St John's Wort for Menopause

St. John's wort is a popular herbal remedy recognized for its mood-enhancing properties. Recently, its application has extended to managing menopausal symptoms, with a focus on alleviating psychological and psychosomatic complaints, reducing hot flashes, and improving overall quality of life in women during the climacteric period.

Protocols Studied in Research

St. John's Wort for Menopausal Symptoms of Psychological Origin [1]

• Protocol: In this 12‑week open-label study conducted in a general medical practice, 111 women aged 43–65 with pre‑ and postmenopausal climacteric symptoms received one tablet (900 mg) of St. John's wort extract (Kira) three times daily. Outcomes were assessed at baseline and at weeks 5, 8, and 12 using the Menopause Rating Scale, a sexuality questionnaire, and the Clinical Global Impression scale.
• Outcome: Significant improvements in psychological and psychosomatic symptoms were observed, with 76.4% of patients (by self‑evaluation) and 79.2% (by physician evaluation) reporting diminished climacteric complaints; sexual well‑being also improved.

St. John's Wort for Hot Flashes in Menopausal Women [2]

• Protocol: In a randomized, double‑blind, placebo‑controlled trial at an academic medical center in Shiraz, Iran, 100 premenopausal, perimenopausal, and postmenopausal women received either St. John's wort extract or placebo for 8 weeks. Hot flash frequency, duration, and severity were evaluated using the Blatt‑Kupperman Index at follow‑up visits.
• Outcome: Both groups experienced significant within‑group improvements; however, by week 8, the St. John's wort group showed significantly greater reductions in hot flash duration (P < 0.001), frequency (P ≤ 0.005), and severity (P ≤ 0.004) compared with placebo.

St. John's Wort on Hot Flashes and Quality of Life in Perimenopausal Women [3]

• Protocol: In a double‑blind, randomized pilot trial, 47 symptomatic perimenopausal women with hot flashes (≥3 per day) were assigned to receive ethanolic St. John's wort extract (900 mg TID) or placebo over 12 weeks. Participants maintained daily diaries to record hot flash frequency and intensity, with quality of life measured by a menopause‑specific questionnaire.
• Outcome: Although reductions in hot flash frequency and scores favored St. John's wort, differences were not statistically significant. Notably, women receiving St. John's wort reported significantly better menopause‑specific quality of life (P = 0.01) and fewer sleep problems (P = 0.05) compared with placebo.

Hypericum perforatum for Postmenopausal Symptoms and Depression [4]

• Protocol: In this randomized controlled study conducted in Izeh, Iran, 80 postmenopausal women aged 45–60 were assigned to receive either Hypericum perforatum tablets (270–330 μg) three times daily or placebo for 2 months. Menopausal symptoms were measured using a modified Kupperman index at multiple time points, and depression was assessed via the Hamilton Depression Rating Scale at baseline and week 8.
• Outcome: The intervention group experienced significant decreases in both the frequency and intensity of hot flashes and overall menopausal symptoms (P < 0.001) as well as marked reductions in depression scores—with 80% free of depression at study end versus 5.7% in the placebo group.

Black Cohosh with or without St. John's Wort for Climacteric Treatment [5]

• Protocol: In a large‑scale, prospective, controlled observational study conducted in Germany, 6,141 women treated in outpatient gynecological practices received either Black cohosh monotherapy or a fixed combination of Black cohosh with St. John's wort. Treatment was administered per recommended doses, and patients were followed for 6 (optionally 12) months with menopausal symptoms assessed using the Menopause Rating Scale (MRS), focusing on the PSYCHE subscore.
• Outcome: Both regimens led to significant reductions in menopausal symptoms, with the combination therapy proving superior in alleviating climacteric mood symptoms (adjusted PSYCHE scores at Month 3: 0.23 vs 0.37, P < 0.001) and a very low incidence of treatment‑related adverse events (0.16%).

