Last checked September 2026 against 6 sources · Editorial policy
Ashwagandha for menopause
Ashwagandha has limited evidence for menopause. In one 8-week trial in India, 100 perimenopausal women took 300 mg of root extract twice a day or placebo; ashwagandha lowered menopause symptom scores and hot flash scores and raised estradiol. NCCIH says evidence isn't enough to judge it for menopause, though some preparations may help insomnia and stress. Rare liver injury has been reported, and it's not recommended with thyroid or autoimmune conditions.
One 8-week trial found ashwagandha lowered perimenopause symptom scores. What it may do for sleep and stress, the dose used, and rare liver and thyroid cautions.
Ashwagandha for menopause: expectation vs reality
What people often expect
“Ashwagandha is a gentle, proven adaptogen that balances menopause hormones”
What the evidence shows
The menopause evidence is a single small trial, and one trial isn't enough to prove benefit. Ashwagandha isn't risk-free: NCCIH lists rare liver injury, interactions with thyroid, diabetes, blood pressure, sedative and anti-seizure medicines, and advises avoiding it with autoimmune or thyroid disorders.
Ashwagandha and menopause: what studies show
Ashwagandha for perimenopause: the trial
In an 8-week randomized, double-blind trial, 100 women with perimenopausal symptoms took 300 mg of ashwagandha root extract twice daily or placebo, and 91 completed it. Ashwagandha reduced total menopause rating scale scores, including psychological, physical and urogenital domains, and improved menopause-specific quality of life compared with placebo.
Ashwagandha for hot flashes
The same trial measured hot flash scores as part of its outcomes and reported improvement with ashwagandha. That's a single small, short study; there are no larger confirmatory trials in our sources. The North American Menopause Society doesn't recommend herbal remedies for hot flashes.
Learn more →Ashwagandha and estrogen
In the trial, ashwagandha was associated with higher estradiol and lower FSH and LH than placebo, with no change in testosterone. NCCIH notes limited evidence that ashwagandha may raise testosterone in men, and advises people with hormone-sensitive prostate cancer to avoid it. Whether it's estrogenic in women isn't well established.
Learn more →Ashwagandha for stress and sleep
NCCIH says research shows some ashwagandha preparations may be effective for insomnia and stress, while evidence on anxiety is unclear. Sleep and stress are common complaints in perimenopause, so this is the most plausible use, but CBT for insomnia has stronger evidence.
Learn more →Ashwagandha side effects
Ashwagandha may be safe short term, up to 3 months, but long-term safety isn't known. Some people get drowsiness, stomach upset, diarrhea or vomiting. Rarely, liver injury has been linked to ashwagandha supplements. Stop and see a doctor if you notice dark urine, yellow skin or eyes, or unusual tiredness.
Who should avoid ashwagandha
NCCIH says ashwagandha isn't recommended before surgery or for people with autoimmune or thyroid disorders, and shouldn't be used in pregnancy or while breastfeeding. It may interact with medicines for diabetes, high blood pressure and thyroid disease, immunosuppressants, sedatives and anti-seizure medicines.
Ashwagandha vs proven options
For hot flashes, HRT is most effective, and CBT, hypnosis, SSRIs or SNRIs, gabapentin and fezolinetant are recommended without hormones. For sleep, CBT is offered by the NHS. Ashwagandha may be worth discussing with your doctor if stress and sleep are your main issues and you have no conditions or medicines that rule it out.
Learn more →Ashwagandha by the numbers
300 mg
8 weeks
91
3 months
The menopause evidence rests on one small trial in India.
Ashwagandha and alternatives compared
Ashwagandha root extract
Good for
Lowered menopause symptom scores in one 8-week trial; may help stress and insomnia.Watch
Rare liver injury; many drug interactions; avoid with thyroid or autoimmune conditions.CBT
Good for
Recommended for hot flashes and used for insomnia.Watch
Takes several weeks.Black cohosh
Learn more →Good for
More research for hot flashes than ashwagandha.Watch
Mixed results; rare liver damage.HRT
Learn more →Good for
Most effective for hot flashes; can improve sleep disturbed by night sweats.Watch
Needs a prescription.
How to use ashwagandha safely
- Don't use it if you have a thyroid or autoimmune condition, are pregnant or breastfeeding, or have surgery coming up.
- Check interactions if you take diabetes, blood pressure, thyroid, sedative or anti-seizure medicines.
- Limit use to about 3 months, the period with safety data.
- Stop at any sign of liver trouble.
When to stop ashwagandha and see a doctor
Dark urine, yellow skin or eyes, or unusual tiredness
Stop ashwagandha and see a doctor.
Thyroid disease or thyroid medicine
Talk to your doctor; ashwagandha isn't recommended and may interact.
Insomnia lasting weeks
Ask about CBT and treating night sweats.
More →
Ashwagandha and menopause: questions women ask
Does ashwagandha help menopause?
One 8-week trial of 100 perimenopausal women found lower symptom and hot flash scores than placebo. NCCIH says there isn't enough evidence yet to judge it for menopause.
Does ashwagandha increase estrogen?
In the perimenopause trial, estradiol was higher and FSH and LH lower with ashwagandha than placebo. That's one small study; its hormonal effects in women aren't well established.
Does ashwagandha help hot flashes?
The single menopause trial reported improved hot flash scores, but that isn't enough to recommend it. NAMS doesn't recommend herbal remedies for hot flashes.
Is ashwagandha good for perimenopause sleep and stress?
NCCIH says some ashwagandha preparations may help insomnia and stress. CBT has stronger evidence for insomnia.
Is ashwagandha safe for menopausal women?
It may be safe for up to 3 months, but rare liver injury has been reported, and it's not recommended with thyroid or autoimmune disorders. It interacts with several medicines.
How much ashwagandha should I take for menopause?
The perimenopause trial used 300 mg of root extract twice daily for 8 weeks. There's no established dose for menopause; ask your doctor first.
Can ashwagandha affect thyroid?
NCCIH advises people with thyroid disorders not to use ashwagandha and warns it may interact with thyroid hormone medicines.
Sources
- Gopal S, Ajgaonkar A, Kanchi P, et al. Effect of an ashwagandha (Withania Somnifera) root extract on climacteric symptoms in women during perimenopause: A randomized, double-blind, placebo-controlled study. J Obstet Gynaecol Res. 2021;47(12):4414-4425.
- NCCIH. Ashwagandha: usefulness and safety.
- The North American Menopause Society. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590.
- NHS. Insomnia.
- Maunder A, Mardon AK, Rao V, et al. Complementary therapies for management of menopausal symptoms: a systematic review to inform the update of the International Menopause Society recommendations on women's midlife health. Climacteric. 2026;29(2):165-209.
- National Center for Complementary and Integrative Health. Black cohosh: usefulness and safety.
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