Congestión (bronquial)

5-HTP is a direct precursor to serotonin, with clinical relevance to perimenopausal mood disturbances, anxiety, sleep disruption, and vasomotor symptoms. Perimenopause-specific expert guidance (Revolution Health, citing clinical sources) includes 5-HTP as a serotonin-supporting supplement when hormonal shifts affect serotonin balance, triggering emotional turbulence.

8-Prenylnaringenin (8-PN), the principal phytoestrogen in hops (Humulus lupulus), is considered one of the most potent plant-derived estrogen receptor ligands known. Standardized hop extracts have been studied in RCTs for menopausal vasomotor symptoms, with a first prospective randomized double-blind placebo-controlled trial (Heyerick et al., 2006) showing reduction of menopausal discomfort.

ALA is the plant-based omega-3 fatty acid abundant in flaxseed, which is used in perimenopause for its phytoestrogenic lignan content as well as its anti-inflammatory fatty acid profile. Flaxseed ALA contributes to the overall perimenopausal benefit profile of flaxseed alongside its lignan content.

Ashwagandha (Withania somnifera) root extract has been directly studied in a published 8-week, randomized, double-blind, placebo-controlled trial (Gopal et al., 2021, Journal of Obstetrics and Gynaecology Research) in 100 perimenopausal women. The ashwagandha group showed significant improvement in climacteric symptoms, quality of life, and hormonal parameters.

Multiple 2025 randomized, double-blind, placebo-controlled trials have evaluated standardized A. racemosus (shatavari) root extract specifically for perimenopausal symptoms including vasomotor symptoms, menstrual irregularities, and hormonal biomarkers, consistently showing significant improvements over placebo. This represents the most clinically developed area of asparagus supplementation research.

Black cohosh (Actaea racemosa) is the most extensively studied botanical for perimenopausal symptoms. Multiple RCTs and reviews report reductions in hot flash frequency and improvements in overall menopausal symptom scores. It appears to act via serotonergic rather than estrogenic pathways. Evidence is mixed but a 2023 clinical trial found significant improvement versus placebo.

Calcium supplementation is officially recommended by the European Menopause and Andropause Society for perimenopausal women to protect bone mineral density as estrogen declines. Combined with vitamin D, it reduces risk of osteoporosis and fractures. Adequate calcium intake is a recognized clinical standard for perimenopausal bone health.

Chaste tree (Vitex agnus-castus) is the same herb as Vitex Agnus-Castus, extensively used and studied for perimenopausal hormonal balance. It modulates dopamine/prolactin pathways to support progesterone/estrogen regulation and has clinical RCT evidence for reducing perimenopausal symptoms including irregular cycles, mood changes, breast tenderness, and hot flashes.

Daidzein is an isoflavone phytoestrogen found in soybeans and red clover that binds ERβ with SERM-like activity. Clinical trials demonstrate that daidzein, especially in equol-producing individuals, reduces vasomotor symptoms including hot flashes and night sweats during the menopausal transition.

Small clinical studies and an observational study with a T. diffusa-containing formulation showed improvements in menopausal transition symptoms. MSKCC acknowledges damiana-containing formulas may improve menopausal symptoms. T. diffusa leaf extract is the only pharmaceutical therapy option in Germany for FSIAD, a condition overlapping with perimenopause.

DHA is a key long-chain omega-3 fatty acid with evidence for cognitive support, mood regulation, and anti-inflammatory activity during perimenopause. It is specifically noted in perimenopausal contexts for brain fog and mood, and is included in algae-based formulations recommended for perimenopausal women.

DHEA has been studied in perimenopausal women alongside postmenopausal populations. Intravaginal DHEA was found to be a safe and effective treatment for vulvovaginal atrophy and dyspareunia in peri- and postmenopausal women. A Cochrane review noted that DHEA may slightly improve sexual function in this population but with uncertain effects on quality of life.

DIM has been studied in perimenopausal and postmenopausal women for its ability to alter urinary estrogen metabolite profiles, specifically increasing the 2-OHE1:16α-OHE1 ratio. A UC Berkeley human clinical trial demonstrated this shift in estrogen metabolites in women with breast cancer history. DIM is used clinically to address estrogen-dominant perimenopausal symptoms.

EPA is an omega-3 fatty acid with specific evidence for reducing perimenopausal depression and hot flash frequency. EPA-dominant formulations demonstrate solid evidence for reducing depressive symptoms—a disproportionately common perimenopausal complaint. Combined EPA+DHA reduces hot flash frequency in clinical studies.

