Ashwagandha for Women: Menopause and Sexual Health

Perimenopause symptom scores over eight weeks

In an eight-week randomized placebo-controlled trial of 100 perimenopausal women with climacteric symptoms, 300 mg ashwagandha root extract twice daily was associated with lower total Menopause Rating Scale and menopause-specific quality-of-life scores than placebo; 91 participants completed the study. Both total-score comparisons were reported at p<0.0001. The available abstract does not supply absolute score differences. This short, selected-population trial does not establish long-term benefit, effects of other extracts or equivalence to menopausal hormone therapy.^[1]

In the same 100-participant perimenopause trial, serum estradiol was higher and FSH and LH were lower with ashwagandha than placebo, while serum testosterone did not differ significantly between groups. The regimen was root extract 300 mg twice daily for eight weeks, with 91 completers. Laboratory differences do not establish that hormonal changes caused symptom improvements, that hormones were normalized, or that ashwagandha can replace hormone therapy.^[1]

A 24-week postmenopause trial

In a 24-week six-arm randomized placebo-controlled trial enrolling 127 postmenopausal women aged 40–55, the ashwagandha-only Sensoril groups at 250 or 500 mg/day reported lower total menopause-specific quality-of-life scores than placebo; 123 women completed, including 20 and 22 in the ashwagandha-only groups. The studied formulation was an aqueous extract of roots and aerial parts, split morning and evening after meals. The total MENQOL finding does not establish a benefit on every individual symptom. Small homogeneous groups, normal thyroid/liver/kidney entry criteria, medical exclusions, unmonitored diet/activity and manufacturer funding limit generalization. This is not a hormone-therapy comparison or evidence of fracture prevention or long-term safety.^[3]

Sexual function in a different population

An eight-week randomized placebo-controlled trial enrolled 80 women aged 18–50 with hypoactive sexual desire disorder who also met FSFI below 26 and/or FSDS above 11 criteria, without hormonal disturbances; KSM-66 root extract 300 mg twice daily was associated with greater improvements in sexual-function and sexual-distress scores than placebo in the 72-woman efficacy analysis. FSFI increased from 14.20 to 22.62 with ashwagandha versus 14.17 to 19.25 with placebo. The GHQ-28 quality-of-life comparison was nonsignificant (p=.078). The selected cohort excluded menopausal women and hormonal abnormalities, and per-protocol analysis and eight-week follow-up limit generalization; this is not a fertility or hormonal-treatment finding.^[2]

Fertility, periods, PCOS, PMS and contraception

The three selected women’s trials reported menopause-related scores or sexual-function outcomes; they did not establish effects on pregnancy rates, PCOS, PMS, menstrual-cycle regulation or contraceptive effectiveness. This is a limit of these cited trials, not a claim that a complete search has found no research on every reproductive question. Sexual-function scores and serum hormone measurements cannot be substituted for fertility or contraceptive outcomes.^{[1], [2], [3]}

Pregnancy, breastfeeding and condition-specific precautions

NCCIH advises avoiding ashwagandha during pregnancy and not using it while breastfeeding. Short-term studies in other adults do not establish safety during pregnancy or breastfeeding; discuss any exposure or supplement plans with a qualified healthcare professional.^[4]

NCCIH does not recommend ashwagandha for people with thyroid or autoimmune disorders or those who are about to have surgery. Discuss these conditions and any planned surgery with your healthcare professional before considering ashwagandha; supplement research does not justify changing prescribed care.^[4]

Ashwagandha may interact with medicines for diabetes or high blood pressure, immunosuppressants, sedatives, anticonvulsants, and thyroid hormone medicines. Discuss possible interactions with your prescriber or pharmacist before use; do not stop, replace, or adjust prescribed medicines based on supplement information.^[4]

Rare reports have linked ashwagandha supplements with liver injury. Short-term tolerability findings do not rule out rare harms or establish long-term safety.^[4]

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