Sage vs Red Clover for Perimenopause: Which Supplement Works Better?
Sage and red clover are popular herbal supplements for perimenopause symptoms. Here is how they compare on evidence, safety, and use cases.
Two Popular Herbal Options for Perimenopause
Women looking for non-hormonal relief from perimenopause symptoms frequently encounter sage and red clover as herbal alternatives. Both have a reasonable evidence base compared to many herbal products on the market, and both are widely available in health food shops and pharmacies. However, they work through completely different mechanisms, target slightly different symptoms, and have different safety profiles. Understanding the distinction helps you make a more informed choice rather than simply picking whichever appears first on the shelf.
How Sage Works for Perimenopause
Sage (Salvia officinalis and Salvia lavandulaefolia) has been used for centuries to reduce sweating and hot flashes. The proposed mechanism is not fully established but is thought to involve cholinergic and possibly central nervous system effects that modulate thermoregulation. Sage does not appear to act as a phytoestrogen. Several small clinical trials have found that sage leaf extract reduces hot flash frequency and severity. One German product, Menosan, has been specifically studied and showed statistically significant reductions in hot flash frequency at four and eight weeks. Sage also appears to have modest effects on night sweats and general menopausal discomfort.
How Red Clover Works for Perimenopause
Red clover (Trifolium pratense) contains isoflavones, primarily formononetin and biochanin A, which the body converts to compounds that weakly bind to oestrogen receptors. This phytoestrogenic mechanism is similar to soy isoflavones. Because red clover acts on oestrogen receptors, it may address a broader range of oestrogen-related symptoms beyond just hot flashes, including bone health markers, cardiovascular lipid profiles, and vaginal tissue health. Clinical trials have shown mixed results, but some well-designed studies show meaningful reductions in hot flash frequency. The Promensil brand is the most studied standardised red clover extract.
Comparing Effectiveness for Hot Flashes
Both sage and red clover have evidence for reducing hot flash frequency, but neither has been studied in large, rigorous trials comparable to those done on HRT. For hot flashes specifically, the evidence for sage is reasonably consistent across small trials, pointing to meaningful reductions within four to twelve weeks. Red clover results are more variable, with some trials showing substantial benefit and others showing only modest improvement over placebo. Individual response appears to vary significantly, possibly related to differences in gut bacteria that convert red clover isoflavones to active forms. A useful indicator: women who respond well to dietary soy for symptoms are more likely to respond to red clover.
Beyond Hot Flashes: Broader Symptom Profiles
Sage is primarily indicated for sweating and hot flashes. It has little evidence for mood, sleep, cognitive function, or vaginal symptoms. Red clover's phytoestrogenic activity means it may have broader effects, with some evidence for modest improvements in bone turnover markers and cardiovascular risk factors including cholesterol. Vaginal dryness may respond somewhat to regular red clover use, though the effect is not as targeted as local vaginal oestrogen. If hot flashes and sweating are your primary concern, sage has a focused mechanism well matched to that goal. If you are looking for broader hormonal support across multiple symptoms, red clover's phytoestrogen mechanism may offer wider benefit.
Safety and Contraindications
Sage is generally well tolerated. High doses of certain sage species contain thujone, which can be toxic in excess, but standardised extracts at recommended doses avoid this risk. Sage should be used cautiously in women with seizure disorders. Red clover's phytoestrogenic activity raises questions about use in women with hormone-sensitive conditions such as oestrogen receptor positive breast cancer, uterine cancer, or endometriosis. Evidence on actual risk is limited and somewhat reassuring for low-dose food-equivalent intakes, but medical advice is warranted before using red clover supplements in these cases. Neither supplement is recommended during pregnancy or breastfeeding.
Choosing Between Them
If hot flashes and sweating are your dominant symptoms, sage is a well-targeted, safe option with no hormonal mechanism. If you have hormone-sensitive conditions and want to avoid phytoestrogens, sage is the safer choice. If you are looking for broader symptom relief and are comfortable with mild phytoestrogenic activity, red clover is worth trying, particularly if you already notice that soy foods help your symptoms. Both can be taken for eight to twelve weeks to assess response. If neither produces adequate relief, they can be combined with other non-hormonal approaches or used as a bridge while considering hormonal options with a doctor. Neither should replace medical assessment for severe or persistent symptoms.
Related reading
Get your personalized daily plan
Track symptoms, match workouts to your day type, and build a routine that adapts with you through every phase of perimenopause.