Hypericum perforatum with Vitex agnus‑castus for Menopausal Symptoms [6]

• Protocol: In a 16‑week, double‑blind, randomized, placebo‑controlled trial, 100 late‑perimenopausal or postmenopausal women experiencing hot flushes and other symptoms received either a combination of Hypericum perforatum and Vitex agnus‑castus (administered twice daily) or placebo. Primary and secondary outcomes included hot flush frequency, scores on the Greene Climacteric Scale, the Hamilton Depression Inventory, and the Utian Quality of Life Scale.
• Outcome: No significant differences were found between the herbal combination and placebo for any endpoints at weeks 4, 8, or 12, although both groups showed improvement over time; the combination was well tolerated with no significant adverse events.

Hypericum perforatum with Vitex agnus‑castus for PMS‑Like Symptoms in Late‑Perimenopausal Women [7]

• Protocol: In a subpopulation analysis from a double‑blind, randomized, placebo‑controlled trial over 16 weeks, 14 late‑perimenopausal women with PMS‑like symptoms were assessed using the Abrahams Menstrual Symptoms Questionnaire, which measured subclusters including anxiety, depression, hydration, and cravings. Participants received either the herbal combination (administered twice daily) or placebo.
• Outcome: The herbal combination significantly reduced total PMS‑like scores (P = 0.02) as well as scores for the depression (P = 0.006) and cravings (P = 0.027) subclusters, with significant reductions also noted for anxiety (P = 0.003) and hydration (P = 0.002) clusters, indicating a promising clinical application for managing PMS‑like symptoms.

Research Interpretation: Summary and Conclusion

Across several studies, St. John's wort—whether used alone or in combination with other botanicals—has shown promise in reducing menopausal mood disturbances and related symptoms. Trials reported significant improvements in psychological well-being, reductions in hot flash frequency and duration, and enhanced quality of life, although some outcomes did not reach statistical significance.

In simple terms, these findings suggest that St. John's wort may be a safe and effective option for managing mood-related menopausal symptoms, with additional benefits for sleep and sexual well-being.

Publications

[1] Grube B, Walper A, Wheatley D. St. John's Wort extract: efficacy for menopausal symptoms of psychological origin. Adv Ther. 1999 Jul-Aug;16(4):177-86. PMID: 10623319.

[2] Abdali K, Khajehei M, Tabatabaee HR. Effect of St John's wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study. Menopause. 2010 Mar;17(2):326-31. doi: 10.1097/gme.0b013e3181b8e02d. PMID: 20216274.

[3] Al-Akoum M, Maunsell E, Verreault R, Provencher L, Otis H, Dodin S. Effects of Hypericum perforatum (St. John's wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial. Menopause. 2009 Mar-Apr;16(2):307-14. doi: 10.1097/gme.0b013e31818572a0. PMID: 19194342.

[4] Eatemadnia A, Ansari S, Abedi P, Najar S. The effect of Hypericum perforatum on postmenopausal symptoms and depression: A randomized controlled trial. Complement Ther Med. 2019 Aug;45:109-113. doi: 10.1016/j.ctim.2019.05.028. Epub 2019 May 31. PMID: 31331546.

[5] Briese V, Stammwitz U, Friede M, Henneicke-von Zepelin HH. Black cohosh with or without St. John's wort for symptom-specific climacteric treatment--results of a large-scale, controlled, observational study. Maturitas. 2007 Aug 20;57(4):405-14. doi: 10.1016/j.maturitas.2007.04.008. Epub 2007 Jun 21. PMID: 17590291.

[6] van Die MD, Burger HG, Bone KM, Cohen MM, Teede HJ. Hypericum perforatum with Vitex agnus-castus in menopausal symptoms: a randomized, controlled trial. Menopause. 2009 Jan-Feb;16(1):156-63. doi: 10.1097/gme.0b013e31817fa9e0. PMID: 18791483.

[7] van Die MD, Bone KM, Burger HG, Reece JE, Teede HJ. Effects of a combination of Hypericum perforatum and Vitex agnus-castus on PMS-like symptoms in late-perimenopausal women: findings from a subpopulation analysis. J Altern Complement Med. 2009 Sep;15(9):1045-8. doi: 10.1089/acm.2008.0539. PMID: 19757982.