There is a lot going on hormonally for women in their 40s. To start with, women with premenstrual syndrome (PMS) in their 20s and 30s will typically continue to have PMS in their 40s if untreated. (1) Some women even experience more severe PMS symptoms in their late reproductive years. (2) Additionally, perimenopause (or the menopause transition) is underway, bringing a host of symptoms along with it.

People with a uterus who do not have a menstrual cycle disorder will ovulate predictably each menstrual cycle into their late 30s/early 40s. When perimenopause starts, ovulation becomes more haphazard and as a woman gets closer and closer to menopause, they ovulate less and less often until eventually they stop ovulating altogether (menopause).

The result is that women in their 40s are often simultaneously experiencing PMS symptoms (in the months when they’ve ovulated) AND perimenopausal symptoms. This can be really challenging for many women, and is not something you need to take on alone!


Botanical Support for PMS

PMS occurs during the premenstrual (luteal) phase of ovulatory menstrual cycles. In other words, if you didn’t ovulate it isn’t PMS. This isn’t to say that if you’re on the birth control pill (which blocks ovulation) your symptoms aren’t real! Your symptoms are absolutely real – but it is not PMS.

Ovulation is when an oocyte (egg) is released from its follicle in the ovary. The follicle then becomes a corpus luteum, and the corpus luteum produces progesterone and estrogen.

In PMS, the nervous system responds abnormally to the normal hormone changes brought about by ovulation. The result is symptoms such as: (3,4,5,6)

  • mood symptoms of PMS: mood swings, irritability, anger, anxiety, sadness, hopelessness, depression, emotional sensitivity
  • physical symptoms of PMS: bloating, breast tenderness, headaches, fatigue, hot flashes, dizziness

This is where our first botanical comes in – Chaste Tree (Vitex agnus-castus). This beautiful plant is supported by a strong body of evidence as benefiting both the mood and physical symptoms of PMS. (7,8) Additionally, side effects of Chaste Tree tend to be infrequent and mild. You’ll need to take Chaste Tree consistently for at least 3 months (and track your menstrual cycle and symptoms for that period of time) in order to determine whether or not it is helping to alleviate your PMS symptoms. A naturopathic doctor can guide you through this process and help you find the dosing strategy that offers you the greatest benefit and safety.


Botanical Support for Perimenopause

Symptoms of perimenopause result from the fluctuating hormone levels experienced during this hormonal transition. Due to the fact that ovulatory cycles become less frequent, estrogen and progesterone levels can fluctuate widely over the perimenopausal years. (9) Some of the most common symptoms affecting women in perimenopause are: (10,11)

  • hot flashes/night sweats
  • irregular menstrual cycles
  • sleep disturbances
  • mood symptoms
  • vaginal dryness 

In this article, I’m going to specifically discuss botanical support for hot flashes and night sweats (collectively referred to as vasomotor symptoms), but please know that botanical support exists for other perimenopausal symptoms as well.

Hot flashes and night sweats are the most common symptom of the menopausal transition, affecting up to 80% of women. (12,13,14) Typically, they occur multiple times per day and are actually more common at nighttime. They substantially impact many areas of a woman’s life, including her sleep quality, mood, ability to focus and concentrate, her engagement in social activities and exercise, and her overall quality of life. Hot flashes are not a mere inconvenience to be dismissed.

Enter our second botanical – Sage (Salvia officinalis). Sage has demonstrated efficacy in reducing the intensity and frequency of hot flashes, and is well-tolerated (meaning side effects are typically mild and infrequent). (15,16) You’ll need to take Sage consistently for at least 4-8 weeks (and track the intensity, frequency, and duration of your hot flashes for that period of time) in order to determine whether or not it is helping to alleviate your hot flashes. A naturopathic doctor can guide you through this process and help you find the dosing strategy that offers you the greatest benefit and safety.


Need support?

If you are struggling with symptoms of PMS and/or perimenopause, or you would simply like more knowledge and support around your hormonal and menstrual health, please book an appointment today! I offer both in-office and telemedicine appointments.

