Summary: In 70 Iranian women with newly diagnosed PCOS (aged 15–40 years), 330 mg of Salvia officinalis extract daily for eight weeks significantly reduced triglycerides and malondialdehyde compared with placebo, with significant favourable mean changes also seen in HDL cholesterol and total antioxidant capacity. Other lipid parameters (LDL cholesterol, total cholesterol) were unchanged. The extract was positioned as a potential adjunctive therapy for the metabolic and oxidative dimensions of PCOS rather than a replacement for conventional care.
PICO Summary
| Element | Detail |
|---|---|
| Population | 70 Iranian married women aged 15–40 years with newly diagnosed PCOS. |
| Intervention | Salvia officinalis (sage) extract 330 mg daily for 8 weeks. |
| Comparison | Matching placebo daily for 8 weeks. |
| Outcome | Significant reductions in triglycerides and malondialdehyde, and significant favourable mean changes in HDL cholesterol and total antioxidant capacity. LDL cholesterol and total cholesterol unchanged. |
Sage Extract in PCOS
RCT · PCOS · 8 weeks
Sage 330 mg/day for 8 weeks significantly lowered triglycerides (MD -17.25 mg/dL) and malondialdehyde versus placebo in PCOS, with favourable HDL and antioxidant-capacity changes; LDL and total cholesterol were unchanged. A small, short, surrogate-endpoint trial: promising adjunct, not proven.
Clinical Context
Polycystic ovary syndrome affects 6–12% of reproductive-age women and extends well beyond reproductive concerns. It is increasingly recognised as a metabolic disorder with insulin resistance, dyslipidaemia, oxidative stress, and chronic low-grade inflammation at its core, carrying elevated cardiovascular and diabetes risk. Standard treatment includes lifestyle modification, metformin for insulin resistance, and symptom-specific management, but many women seek complementary approaches. Salvia officinalis contains rosmarinic acid, carnosic acid, and polyphenols with antioxidant and anti-inflammatory properties, providing a rationale for testing its metabolic effects.
Clinical Pearls
- Triglycerides are particularly insulin-sensitive in PCOS. The reduction in triglycerides without change in LDL or total cholesterol is consistent with a hepatic or insulin-sensitising effect rather than broad lipid lowering.
- Oxidative stress reduction addresses a core mechanism. The fall in malondialdehyde and rise in total antioxidant capacity suggest the polyphenols are exerting meaningful antioxidant effects on a pathway central to PCOS pathophysiology.
- Selective effects are more convincing than pan-improvement. Targeted improvement in triglycerides and oxidative markers, rather than every parameter, argues against a non-specific placebo response or statistical artefact.
- RCT evidence differentiates sage from unproven claims. Evaluation in a placebo-controlled trial places sage in a higher evidence tier than most botanical remedies for PCOS, though it remains preliminary.
Practical Application
Sage extract may be considered an adjunct for motivated patients with PCOS already on standard treatment who want a complementary option, particularly where elevated triglycerides or oxidative stress are a concern. It is not a replacement for metformin, lifestyle change, or conventional management, and the evidence should be framed as promising rather than proven. If patients choose to use it, recommend standardised extracts from reputable manufacturers, and remain alert to potential interactions (anticonvulsants, sedatives, glucose-lowering agents) and the thujone content of high doses.
Broader Evidence Context
Multiple supplements have been studied in PCOS with variable evidence quality. Inositol has the strongest support, with benefits for ovulation, insulin resistance, and metabolic parameters across several trials, while omega-3 fatty acids, vitamin D, and berberine also have supporting data. Sage joins a group of botanicals, alongside berberine, fenugreek and cinnamon, that show modest short-term benefits but lack long-term cardiovascular outcome data. The finding aligns with a pathophysiology-focused approach to PCOS that treats metabolic dysfunction as central rather than incidental.
Study Limitations
The trial was small and short at eight weeks, and clinical outcomes such as cardiovascular events, diabetes incidence, and pregnancy rates were not assessed. The clinical significance of the triglyceride reduction is uncertain, and single-study results require replication in larger and more diverse populations before confident recommendations can be made.
Expert Commentary
My instinct with botanical supplements in PCOS is caution bordering on scepticism, because the field is crowded with small studies that improve every variable they measure and convince me of nothing. This trial is more disciplined than most, and that is precisely why it holds my attention. Sage moved triglycerides and oxidative markers but left LDL and total cholesterol alone, and that selectivity is reassuring, since a real biological effect should be patchy rather than universal. I am cautiously interested rather than convinced. The honest problem is scale and horizon: seventy women over eight weeks, with surrogate biochemistry rather than ovulation, pregnancy, or cardiovascular endpoints, and no durability data. That is not enough to write sage into a management plan. Can I use this with my patients? Only at the margins, as a reasonable adjunct for the woman already on metformin and lifestyle measures who specifically wants a complementary option and has troublesome triglycerides, and only with a frank conversation that this is promising, not proven. I would want a larger and longer trial with clinical endpoints before I said anything stronger.
References
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