Calming your Internal Inferno with Herbal Medicine

Ah, the infamous hot flash: a mischievous fairy tap-dances on your skin, then boom – your body declares war on Antarctica! Your face turns into a Picasso masterpiece of red and pink. Beads of sweat stage a surprise attack and you’re left fanning yourself with whatever’s within reach, be it a magazine, a leaflet, or even your own hands. Just when you think it’s over, the heat train halts, leaving you in a bewildered cold aftermath. And there you stand, a survivor of the hot flash rollercoaster, ready to face the day – and maybe invest in a portable fan for future unexpected heatwaves.

Hot flashes and/or night sweats affect 75% of women over the age of 50 and many of these women experience hot flashes and night sweats that negatively affect their quality of life. ¹ It’s no wonder that hot flashes are a symptom that brings many women in perimenopause into my practice, second only to insomnia. In my practice, I’ve helped countless women find relief from severe or frequent hot flashes, helping them regain quality rest and sail through this transition more smoothly. By taking a holistic approach and addressing the root causes of hot flashes with a customized treatment plan that includes herbal medicine, I help women to get back to feeling like themselves again.

The key, however, is knowing which herbs are a good match for you. When it comes to finding natural relief from hot flashes, I’ve found there are three powerhouse herbs that I frequently recommend to help cool those internal fires. The herbal supplement I typically recommend first for perimenopausal women is evening primrose oil (Oenothera biennis). If you’re still having monthly cycles or have had your last period within the past year, evening primrose oil can be especially helpful. I often suggest it for women who notice hot flashes or night sweats that flare up mainly in the few days right before their period starts. The reason it targets this premenstrual time frame so well is that evening primrose oil has anti-inflammatory properties.²

For those with a history of inflammatory issues like endometriosis, migraines, or menstrual cramps, evening primrose oil’s anti-inflammatory effects make it a top choice for easing challenging symptoms. Many of my patients have found noticeable relief not just from hot flashes but also breast tenderness, bloating, and mood changes. I recommend an evening primrose supplement derived from the plant’s cold-pressed oil to maximize the concentration of essential fatty acids.

The second herb I frequently suggest for menopausal hot flashes is maca root (Lepidium peruvianum and/or Lepidium meyenii). For women later in menopause no longer having periods, maca often becomes one of my go-to options. In addition to decreasing troublesome hot flashes, maca helps support healthy cholesterol levels, bone density, energy levels, and even restores libido.³ The research confirms my clinical experience, showing maca root can boost physical desire and vaginal lubrication as women navigate hormone changes.⁴

One of the key reasons maca root can be so restorative for menopausal women is its adaptogenic activity. Adaptogens are herbs that help the body naturally cope with all sorts of physical and emotional stresses more successfully. As an adaptogen, maca helps regulate hormones, boosts resilience against anxiety and overwhelm while supporting more stable energy levels. This makes it easier to push through fatigue, recover from stressful events more quickly, and manage mood swings or irritability that may come along with hormonal fluctuations. I find most women notice the positive effects from maca supplementation within 3-6 weeks. Anxiety levels may recede, endurance returns, sleep improves, and responses to stresses become more “normal”. When choosing a maca supplement, look for gelatinized Peruvian maca, grown at a higher elevation (3500 – 4500 m above sea level).⁵

The third herb I want to highlight for relieving hot flashes is ashwagandha (Withania somnifera). While it may not be top of mind, I’ve seen ashwagandha work wonders for the right woman. Like maca, ashwagandha is an adaptogenic herb, great for mitigating stress and soothing anxieties that can exacerbate hot flashes.⁶ It also promotes deeper, more restorative sleep – critical when nights are interrupted by dripping sweats. Ashwagandha has been shown in studies to boost libido and sexual health like maca, too.

However, where ashwagandha really shines is for menopausal women also struggling with chronic inflammation or autoimmunity. Ashwagandha is a natural anti-inflammatory. So, if you notice joint pain flaring with your hot flashes or have gut issues, ashwagandha can provide immense relief. It targets the link between inflammatory pathways, stubborn immune activation, and troublesome menopause symptoms like hot flashes.⁷ Where stress, poor sleep and inflammation collide, ashwagandha helps restore equilibrium providing a soothing, cooling reprieve internally and externally.⁸ To give ashwagandha the best chance at providing relief, choose a supplement standardized to contain around 30 mg of withanolides per day, and take it for 4-6 weeks before deciding if it is effective for you.

Resources and References:

1. Utian WH. Psychosocial and socioeconomic burden of vasomotor symptoms in menopause: a comprehensive review. Health Qual Life Outcomes. 2005 Aug 5;3:47. doi: 10.1186/1477-7525-3-47. PMID: 16083502; PMCID: PMC1190205.
2. Gentry-Maharaj A, Karpinskyj C, Glazer C, Burnell M, Ryan A, Fraser L, Lanceley A, Jacobs I, Hunter MS, Menon U. Use and perceived efficacy of complementary and alternative medicines after discontinuation of hormone therapy: a nested United Kingdom Collaborative Trial of Ovarian Cancer Screening cohort study. Menopause. 2015 Apr;22(4):384-90. doi: 10.1097/GME.0000000000000330. PMID: 25290539; PMCID: PMC4470524.
3. Dording CM, Fisher L, Papakostas G, Farabaugh A, Sonawalla S, Fava M, Mischoulon D. A double-blind, randomized, pilot dose-finding study of maca root (L. meyenii) for the management of SSRI-induced sexual dysfunction. CNS Neurosci Ther. 2008 Fall;14(3):182-91. doi: 10.1111/j.1755-5949.2008.00052.x. PMID: 18801111; PMCID: PMC6494062.
4. Menopause 2008;15(6):1157-1162.
5. Chemical composition and health effects of maca (Lepidium meyenii). https://www.sciencedirect.com/science/article/abs/pii/S0308814619303942
6. Speers, A. B. et al. (2021). Effects of Withania somnifera (Ashwagandha) on Stress and the Stress-Related Neuropsychiatric Disorders Anxiety, Depression, and Insomnia. Current Neuropharmacology, 19(9), 1468.
7. Priyanka, G., et al. (2020). Adaptogenic and immunomodulatory activity of Ashwagandha root extract: An experimental study in an equine model. Frontiers in veterinary science, 7, 541112.
8. Gopal S, Ajgaonkar A, Kanchi P, Kaundinya A, Thakare V, Chauhan S, Langade D. Effect of an ashwagandha (Withania Somnifera) root extract on climacteric symptoms in women during perimenopause: A randomized, double-blind, placebo-controlled study. J Obstet Gynaecol Res. 2021 Dec;47(12):4414-4425. doi: 10.1111/jog.15030. Epub 2021 Sep 22. PMID: 34553463.