Evening primrose oil (EPO), rich in gamma-linolenic acid (GLA), has been investigated for reducing hot flash severity in perimenopausal women. A 2018 RCT found EPO reduced hot flash severity, though a 2021 study found no significant effect on frequency. It is widely used traditionally for menopausal symptom relief and is listed by NCCIH among studied botanicals.

Fenugreek's phytoestrogenic action is applicable to perimenopause, the transitional period of declining estrogen preceding full menopause. RCT evidence using standardized extracts in women experiencing menopausal symptoms supports benefit for vasomotor, urogenital, and mood-related symptoms that begin during perimenopause.

Flaxseed is the richest dietary source of lignans (secoisolariciresinol diglucoside, SDG), which are converted by gut microbiota to enterodiol and enterolactone—phytoestrogens that bind estrogen receptors. A 2024 single-blind RCT specifically in perimenopausal women found significant increases in lignan metabolites and improvements in perimenopausal symptoms.

GABA is the primary inhibitory neurotransmitter, with declining availability during perimenopause contributing to anxiety, insomnia, and mood instability. Revolution Health's evidence-based perimenopause guidance lists GABA supplements for mood stabilization. Progesterone's metabolite allopregnanolone is a potent GABA-A modulator, and its decline during perimenopause directly impairs GABAergic signaling.

Gamma oryzanol's evidence for menopausal symptom relief extends to perimenopausal women undergoing the menopausal transition. A 2023 RCT (NCT05922800) specifically enrolled women during the menopausal transition period alongside postmenopausal women. Its hypothalamic-pituitary modulating effects are relevant during the perimenopausal hormonal fluctuation phase.

Genistein is the most bioactive soy and red clover isoflavone, binding ERβ preferentially and acting as a SERM. Clinical evidence supports reduction of hot flashes, night sweats, and improved bone mineral density in menopausal women. It is the most studied individual soy isoflavone for menopausal symptoms.

Ginseng (Panax ginseng, Asian/Korean) has been evaluated in multiple RCTs for menopausal symptoms. A systematic review found ginseng may improve hot flashes and quality of life in menopausal women. It is particularly noted for psychological symptoms and sleep. However, evidence for vasomotor symptom reduction is limited.

Gamma-linolenic acid (GLA), an omega-6 fatty acid predominant in evening primrose oil and borage oil, has been studied as an active component for perimenopausal hot flash relief via prostaglandin pathway modulation. It is the key bioactive constituent underlying evening primrose oil's studied benefits during perimenopause.

HMRlignan's phytoestrogenic metabolite enterolactone modulates estrogen receptors ERα and ERβ, offering weak estrogenic support relevant to the hormonal fluctuations of perimenopause. The clinical study in postmenopausal women demonstrating hot flash reduction, combined with its established bioconversion to enterolactone, supports relevance to the broader perimenopausal transition. Evidence is preliminary and limited to one small industry-funded clinical study.

The phytoestrogen 8-prenylnaringenin in hops exerts estrogenic activity relevant to the perimenopausal transition. Clinical trials of standardized hop extracts have reported improvements in the broader Menopause Rating Scale (MRS) including physical, psychological, and urogenital symptom domains. Evidence is largely the same body of trials supporting hot flash reduction.

Perimenopause is associated with increased insulin resistance, dyslipidemia, and cardiometabolic risk; inositol has been clinically studied in peri- and postmenopausal women for these outcomes. A 6-month RCT in postmenopausal women with metabolic syndrome found myo-inositol supplementation improved fasting glucose, insulin sensitivity, and lipid profiles. Inositol also transduces TSH signaling, which becomes increasingly relevant as thyroid function changes around menopause.

Isoflavones are a class of phytoestrogens (including genistein, daidzein, formononetin, biochanin A) from soy and red clover with well-studied clinical evidence for perimenopausal and menopausal vasomotor symptoms, bone health, and mood. Meta-analyses confirm modest but statistically significant reductions in hot flash frequency and severity.

Three randomized controlled trials in perimenopausal and menopausal women have found kava extracts significantly reduce anxiety, depression, and irritability associated with the perimenopausal transition. One trial in 40 perimenopausal women found statistically significant improvement on anxiety scales; another found kava augmented the anxiolytic effect of hormone replacement therapy. Hot flash reduction was not a primary or consistent endpoint.

