The menopause transition brings a host of physical and mental changes that can impact our quality of life. Everyone’s experience is unique, and there are many different approaches to managing the changes that occur during this pivotal time. Frequently, clients ask about supplements and if they can help with menopause. One of the supplements I am asked about frequently is ashwagandha.
In today’s post, I review the evidence on ashwagandha for menopause, including safety considerations, such as potential interactions with medications and pre-existing health conditions.
It’s important to note that taking a supplement can not make up for lack of sleep, inadequate movement or nourishment, or lack of social connection and support. These are the foundational aspects of our health that are best addressed before turning to supplements or other treatments to augment our well-being.
That being said, sometimes we just want to take something quick and easy to kickstart a change.
I get it.
Let’s look at what ashwagandha is and if it can help with menopause symptoms.
What is ashwagandha?
Ashwagandha, or Withania somnifera, is a shrub that grows in India, Africa, and some parts of the Middle East. It is commonly used in traditional Ayurvedic medicine for increased energy and stress relief. Ashwagandha is also known as “Indian ginseng” or “Indian Winter cherry.”
For centuries, people have turned to extracts and powders made from this plant to relieve stress, increase energy and fight inflammation. With the rise of the wellness influencer, supplements like ashwagandha have become more popular outside of these traditional medicine spaces.
There is a fair amount of research on ashwagandha, demonstrating that it can reduce markers of inflammation and stress. However, much of the literature is on animal or cell models. There is much less research on human subjects available to understand its effects.
Ashwagandha is an adaptogen
Ashwagandha is considered to be an adaptogen. Adaptogens are a class of herbs or mushrooms that are thought to help the body tolerate more emotional and physical stress.
Our bodies like to be in a state of homeostasis, or balance, and it has many mechanisms that work hard to keep it that way. Adaptogens such as ashwagandha are thought to help the body return to homeostasis in times of stress.
We are still learning how ashwagandha affects the body and how it might help with our stress response. One theory is that ashwagandha is involved with the cortisol response to stress through the hypothalamus-pituitary-adrenal (HPA) axis. In response to a stressor, this axis kicks in and ultimately leads to increases in cortisol as an adaptive mechanism. You may know it better as the “fight or flight” response. When we experience chronic stress, cortisol levels may be higher than needed. It is thought that ashwagandha can help lower cortisol levels, reducing stress.
What does the research say about ashwagandha and menopause symptoms?
Very, very little.
There has been only one study conducted on people in menopause.
The study, published in The Journal of Obstetrics and Gynaecology Research, included 100 perimenopausal women between 45 and 60 years old. The researchers investigated the effect of ashwagandha on all menopause-related symptoms for eight weeks. The participants were randomized into two groups. One group was provided 600 mg of ashwagandha daily and the other a placebo. The researchers compared participants’ symptoms and hormone levels at the beginning, middle and end of the study.
The results showed improved quality of life based on several assessment scales. Participants taking ashwagandha had reduced anxiety, irritability, and depressive symptoms compared with those taking the placebo. This study also found increases in estradiol in response to taking ashwagandha, providing a potential explanation for the results.
While the results are promising, the study is small and much more research is needed to verify its results.
Some research shows ashwagandha can help with stress
Although not explicitly conducted on people going through menopause, a growing number of studies aim to answer the question: can ashwagandha help with stress?
And we know that menopause can often increase stress, right?
A systematic review from 2014 of five intervention studies showed that ashwagandha improved stress scores on various standardized assessment scales. However, the studies included showed high or unclear risk of bias, so the results should be interpreted with caution.
Since this review, there have also been a couple of intervention studies investigating stress and ashwagandha:
- Lopresti et al. (2019) conducted a randomized, controlled trial where 60 adults were allocated to take either a placebo or 240 mg of ashwagandha once daily. Compared with the placebo, ashwagandha supplementation was associated with reductions in anxiety scores and decreases in morning cortisol levels. Participants included both men and women. Although data on menopausal status was not gathered, the average age was around 40, so some of the women may have been in the early stages of the menopause transition. This study was small in sample size, short in duration, and only used healthy individuals. So we don’t know if the results would be consistent among larger groups of individuals or among those with health conditions.
