Does Ashwagandha Help Menopause Symptoms?

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Ashwagandha is the headline ingredient in a good number of menopause supplements now, usually wrapped in a cortisol story: menopause raises your stress hormone, high cortisol is why you are hot, sleepless and short-tempered, and this ancient root brings it down.

The evidence underneath that story is real but narrow, and it is mostly not about menopause. Here is what has actually been tested, at what dose, in whom — and the three things about ashwagandha that matter more than any of the marketing.

Where the evidence actually sits

The US National Center for Complementary and Integrative Health puts it plainly: there is not enough evidence to determine whether ashwagandha is helpful for menopause.¹ Almost the entire clinical literature sits in short trials — six to twelve weeks — of stress, anxiety and sleep, in general adult populations, conducted in India, with the extract supplied or funded by its manufacturer.²

Stress and cortisol

The most-quoted trial randomised 60 stressed but healthy adults into three arms of 20 — a root extract at 250 mg or 600 mg a day, or placebo — for eight weeks. At 600 mg, perceived stress scores fell 38.3% against 26.7% on placebo, serum cortisol fell 32.6% against 3.9%, anxiety scores fell 16.4% against 8.1%, and sleep scores improved 46.0% against 16.4%.³

Read those placebo numbers again. Twenty people per arm, healthy Indian adults rather than menopausal women, eight weeks — and the placebo group improved by more than a quarter on the stress scale, which is most of the ashwagandha effect. The authors themselves said a larger and broader population is needed for conclusive results, and thanked the extract’s manufacturer for supplying it.³

A second trial in 60 stressed adults using a different branded extract at 240 mg a day for 60 days found anxiety scores improved marginally at p=0.040, while the broader depression-anxiety-stress score did not reach significance at p=0.096. Morning cortisol fell, and so did DHEA-S — which is not obviously a benefit.⁴

Sleep

A 2021 meta-analysis of 5 randomised trials in 400 participants found an overall sleep effect size of −0.59, which the authors described as small but significant, with a larger effect in people with insomnia. Doses ranged from 120 to 600 mg a day over 6 to 12 weeks. Their own caveat is worth carrying: data on serious adverse effects are limited, and more safety data would be needed to assess whether it is safe for long-term use.⁵

None of those sleep trials was conducted in menopausal women. Menopausal insomnia driven by night sweats is not the same clinical problem as ordinary insomnia — a distinction that also matters for night waking caused by the bladder.

The menopause evidence: three trials, and that is all

Trial one (2021). One hundred perimenopausal women randomised, 91 completing, given a root extract standardised to more than 5% withanolides at 300 mg twice daily — 600 mg a day — for eight weeks. Menopause Rating Scale scores fell 23.5% against 10.9% on placebo. Oestradiol rose and FSH fell. The published appraisal describes it as the only trial at that point to assess ashwagandha for perimenopausal symptoms using menopause-specific outcome measures, and flags that participants were in late-stage perimenopause only, that progesterone was not measured, and that a more diverse cohort is needed.⁶

Trial two (2025). Sixty women aged 45 to 55 with diagnosed menopause and at least ten hot flush events a week, given the same extract at 300 mg twice daily for 56 days. Total Menopause Rating Scale score fell from 31.37 to 18.53, against 30.73 to 30.03 on placebo. Hot flush events, quality of life and perceived stress all improved. Single centre, in Andhra Pradesh; the authors report no financial support received, with the extract supplied by its manufacturer; their stated limitations include short duration, small sample, a homogeneous cohort and limited generalisability.⁷

Trial three (2025). The longest of the three: 127 postmenopausal women aged 40 to 55 enrolled across six arms, testing a different ashwagandha extract at 250 or 500 mg alongside shatavari, over 24 weeks. Menopause quality-of-life scores improved dose-dependently against placebo, with reductions in bone-resorption markers and around 20% lower hsCRP at the higher ashwagandha doses. Funded by the ingredient’s own manufacturer; limitations listed as a small homogeneous sample in a single geographic region.⁸

That is the whole base. Roughly 280 women, all in India, all using extract supplied or funded by the ingredient manufacturer, longest study 24 weeks, no independent replication outside that supply chain. Two different products with different plant material and different outcome instruments, so the results do not pool.

One finding deserves separate flagging. Two of these trials report oestradiol rising and FSH and LH falling in peri- and postmenopausal women.⁶⁷ That describes partially reversing the defining endocrinology of menopause. It is unreplicated, no accepted mechanism is offered, and it comes from related teams working with the same extract. We report it as what those papers reported. It is not an established property of ashwagandha — and if it were true, it would be a reason for caution in women with hormone-sensitive cancer, not a selling point.

