Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age, estimated to affect 5 to 15% of women worldwide. The condition goes well beyond cycle irregularities — it is associated with metabolic issues such as lipid disorders, insulin resistance and increased oxidative stress. Two clinical studies from 2025/2026 have examined whether sage (Salvia officinalis) may affect metabolic parameters and fertility markers in women with PCOS — a long-known plant now in the spotlight of current research.
What characterises PCOS, and why sage is being studied
PCOS is a complex endocrine condition usually defined by three main features: irregular or absent menstrual cycles (oligo- or amenorrhoea), clinical or laboratory signs of elevated male hormones (hyperandrogenism), and the characteristic appearance of many small ovarian follicles on ultrasound.
Beyond cycle irregularities, many affected women — regardless of body weight or ethnicity — experience a lipid metabolism disorder with elevated triglycerides and LDL cholesterol alongside lowered HDL cholesterol. This lipid disorder is linked not only to increased cardiovascular risk but also to reduced fertility, since it can affect egg maturation, embryo quality, and the receptivity of the uterine lining. Oxidative stress adds to the picture: elevated levels of reactive oxygen species are associated with worsening insulin resistance, inflammatory processes, and damage to ovarian cells.
Salvia officinalis contains a complex mix of compounds including carnosic acid, rosmarinic acid, diterpenoids, triterpenoids, flavonoids and phenolic glycosides. Research attributes to these substances lipid-lowering, metabolism-regulating (partly via inhibition of α-glucosidase and α-amylase), antioxidant and anti-inflammatory properties. One discussed mechanism is activation of the peroxisome proliferator-activated receptor γ (PPARγ), a key regulator of lipid metabolism and insulin sensitivity.
What an Iranian study shows about lipid metabolism and oxidative stress
A randomised, placebo-controlled clinical trial published in March 2025 in the journal BMC Complementary Medicine and Therapies examined 70 Iranian women aged 15 to 40 with newly diagnosed PCOS according to the Rotterdam criteria. Participants received either 330 mg of an ethanolic sage extract or a placebo (corn starch) daily for eight weeks.
The study found a statistically significant reduction in triglycerides in the sage group compared with placebo (p < 0.001), as well as a significant reduction in malondialdehyde (MDA), a marker of oxidative cell damage (p < 0.001). For other lipid parameters — total cholesterol, LDL and HDL cholesterol — the sage group showed improvement trends, though these didn't consistently reach statistical significance (p-values between 0.09 and 0.31). Total antioxidant capacity (TAC) also differed significantly in favour of the sage group. The study authors interpret this as suggesting sage extract could be a possible complementary option for influencing lipid metabolism and oxidative stress in PCOS, while themselves noting limitations: a relatively short eight-week study duration, a single dose tested, and the need for larger follow-up studies.
What a second study reports about fertility parameters
A second study, published in June 2025 in the journal Ginekologia i Poloznictwo, examined from Iraq whether sage was also associated with fertility parameters in PCOS patients undergoing intrauterine insemination (IUI). The study included 461 women, with 400 IUI cycles evaluated; one group received 500 mg of sage leaf extract daily for eight weeks before insemination, the other a placebo. Reported outcomes in the sage group included a higher number of dominant follicles, greater endometrial thickness, higher oestradiol levels, and higher clinical pregnancy and live birth rates.
An honest assessment of this second study should note some caveats: Ginekologia i Poloznictwo is a considerably less established journal than the BMC journal that published the first study, and the publication couldn't be independently verified in the same depth as the Iranian study. It also reports an unusually large number of statistically significant effects across very different endpoints (follicle count, endometrial thickness, hormone levels, pregnancy and birth rates) — which, without having reviewed the full text in detail, suggests some methodological caution is warranted. These results should therefore be considered preliminary and in need of confirmation by independent, larger studies, rather than established evidence of a fertility-boosting effect of sage.
Discussed mechanisms of action
Several mechanisms, some studied only preclinically, are discussed in the literature for the observed effects:
- Inhibition of fat-splitting enzymes: sage compounds are associated with inhibiting pancreatic lipase, which could reduce fat absorption in the gut.
- PPARγ activation: a possible influence on the HDL-to-LDL ratio and on adipose tissue.
- Antioxidant activity: polyphenolic compounds that can neutralise free radicals.
- Insulin sensitivity: an earlier study by the same Iranian research group (2020) already examined a possible effect of sage extract on glycaemic control in PCOS patients.
Practical context
The two studies discussed here used different doses: 330 mg of sage extract daily for eight weeks in the metabolic study, and 500 mg of sage leaf extract daily for eight weeks before IUI in the fertility study. Both studies themselves point to open questions: the relatively short study duration, single doses tested, lack of long-term data, and the need for further, larger studies with different doses and additional hormonal analyses.
Important overall context: these studies examine a plant extract as a possible complementary approach alongside, not instead of, medical care for PCOS. Diagnosing and treating PCOS — especially when trying to conceive or undergoing fertility treatment — belongs in medical hands.
Zyklus essentia by Natura Nova
Five plants from European herbal tradition — lady's mantle, yarrow, lemon balm, sage and pomegranate — combined with folic acid, vitamin B6 and vitamin B12. The sage leaf extract is standardised to 20% polyphenols. Vitamin B6 contributes to the regulation of hormonal activity. Folic acid, vitamin B6 and vitamin B12 contribute to normal red blood cell formation and to normal psychological function.
Conclusion
Two recent studies provide early clinical hints that sage extract may be associated with improvements in certain metabolic and oxidative stress markers in women with PCOS; for the reported effects on fertility parameters, the evidence base is methodologically less well secured and needs independent confirmation. Sage thus emerges as a plant under active research in the context of PCOS — with one solid study on metabolism and one preliminary, more critically assessed study on fertility. Further, larger and independently replicated studies are needed before firm recommendations can be drawn from this.
This article is intended for general information about sage in the context of PCOS and the current state of research and does not replace medical advice, diagnosis or treatment. If you suspect PCOS or are trying to conceive, please consult a doctor or pharmacist.
Sources
- Maleki-Hajiagha A, Mojab F, Amidi F, Amini L: Exploring the therapeutic impact of Salvia officinalis on lipid and oxidative stress markers in patients with polycystic ovary syndrome – a randomized placebo-controlled clinical trial. BMC Complement Med Ther. 2025;25(1):114. doi: 10.1186/s12906-025-04858-2 (PMC, Open Access)
- Al-Anbari LA, Jwad MA, Abbood MS, Kadhim AAM, Ridha-Salman H: Oral intake of Salvia officinalis improves intrauterine insemination outcomes in women with polycystic ovary syndrome. Ginekol Poloznictwo. 2025;20:1–5.
- Amini L, Mojab F, Jahanfar S, Sepidarkish M, Raoofi Z, Maleki-Hajiagha A: Efficacy of Salvia officinalis extract on the prevention of insulin resistance in euglycemic patients with polycystic ovary syndrome: a double-blinded placebo-controlled clinical trial. Complement Ther Med. 2020;48:102245. doi: 10.1016/j.ctim.2019.102245