- Salve et al. (2019) conducted a similar double-blind placebo-controlled study lasting eight weeks. The study included 60 male and female participants randomized into three groups: 125 mg of ashwagandha, 300 mg of ashwagandha, or an identical placebo twice daily. The researchers measured perceived stress, anxiety and morning cortisol at baseline and eight weeks. Sleep quality was also assessed, demonstrating improved sleep quality for participants taking ashwagandha.
Although the research is still emerging, there may be some benefit to taking ashwagandha for short periods in adults with chronic stress. The studies above have demonstrated that ashwagandha can decrease cortisol and reduce perceived stress compared to a placebo.
A couple of studies show ashwagandha can help with sleep
Oh, sleep, elusive sleep.
Some research supports ashwagandha’s use for sleep, which may also have a knock-on effect when it comes to stress. After all, it’s pretty challenging to deal with chronic stress when we feel tired all the time.
A small meta-analysis of patients with insomnia showed modest improvement in overall sleep and sleep quality compared to a placebo. Another clinical trial suggests those with non-restorative sleep might benefit from ashwagandha. A six week study of individuals taking a daily 125 mg dose of ashwagandha reported increased sleep quality compared to those taking a placebo. Again, these are smaller studies of short duration.
Perhaps ashwagandha can help improve sexual function
There has been one study investigating the effect of ashwagandha on female sexual function in women between the ages of 21 and 50. Dongre et al. (2015) provided half the participants with 300mg of ashwagandha twice daily for eight weeks. They compared it to a placebo in the other half of the participants. Based on the results from two self-reported assessment scales, the researchers concluded that ashwagandha improves sexual function in healthy women. This was a small pilot study, requiring more studies in the future to validate these results.
Safety considerations: watch out for medication interactions
While ashwagandha is likely safe for many individuals, it is important to consider that studies using the herb are short in duration. We don’t have long-term data on its safety. According to the Natural Medicines Database, ashwagandha is safe to take for up to six months at a dose of up to 1250 mg per day. Most studies reviewed showed benefit at a 600 mg total daily dose.
Mild side effects typically include stomach upset, nausea, or diarrhea, occurring at higher doses. In the study conducted on perimenopausal women, the dropout rate due to side effects was equal in both the intervention and placebo groups and side effects reported were mild. A couple of case reports have demonstrated liver injury from its use, although one incident was from taking twice the recommended dose.
An important consideration to make with this, and any supplement, is any possible medication interactions. Ashwagandha may increase the risk of hypoglycemia in individuals taking medications for diabetes. Ashwagandha can also interact with thyroid medication and affect thyroid blood tests.
Since ashwagandha can stimulate the immune system, there is a possibility that it could make autoimmune conditions worse. For those living with conditions such as rheumatoid arthritis, lupus, multiple sclerosis, etc., check with your specialist before taking and closely monitoring disease activity.
Can you take ashwagandha with HRT?
If you are taking menopause hormone therapy (also known as hormone replacement therapy or HRT), it is likely safe to take ashwagandha alongside HRT. However, it is best to run this by your practitioner first.
Bottom line
There isn’t enough significant data on ashwagandha for menopause to make any recommendations regarding symptoms. However, the research suggests that it may be worth considering for stress relief.
Stress is a part of life. Having various tools to support stress management makes everyday stressors easier to deal with. A supplement won’t make up for poor quality sleep or inadequate movement and nourishment. And it certainly cannot replace mental health interventions, such as therapy or medication needed for clinical anxiety disorders. But it could be the boost you are looking for to combat stress.
If you think ashwagandha might be worth exploring as part of your arsenal against stress, check with your health care provider first.
When my clients are interesting in trying a supplement like this one, I suggest a little experiment if it is deemed safe to take. Try the supplement consistently for a couple months, then stop taking it for a couple months to compare the results. This way, they can see if the supplement really works for them.
Thank you to UBC FNH Student Shirley Liu for assisting with the research used in this post.