The same phytoestrogenic mechanisms and clinical evidence supporting licorice for menopausal hot flashes apply to the perimenopausal transition. Authoritative reviews list menopause and its peri-phase as key indications for glycyrrhizin-containing licorice. A double-blind RCT in menopausal women demonstrated clinically significant reduction in vasomotor symptoms.

Lignans act as phytoestrogens whose metabolites (enterolactone, enterodiol) structurally resemble estradiol, potentially moderating hormonal fluctuations during the perimenopausal transition. A 2025 review confirmed flaxseed lignans reduced perimenopausal symptoms. The phytoestrogenic action may help buffer against declining endogenous estrogen levels through partial agonist/antagonist activity at estrogen receptors.

Lily bulb polysaccharides and saponins have been studied in ovariectomized mouse models for menopausal symptoms, demonstrating effects on anxiety, depression, cognition, and endocrine markers via estrogen receptor β pathways. Preliminary clinical evidence supports lily-bulb-containing herbal formulas for alleviating climacteric syndrome. A PMC study (PMC6683782) specifically found total polysaccharides ameliorated menopause-like behavior in OVX mice.

Maca (Lepidium meyenii), traditionally used in the Peruvian Andes, has been studied in RCTs for perimenopausal and menopausal symptoms. RCT evidence shows modest reductions in vasomotor symptoms, anxiety, and depression. It is considered non-estrogenic, acting via hypothalamic-pituitary axis modulation.

Magnesium is commonly used for perimenopausal symptoms including sleep disturbance, mood instability, muscle relaxation, and general hormonal balance. Evidence indicates it improves sleep and well-being during the menopause transition. An active 2026 clinical trial (NCT07235878) is specifically investigating magnesium hydroxide supplementation on perimenopausal symptoms.

Melatonin levels decline during perimenopause, paralleling worsening sleep. A review found doses above 3 mg improved common menopausal symptoms including hot flashes, insomnia, mood changes, and sexual disorders. An RCT in perimenopausal women taking 3 mg nightly for 6 months showed improved sleep quality and tolerability.

Omega-3 fatty acids (EPA and DHA) have evidence for reducing hot flash frequency, improving mood, and supporting cognitive health during the menopausal transition. A 2020 study found omega-3 supplementation reduced hot flash frequency in menopausal women. EPA-dominant formulations have solid evidence for depressive symptoms, which are disproportionately common during perimenopause.

Passionflower (Passiflora incarnata) is used for perimenopausal sleep disturbances, anxiety, and mood symptoms. Clinical evidence supports its anxiolytic and sleep-promoting effects via GABA-A receptor modulation. Perimenopause expert guidance (Revolution Health) specifically lists passionflower alongside melatonin and valerian for perimenopausal sleep cycle disruption.

Phytoestrogens are plant-derived compounds (isoflavones, lignans, coumestans, prenylated flavonoids) that bind ERβ as weak SERMs. They are the most extensively studied class of natural compounds for perimenopausal vasomotor symptoms, bone health, and mood. Major dietary sources include soy, red clover, flaxseed, and hops.

The 2023 systematic review and meta-analysis (Wiley Phytotherapy Research) included perimenopausal women and found pomegranate significantly improved hot flash severity, menopausal symptom scores, and FSH levels across peri- and postmenopausal populations. Pomegranate seed oil phytoestrogens are the proposed active components.

During perimenopause, ovarian steroid output becomes erratic while adrenal pregnenolone-derived hormones gain importance. Pregnenolone's role as upstream precursor to progesterone, DHEA, and estrogens positions it as a potential therapeutic target. Its neurosteroid properties also address the mood, sleep, and cognitive changes characteristic of perimenopause.

Red clover (Trifolium pratense) contains isoflavones—formononetin, biochanin A, daidzein, and genistein—that act as phytoestrogens, binding estrogen receptors to produce weak estrogenic effects. A review of 4 RCTs showed one trial with significant hot flash reduction versus placebo. Doses of 40–80 mg isoflavones/day are commonly used.

Multiple clinical trials specifically enrolled perimenopausal women and tested ERr 731 (Rheum rhaponticum root extract), demonstrating significant reductions in climacteric complaints including vasomotor symptoms, anxiety, and sleep disturbances with 4 mg/day for 12 weeks.

Sage (Salvia officinalis) is used traditionally and in clinical practice for perimenopausal hot flashes and night sweats. A NIH/NCCIH-referenced RCT (n=30, sage plus alfalfa) showed significantly greater reduction in hot flash frequency at 12 weeks versus placebo. Sage can lessen hot flash intensity within weeks.