**Please remember that this article is meant for educational purposes only and should not be viewed as medical advice. You should always discuss any treatment option with a licensed healthcare provider to ensure it will be safe and effective for you.

Learn more about naturopathic care for perimenopause, menopause, and PMS & PMDD.

Photo Credit: Griffin Taylor (photo of Chaste Tree) and Matt Montgomery (photo of Sage)


Literature Cited

  1. Rapkin AJ, Winer SA. Premenstrual syndrome and premenstrual dysphoric disorder: quality of life and burden of illness. Expert Rev Pharmacoecon Outcomes Res. 2009;9(2):157-170. doi:10.1586/erp.09.14
  2. Cohen LS, Soares CN, Otto MW, Sweeney BH, Liberman RF, Harlow BL. Prevalence and predictors of premenstrual dysphoric disorder (PMDD) in older premenopausal women. The Harvard Study of Moods and Cycles. J Affect Disord. 2002;70(2):125-132. doi:10.1016/s0165-0327(01)00458-x
  3. Halbreich U, Backstrom T, Eriksson E, et al. Clinical diagnostic criteria for premenstrual syndrome and guidelines for their quantification for research studies. Gynecol Endocrinol. 2007;23(3):123-130. doi:10.1080/09513590601167969
  4. Freeman EW, Halberstadt SM, Rickels K, Legler JM, Lin H, Sammel MD. Core symptoms that discriminate premenstrual syndrome. J Womens Health (Larchmt). 2011;20(1):29-35. doi:10.1089/jwh.2010.2161
  5. Pearlstein T, Yonkers KA, Fayyad R, Gillespie JA. Pretreatment pattern of symptom expression in premenstrual dysphoric disorder. J Affect Disord. 2005;85(3):275-282. doi:10.1016/j.jad.2004.10.004
  6. Mortola JF, Girton L, Beck L, Yen SS. Diagnosis of premenstrual syndrome by a simple, prospective, and reliable instrument: the calendar of premenstrual experiences. Obstet Gynecol. 1990;76(2):302-307.
  7. Csupor D, Lantos T, Hegyi P, et al. Vitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials. Complement Ther Med. 2019;47:102190. doi:10.1016/j.ctim.2019.08.024
  8. van Die MD, Burger HG, Teede HJ, Bone KM. Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials. Planta Med. 2013;79(7):562-575. doi:10.1055/s-0032-1327831
  9. Burger HG. Unpredictable endocrinology of the menopause transition: clinical, diagnostic and management implications. Menopause Int. 2011;17(4):153-154. doi:10.1258/mi.2011.011026
  10. Woods NF, Mitchell ES. Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women’s lives. Am J Med. 2005;118 Suppl 12B:14-24. doi:10.1016/j.amjmed.2005.09.031
  11. Dennerstein L, Dudley EC, Hopper JL, Guthrie JR, Burger HG. A prospective population-based study of menopausal symptoms. Obstet Gynecol. 2000;96(3):351-358. doi:10.1016/s0029-7844(00)00930-3
  12. Gold EB, Colvin A, Avis N, et al. Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: study of women’s health across the nation. Am J Public Health. 2006;96(7):1226-1235. doi:10.2105/AJPH.2005.066936
  13. Randolph JF Jr, Sowers M, Bondarenko I, et al. The relationship of longitudinal change in reproductive hormones and vasomotor symptoms during the menopausal transition. J Clin Endocrinol Metab. 2005;90(11):6106-6112. doi:10.1210/jc.2005-1374
  14. Thurston RC, Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women’s Health across the Nation. Obstet Gynecol Clin North Am. 2011;38(3):489-501. doi:10.1016/j.ogc.2011.05.006
  15. Bommer S, Klein P, Suter A. First time proof of sage’s tolerability and efficacy in menopausal women with hot flushes. Adv Ther. 2011;28(6):490-500. doi:10.1007/s12325-011-0027-z
  16. Dadfar F, Bamdad K. The effect of Saliva officinalis extract on the menopausal symptoms in postmenopausal women: An RCT. Int J Reprod Biomed. 2019;17(4):287-292. Published 2019 May 28. doi:10.18502/ijrm.v17i4.4555