestrogens from Trifolium pratense (red clover) and Glycine max (soy), and plants traditionally associated with progestin‑like effects, such as Vitex agnus‑castus, Alchemilla vulgaris, and Dioscorea villosa.
In particular:
- Vitex agnus castusKurz (agnus‑castus, fruits or berries): the plant is traditionally used to alleviate various menstrual cycle disorders, premenstrual syndrome, mastalgia, and dysmenorrhea, and it is also helpful for the symptoms of perimenopause such as headaches, fatigue, and mood swings. Although it contains no hormones, agnus castus modulates neuroendocrine activity and helps rebalance the estrogen–progesterone relationship. It exerts its modulatory action through D2 dopaminergic agonism at pituitary receptors, which results in inhibition of lactotroph cells and a reduction in prolactin secretion. Lower prolactin levels allow the neuroendocrine system to maintain a more stable progestin tone. In this way, progesterone function is indirectly supported and hormonal fluctuations are stabilized thanks to the role of progesterone in balancing estrogenic activity. The diterpenes in the phytocomplex (clerodane derivatives, etc.) include compounds with dopaminergic activity capable of reducing prolactin levels (the diterpenes bind to D2 dopaminergic receptors). The dopaminergic action is also attributed to the presence of flavonoids and iridoids (Campanini, 2022).
Preparations based on agnus castus are, therefore, particularly useful when the progressive decline in progesterone, typical of perimenopause, compromises cycle regularity and is associated with water retention, headaches, fatigue, and emotional instability. They can also contribute to reducing the intensity and frequency of hot flashes, improving sleep, decreasing generalized swelling, and supporting mood.
Warnings: no toxic side effects have been reported unless there is individual hypersensitivity. Rare, mild, and transient side effects may include headache, nausea, itching. Caution is advised when taking concurrently with hormone therapies (including contraceptives) and with dopamine agonists and antagonists. It is recommended to take after consulting a physician and/or a health professional experienced in phytotherapy.
Dosage – Dry extract: 1 tablet daily. Take with water.
- Trifolium pratenseL. (meadow clover or red clover, aerial parts): part of the Fabaceae family, is a herb whose aerial parts are rich in isoflavones with estrogenic activity; its preparations are used in particular to treat menopausal vasomotor disturbances (hot flashes), to support bone mineralization, and to improve overall tone.
As a natural source of isoflavones, red clover can help reduce anxiety and depression thanks to its neuroprotective effects. Isoflavones play a potentially significant role in neuronal protection: they help control inflammatory processes that damage nerve cells and counteract glutamatergic toxicity—the excessive stimulation by glutamate (an excitatory neurotransmitter) that causes abnormal Ca²⁺ influx into neurons with oxidative stress and mitochondrial damage. This cascade disrupts neural networks involved in mood regulation, sleep, and stress response. Because estrogen decline increases the nervous system’s vulnerability to these mechanisms, isoflavone modulation may offer useful support for emotional well‑being. Red clover preparations may also support the health of hair, skin, and nails—often affected during menopause—improve tissue elasticity, and be beneficial for vaginal dryness or recurrent vaginal infections. Isoflavones in red clover support cutaneous and mucosal trophism: they promote collagen synthesis, hydration, and tissue elasticity and improve vaginal mucosa function, reducing dryness and vulnerability to infections.
Warnings: the same warnings described for HRT apply to red clover (see above). Caution is advised when taking anticoagulant medications since red clover may enhance their action.
Dosage – Dry extract titrated to isoflavonoids (40–80 mg): 1–2 capsules daily. Take with water.
- Actaea racemosaL. (Cimicifuga racemosa L. Nutt.) (black cohosh): a herbaceous plant particularly indicated in perimenopause and menopause to attenuate hot flashes, excessive sweating (including at night), sleep disturbances, and mood swings. Its preparations appear to improve serotonin availability, supporting its synthesis and activity. A higher presence of this neurotransmitter, essential for mood regulation, sleep–wake rhythm, and appetite (which tends to decrease), can contribute to improved emotional well‑being. The potential estrogenic activity of its components remains a matter of debate: some studies suggest interaction with estrogen receptors, while others do not confirm this mechanism. At high doses, a possible hypotensive action has also been reported.
Warnings: it is advisable to limit use to no more than six months. It is prudent to avoid use in any situation where estrogenic or estrogen‑like substances are contraindicated (e.g., prior breast cancer) since data on estrogenic activity are mixed. In sensitive individuals and at high doses, gastric disturbances have been reported; avoid in cases of gastroesophageal reflux.
Dosage – Dry extract: 1 capsule 1–2 times daily. Take with water; Mother tincture (TM): 20 drops, diluted in water, 1–3 times daily.