Secoisolariciresinol diglucoside (SDG) is the principal lignan in flaxseed, converted by gut microbiota to mammalian phytoestrogens enterodiol and enterolactone. A 2024 single-blind RCT in perimenopausal women found flaxseed/SDG supplementation significantly increased lignan metabolite levels and improved perimenopausal symptoms.

Soy isoflavone supplementation has been specifically studied in perimenopausal women for relief of vasomotor symptoms. A 2025 meta-analysis of RCTs in perimenopausal women found significant efficacy for hot flashes and overall menopausal symptom scores with soy isoflavones vs. placebo.

Soy isoflavones (genistein, daidzein, glycitein) are phytoestrogens that bind ERβ and exert mild estrogenic effects useful in perimenopause. A 2025 meta-analysis of 12 RCTs (533 participants) found statistically significant benefit for menopausal symptoms (Hedges' g = −0.25). Evidence supports reduction in hot flash frequency and potential bone benefit.

Soy isoflavones have been studied in perimenopausal women for relief of vasomotor and other transitional symptoms, with a 2025 PMC systematic review and meta-analysis specifically evaluating their effects in this population. Effects on hot flashes and depression symptoms have been documented in perimenopausal women. The phytoestrogenic activity of soy isoflavones is considered especially relevant during the perimenopausal transition when endogenous estrogen is fluctuating.

St. John's Wort (Hypericum perforatum) is well-established for mild to moderate depression and has specific evidence for perimenopausal mood-related symptoms. Combined with black cohosh, it significantly improved mood swings in perimenopausal women in clinical trials. The NCCIH and NCCIH-referenced sources cite it as one of the studied supplements for menopause.

Valerian root is a traditional medicinal plant with established use for anxiety and insomnia, conditions highly prevalent during perimenopause. NCCIH acknowledges its study for menopausal symptoms. GoodRx and clinical perimenopause guidance list valerian for sleep cycle disruption and anxiety in perimenopausal women.

Vitamin D is critical for bone health during perimenopause, as declining estrogen accelerates bone turnover. It is officially recommended by the European Menopause and Andropause Society, works synergistically with calcium to reduce osteoporosis risk, and is associated with improved mood, reduced inflammation, and support for vasomotor and immune function during the menopausal transition.

Vitamin D3 (cholecalciferol) is the preferred, most bioavailable form of vitamin D for supplementation and is specifically used in perimenopausal care for bone health, mood, immune function, and overall hormone regulation during the menopausal transition. European Menopause Society guidelines support its use.

Vitex agnus-castus (chaste tree berry) has been used since ancient Greece for female hormonal regulation. Clinical studies and a 2025 PubMed review confirm it modulates dopaminergic and serotonergic pathways to reduce prolactin and support progesterone/estrogen balance. It shows benefit for perimenopausal symptoms including irregular cycles, mood changes, and breast tenderness.

Alfalfa's phytoestrogen content has led to its traditional and modern herbal use for perimenopausal hormonal fluctuations, including mood swings, hot flashes, and cycle irregularities. Scientific evidence specific to perimenopause and alfalfa alone is lacking; its use is extrapolated from phytoestrogen pharmacology.

Epimedium has a classical TCM use for menopausal syndrome, including perimenopausal symptoms related to kidney deficiency and declining reproductive hormones. Its phytoestrogenic activity provides biological plausibility. The 2022 review confirms its broad clinical use in China for aging and hormone-related diseases including menopausal syndrome.

Dong quai (Angelica sinensis) has been used for over two millennia in Traditional Chinese Medicine (TCM) for female hormonal complaints including menstrual irregularity, menopausal symptoms, and insomnia. Scientific RCT evidence when used alone shows no significant benefit over placebo for hot flashes, but combination TCM formulas show positive results.

Dong quai root (Angelica sinensis root) is the specific plant part used in Traditional Chinese Medicine formulations for perimenopausal hormonal support, menstrual regulation, and symptom relief. Combination studies with other botanicals show reduction in hot flashes and night sweats during the menopausal transition.

Wild yam (Dioscorea villosa) has a long traditional use in North American herbal medicine for female hormonal complaints including perimenopausal symptoms. It contains diosgenin, a steroid sapogenin used industrially to synthesize progesterone, but the body cannot perform this conversion. Animal and human studies suggest it may protect against osteoporosis.

The same traditional framework and in vitro estrogenic data that apply to menopause extend to perimenopause. Traditional European and Persian herbal practice includes yarrow as a female hormonal regulator, but dedicated perimenopausal clinical studies do not exist.