GradedHealth

Sage

Last reviewed October 2026 · Based on 9 studies

Bottom line

Small trials suggest sage (Salvia officinalis) may reduce how often and how strongly hot flashes happen in menopause, and may improve sleep and other menopause symptoms. The trials are few and small, the strongest was partly funded by a sage tablet maker, and no long-term or interaction safety data were found.

What it helps with

  • Reduces how often hot flashes happen — Benefit, evidence grade C (Limited). Meta-analysis of four small trials (310 women) plus one placebo-controlled trial; started at B for some RCTs, downgraded for small sample and high heterogeneity (I2 71%), and the pooled confidence interval includes no effect.
  • Reduces how strong hot flashes feel — Mixed results, evidence grade C (Limited). Pooled severity result was not significant and one trial found no difference at weeks 2 and 8; the placebo-controlled result comes from one sponsor-funded trial; downgraded for inconsistency and small size.
  • Improves sleep during menopause — Benefit, evidence grade C (Limited). Two placebo-controlled trials (66 and 80 women) measured sleep quality; started at B for some RCTs, downgraded for small total sample and because one trial is sponsor-funded.
  • Eases overall menopause symptoms — Benefit, evidence grade C (Limited). One placebo-controlled trial (sponsor-funded) and one open trial without placebo found lower Menopause Rating Scale scores; downgraded for small size, lack of placebo in one study and sponsor link.

What it is

Sage (Salvia officinalis) is a garden herb traditionally used for sweating and menopausal hot flushes [1]. The trials used fresh-leaf tablets, tablets of a branded ethanolic extract, and capsules of sage extract [1][2][3].

How it might work

Proposed, not established: sage may act through plant estrogens called phytoestrogens. In lab tests, a water-ethanol part of a sage tincture showed estrogenic activity, while the whole tincture did not, and a flavonoid, luteolin-7-O-glucuronide, was identified as one active compound [4]. The Menosan trial linked symptom relief to changes in brain-wave readings, but the authors did not show that this link causes the relief [2].

What the research says

A 2023 meta-analysis of four trials with 310 postmenopausal women found fewer hot flashes with sage than with placebo, but the pooled range (-2.37 to 0.14) includes no effect; the pooled severity result was not significant [5]. A double-blind, placebo-controlled trial of 66 women found sage tablets reduced flushing and night-sweat scores more than placebo after three months, and the sleep score fell from 9.4 to 5.6 in the sage group [6]. A double-blind, placebo-controlled trial of 80 women found the hot flash severity score fell by 55.3% on sage over four weeks, and the Menopause Rating Scale fell by 39.2%; the trial was sponsored by the tablet's manufacturer [2]. An open trial without placebo found hot flash scores fell by 64% over eight weeks [1], and a single-group study of 30 women found severity lower after four weeks of a 100 mg capsule [3].

Doses used in studies

Trials used 100 mg extract tablets three times a day for three months [6], one fresh-leaf tablet a day for eight weeks [1], one 100 mg capsule a day for four weeks [3], and a branded ethanolic extract tablet for four weeks [2]. The meta-analysis reported daily doses of 100 to 280 mg [5]. These are doses used in studies, not recommendations.

Safety and interactions

Side effects: the open trial called the fresh-sage tablets very well tolerated [1]; the Menosan trial recorded three adverse events in total, none linked to treatment [2]. Upper limits or toxic doses: no study found. Medicine interactions: no study of sage with prescription medicines was found; herbal products in general may interact with prescription drugs [5]. Pregnancy and breastfeeding: no data found. Kidney, liver and bleeding disorders: no data found. Hormone-sensitive conditions: the lab work found estrogen-like activity [4], and the trials did not study women with hormone-sensitive cancers [5]. Women with these conditions, and anyone taking medicines, should ask a doctor first.

Caveats and open questions

Only four trials were pooled, with between 30 and 84 women each [5]. The meta-analysis calls its frequency result significant, but the confidence interval it reports includes no effect [5]. Two studies had no placebo group [1][3]. One placebo-controlled trial was sponsored by the maker of the tested tablet [2]. Trials ran for three months at most [6], so long-term effects are unknown.

References

  1. First time proof of sage's tolerability and efficacy in menopausal women with hot flushes.. Adv Ther, 2011.
  2. Effectiveness of Menosan® Salvia officinalis in the treatment of a wide spectrum of menopausal complaints. A double-blind, randomized, placebo-controlled, clinical trial.. Heliyon, 2021.
  3. The effect of Saliva officinalis extract on the menopausal symptoms in postmenopausal women: An RCT.. Int J Reprod Biomed, 2019.
  4. Salvia officinalis for hot flushes: towards determination of mechanism of activity and active principles.. Planta Med, 2013.
  5. The Effect of Salvia Officinalis on Hot Flashes in Postmenopausal Women: A Systematic Review and Meta-Analysis.. Int J Community Based Nurs Midwifery, 2023.
  6. The effect of Salvia officinalis extract on symptoms of flushing, night sweat, sleep disorders, and score of forgetfulness in postmenopausal women.. J Family Med Prim Care, 2020.