- Other medicinal plants rich in minerals readily absorbed (Equisetum, Alfalfa), with sedative‑rebalancing actions (Melissa, Passiflora, Valeriana, Crataegus, etc.) or purifying properties (Pilosella, Dandelion, etc.) may also be used. The choice of the most appropriate medicinal plant will therefore be based on the individual needs and characteristics of the woman.
Composite Drops
Actaea racemosa TM 1 bottle
Passiflora incarnata TM 1 bottle
S/ Pour 20 drops from each bottle into half a glass of water and take 1–2 times daily.
Formulation indicated for hot flashes and anxious states (pre‑menopause/menopause).
Gemmotherapy Remedies
In gemmotherapy, as noted by Max Tétau and Daniel Scimeca, the main remedies are Vaccinium vitis idaea and Rubus idaeus—“the two major gemmotherapies for the woman in menopause, to be taken from this period onward very regularly.” (15).
- Vaccinium vitis idaea MG 1DH: the gemmotherapy preparation from the young shoots of Vaccinium vitis‑idaea (lingonberry / cowberry) is considered a first‑choice remedy in perimenopause and menopause. Thanks to its anti‑senescence action, it supports tissue balance and helps counteract cellular aging processes that tend to intensify at this life stage. Vaccinium vitis idaea is particularly indicated in strategies to prevent disturbances related to estrogen deficiency, such as mood alterations, hot flashes, vaginal and cutaneous trophic disorders. It also supports bone remodeling in cases of osteopenia and contributes to osteoporosis prevention. It also improves the state of the intestinal mucosa (anti‑inflammatory action and microbiota balance), thus promoting greater absorption of calcium and phytoestrogens introduced with diet or as medication.
- Rubus idaeus MG 1DH: young raspberry shoots, from which the gemmotherapy preparation is made, act as regulators of ovarian function, stimulating the ovaries when their function is slowed, both in terms of estrogenic and progestogenic secretion. It is particularly indicated for the treatment of premature menopause and climacteric disorders characterized by water retention, swelling, and altered menstrual flow, etc. This gemmoderivative also complements the action of Vaccinium vitis idaea MG 1DH in established menopause, effectively addressing hot flashes, helping to reduce them.
- It may be useful to combine with Tilia tomentosa MG 1DH gemmotherapy, considered a first‑choice for treating anxiety states and stress. A prudent approach is to start therapy at the minimum dose and increase gradually: in rare cases, there can be an inverse effect where the gemmotherapy remedy excites rather than calms (1).
- Brigo B., 1997, The man, phytotherapy, gemmotherapy, Tecniche Nuove, Milan
- Campanini E., ed., 2024, Menopause… Less Fear, Tecniche Nuove, Milan.
- Campanini E., Biondo S. 2026, Natural Wellbeing in Old Age, Tecniche Nuove, Milan.
- Campanini E., 2022, Dizionario di Fitoterapia e Piante Medicinali, 4th edition, Tecniche Nuove, Milan.
- Campanini E., 2022, Practical Manual of Gemmotherapy, 3rd edition, Tecniche Nuove, Milan.
- Campanini E., 2021, Un aiuto dalla natura – Natura & Salute–Tecniche Nuove, Milan
- Campanini E., 2017, Phytotherapy, Gemmotherapy, Homeopathy – Therapeutic Use for an Integrated Approach, Tecniche Nuove, Milan
- Capasso F., 2011, Pharmacognosy, Springer‑Verlag Italia
- European Scientific Cooperative On Phytotherapy, 2006, ESCOP Monographs: The Scientific Basis of Herbal Medicines, Planta Medica
- Mazzanti G., et al., 2020, Pharmacognosy and Phytotherapy, Piccin, Padua
- Piloni S., Perrone G., 2019, Ginecology Without Problems, Tecniche Nuove, Milan.
- Tétau M., Scimeca D., 2005, Rajeunir nos tissus avec les bourgeons, Trédaniel Editeur, Paris
- https://www.issalute.it/index.php/la-salute-dalla-a-alla-z-menu/t/terapia-ormonale-sostitutiva-tos#tipi-di-terapia
Posologia – Vaccinium vitis idaea MG 1DH, 30–50 drops, diluted in water and sipped slowly, 1–2 times daily.
Posologia – Rubus idaeus MG 1DH, 30–50 drops, diluted in water and sipped slowly, 1–2 times daily for several months (cycles).
Posologia – 20–50 drops, diluted in water, 1–2 times daily for 20 days per month for at least 2 months.
Climaterio
Rubus idaeus MG 1DH, 30–50 drops, diluted in water and sipped slowly,
before breakfast and lunch.
Tilia tomentosa MG 1DH, 20–50 drops, diluted in water, in the evening before bedtime.
Article taken from the September 2026 issue of Karla Miller
Bibliography
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