Whilst Menopause is a completely natural stage in a woman’s life, hot flashes along with other unpleasant symptoms can be incredibly disruptive and taxing. Over the years there have been several herbal remedies tested with varying degrees of success with sage often being touted as a potential solution. The question of course is whether or not sage actually does anything for menopause symptoms.
Sage Extract and Menopause: Can it Help?
Sage has actually been quite extensively studied for hot flashes and night sweats particularly, there has actually been some positive results in this, but it should be mentioned that this has been done mostly standardized extracts designed to contain a specific amount of certain flavonoids (the active compounds) within sage.
The Evidence: Clinical Trials and Research
The most often cited study on sage for menopause was published in the journal "Advances in Therapy" examined the efficacy of a fresh sage in menopausal women. This is actually one of the examples of where a standardized extract wasn’t used and safe was successful. 
The results showed a notable improvement in self reported severity and frequency of hot flushes after eight weeks.
There was a similar study conducted in Iran found that sage extract reduced the severity of hot flushes and night sweats compared to a placebo group. 
There have also been several with standardized extracts, this is important because depending on where it was grown, soil quality and a number of other factors the amount of the active ingredients can vary. Meaning otherwise it is impossible to recommend a specific dosage.
How Does Sage Extract Work?
The main theory is that similar to soy isoflavones, sage’s flavonoids have estrogenic properties that may mimic the effects of estrogen in the body. The thought is that these can help regulate the decline in estrogen production during menopause. There is however another theory, and it could explain why sage doesn’t seem to be too effective at improving other menopause symptoms. The theory is that these flavonoids modulate the neurotransmitters involved in temperature regulation. By influencing these neurotransmitters sage could in theoy help regulate body temperature and reduce the frequency and intensity of hot flushes. Although the evidence to how sage actually works is relatively sparse.
Timing and Dosage of Sage for Menopause
There’s quite a bit of mixed results when it comes to this, and this is likely due to extract variation as well as person to person differences.
For example, some studies have reported improvements in hot flushes within four weeks, whilst others have not shown any significant benefits after eight weeks.
The dosage of sage for menopause is usually around 3000mg in capsule form.
It is best to avoid essential oils as there is a toxic compound in sage that can cause issues with over use and this is more prevalent in oils.
Safety Considerations and Potential Side Effects
Sage contains a compound called thujone which can be toxic in high doses. For example 12 drops of essential oils would be a toxic dose. 
For this reason, it is crucial to follow the recommended dosage and not exceed the recommended amount of sage extract.
Additionally sage extract should not be used during pregnancy.
Individuals with certain medical conditions, such as epilepsy or seizure disorders, should also exercise caution when using sage extract. Thujone has been associated with triggering seizures in susceptible individuals. If you have a history of seizures, it is best to avoid sage extract or seek guidance from your healthcare provider.
Conclusion: Does Sage Work For Menopause?
Whilst it is important to note more research is needed into sage to understand quite how effective it actually is, there are several studies that currently support the use of sage for menopause support and symptom relief, particularly around hot flashes and nigh sweats.
1 - https://pubmed.ncbi.nlm.nih.gov/21630133/
2 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10363264/
3 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003706/