Black Cohosh and Peony Root have been producing incredible benefits for women’s health long before anyone thought to put them in a capsule

More women are approaching menopause differently today. Instead of simply pushing through uncomfortable symptoms, we are asking better questions, looking for deeper understanding, and exploring evidence-based ways to support our bodies through the transition.

That curiosity often leads somewhere interesting: the botanical world.

Plants and herbal remedies have been supporting women through hormonal shifts for centuries, long before modern wellness trends put them in capsules and supplements. Two that consistently stand out in both traditional medicine and modern research are black cohosh and peony root.

These plants aren’t the latest fad. They have long histories, ongoing and growing clinical interest, and a reputation among practitioners for helping women navigate the physical and emotional changes that come with perimenopause and menopause.

If you’re keen to deepen your understanding of the hormonal changes happening during perimenopause and menopause, our guide to hormones and the role they play in perimenopause and menopause explores this topic.

Black Cohosh: One of the Most Studied Herbs for Menopause Symptoms

Black cohosh (Actaea racemosa) grows in the forests of eastern North America and has a long history of use among Indigenous communities including the Algonquin, Cherokee and Iroquois peoples. 

Traditionally it was used for a range of women’s health concerns, from menstrual discomfort to musculoskeletal pain. By the 19th century, black cohosh had also become part of mainstream herbal medicine in Europe and North America.

What makes it particularly interesting for modern women experiencing perimenopause and menopause symptoms is how it appears to interact with the body’s hormonal systems. Research suggests black cohosh may work through pathways in the brain that influence temperature regulation, mood and sleep, which may help explain why it’s commonly used for symptoms linked to the menopause transition.

Today, black cohosh is considered one of the most researched herbal remedies for menopause symptoms.

Menopause Symptoms Black Cohosh May Help With

Two of the most well-known menopause symptoms are hot flushes and night sweats (often referred to medically as vasomotor symptoms). Several clinical trials have investigated black cohosh for these symptoms, including a widely cited 2013 randomised clinical trial that reported meaningful reductions in both the frequency and intensity of hot flushes.

That doesn’t mean it works identically for everyone. Herbal support always interacts with individual physiology, but for many women, black cohosh has become a valuable part of their strategy for managing:

• Hot flushes
• Night sweats
• Hormonal fluctuations
• Sleep disruption linked to menopause

There’s also interest in how it may support overall hormonal regulation, helping the body adjust as oestrogen levels shift during menopause.

This matters more than people often realise. When hormones fluctuate unpredictably, the ripple effects can show up in sleep, mood, cognitive clarity and energy levels. Even small improvements in hormonal balance can change how the day feels.

Peony Root: The Calmer Companion Herb

If black cohosh tends to get most of the attention, peony root (Paeonia lactiflora) plays a quieter but equally important role.

Rather than acting as a sedative, peony is often described as gently calming. This means it can help to take the edge off stress without dulling energy (ideal!).

Peony has been used in Traditional Chinese Medicine (TCM) for more than 1,500 years, where it’s traditionally associated with nourishing the blood, supporting liver function, and helping regulate emotional balance.

In Japanese Kampo medicine, peony root appears in classic formulations still used today, including Shakuyaku-kanzo-to: a traditional herbal combination valued for its ability to relax muscle tension and support overall balance in the body. Peony also appears in a number of other Kampo formulas used to support women through hormonal transitions.

Emerging research is beginning to explore how compounds in peony root, particularly paeoniflorin, interact with hormonal and nervous-system signalling pathways. Studies suggest peony extracts may influence inflammatory responses and neurotransmitter pathways linked to mood and stress regulation. Other research suggests the herb may support hormone balance by influencing reproductive hormone levels and the way the body’s hormone systems communicate.

For many women experiencing perimenopause anxiety, irritability, or emotional sensitivity, the support of peony root can be incredibly valuable.

The Missing Conversation: Stress and Menopause

One factor that doesn’t always receive enough attention in menopause discussions is stress.

When cortisol (the body’s primary stress hormone) remains elevated for long periods, it can interfere with hormonal signalling. During menopause, when hormones are already shifting, this additional pressure can intensify symptoms such as:

• Hot flushes
• Sleep disturbances
• Mood fluctuations
• Fatigue
• Reduced immune resilience

In other words, stress and menopause symptoms can reinforce each other. But thankfully there are natural ways we can work to break that unpleasant cycle!

Peony root’s calming influence may help support stress resilience, which indirectly helps stabilise hormonal communication throughout the body.

And during midlife - a stage that often includes career shifts, family changes, ageing parents, and evolving identities - that kind of emotional support can be just as important as physical symptom relief.

Why Herbal Combinations Often Work Better

Traditional herbal medicine rarely relies on a single magical plant. Instead, it tends to combine herbs that work on different aspects of the same issue.

Black cohosh and peony root are a good example of this approach.

On one hand, black cohosh is typically associated with physical menopause symptoms, particularly hot flushes and hormonal fluctuations. Peony root, meanwhile, supports the stress and emotional regulation side of the menopause experience. 

Together, they cover more ground than either would alone. This kind of multi-herb thinking isn't new; it's actually the basis of most traditional herbal medicine systems, and increasingly it's being validated by how we understand symptom clusters in modern research.

Where These Herbs Come Together: The Foundation Blend

Black cohosh and peony root are two herbs that form part of our Foundation blend, designed as a supportive starting point for women navigating perimenopause and menopause.

Alongside black cohosh and peony root, the formula also includes:

Astragalus root: Widely used in Chinese medicine as an adaptogen to support vitality, immune health and resilience.

Licorice root:  Traditionally valued for adrenal support, anti-inflammatory properties and helping the body respond to long-term stress.

Together, these ingredients work to support:

• Hormone balance during menopause
• Reduced hot flushes and night sweats
• Stress resilience and emotional wellbeing
• Immune health during hormonal transition

It’s not intended as a quick fix. Menopause is a complex biological shift and every woman experiences it differently. But a thoughtfully constructed herbal foundation can offer meaningful and ongoing support.

Supporting the Menopause Transition with Respect for the Body

Menopause is a natural life stage, rather than a condition that needs ‘fixing’. However, anyone experiencing the symptoms that can accompany it - the sleep disruption, the sudden heat waves, the emotional unpredictability – knows that support and understanding are vital at this time.

Black cohosh and peony root have been part of that support for centuries, across cultures and medical traditions. Today, modern research is continuing to explore what many herbal practitioners have long understood: that plants can play a meaningful role in helping women move through menopause with greater comfort and balance.

At The Menopause Co., we honour that history by bringing these ingredients together in supportive formulations that respect both traditional knowledge and modern science.