The cortisol argument has a hole in the middle

The marketing runs: menopause raises cortisol, high cortisol causes your symptoms, ashwagandha lowers cortisol, therefore your symptoms improve. Each link is weaker than it sounds.

Does menopause reliably raise cortisol? In the Seattle Midlife Women’s Health Study, urinary cortisol did rise around the late menopausal transition.⁹ But the Swiss Perimenopause Study, following 127 women aged 40 to 56 with salivary sampling over 13 months, found perimenopausal stage had no significant predictive effect on cortisol over time — the decline observed was ordinary diurnal rhythm.¹⁰ The premise itself is contested.

Does high cortisol cause the symptoms? The Seattle study found women with elevated cortisol in the late transition had more severe vasomotor symptoms — but no differences in mood, sleep, cognition or perceived stress.⁹ That is an association in an observational cohort, and it specifically fails to link cortisol to the mood and sleep complaints these products target. A later study of 306 women with frequent hot flushes found only subtle cortisol differences, which the authors interpreted as a pattern consistent with chronic sleep disturbance¹¹ — in other words, possibly downstream of broken sleep rather than upstream of the flushes.

Does lowering cortisol deliver relief? This is the cleanest answer available, and it is the most important sentence in this article. A 2025 meta-analysis pooling seven cortisol studies and six perceived-stress studies across 488 participants found ashwagandha significantly lowered measured cortisol — by 1.16 µg/dL, p<0.001 — while producing no significant change in perceived stress (p=0.40).¹² The single trial above shows the same shape: cortisol at p<0.001, the symptom scale at p=0.096.⁴

No study has tested the full chain — that reducing cortisol in menopausal women reduces hot flushes, night sweats or insomnia. Cortisol is a biomarker the product moves. It is not evidence the product fixes the symptom. We go through the underlying research in cortisol and menopause.

Dose: the question that decides whether any of this applies to your bottle

Both menopause trials using the Menopause Rating Scale gave 600 mg a day, split into two 300 mg doses, of a root extract standardised to more than 5% withanolides.⁶⁷ Across the wider literature, trials have used 240 to 1,250 mg a day, and benefits appear greater at 500 to 600 mg a day than at lower doses.²

The branded extracts are not interchangeable. One is a root-only extract standardised to more than 5% withanolides per 300 mg capsule; another is made from roots and aerial parts and is marketed at a much lower stated clinical dose.² Different plant material, different marker compounds, different label amounts. A trial on one is not evidence for the other — which is exactly the mismatch the third menopause trial illustrates, since it used the second extract at 250 to 500 mg.⁸

And then there is the proprietary blend problem. Under US labelling rules, a supplement may declare a proprietary blend by name and list only the total weight of the blend, with individual ingredient quantities undisclosed and only the descending order of predominance required.¹³ So a menopause formula can list ashwagandha among eight botanicals inside a 500 mg blend and be entirely compliant while the actual ashwagandha content could be 400 mg or 20 mg.

If the ashwagandha amount is not printed on the label, the product cannot be compared to any trial. That is the honest verdict, and it is a stronger position than guessing. It is the same principle we apply across our menopause supplements guide.

Quality sits on top of dose. An independent 2024 analysis using microscopy and chromatography examined ten commercial supplements labelled as ashwagandha root extract and found that none of the ten fulfilled the manufacturers’ own claims; measured main withanolide content averaged 0.13% against a claimed median of 5%, with plant fragments and starch granules present in all samples.¹⁴ The authors’ reading is that 0.13% matches whole root rather than a concentrated extract — these were not the standardised extracts they claimed to be.

Safety: three things worth knowing

1. Liver injury

NIH’s LiverTox database, updated December 2024, records approximately 23 published cases of clinically apparent liver injury associated with ashwagandha since 2017, reported with increasing frequency. Latency is typically 2 to 12 weeks after starting. The pattern is predominantly cholestatic or mixed, with jaundice and itching. Most cases are mild to moderate and resolve within one to four months of stopping — but rare instances of fatal liver injury or the need for emergency liver transplantation have been reported, particularly in people with pre-existing cirrhosis. Its likelihood score is B: a likely cause of clinically apparent liver injury, with rechallenge to be avoided.¹⁵

Reported doses in those cases were 450 to 1,350 mg daily — ordinary supplement amounts, not megadoses.²

Practical version: if you take ashwagandha and develop jaundice, dark urine, pale stools, itching, unexplained nausea or discomfort under the right ribs — particularly in the first three months — stop and get medical advice.

2. Your thyroid

This matters disproportionately for women over 45, among whom thyroid conditions and levothyroxine are common. A randomised trial in 50 people with subclinical hypothyroidism found 600 mg a day for eight weeks significantly lowered TSH and raised T3 and T4 versus placebo.¹⁶ Whatever you make of that as a benefit, it establishes that ashwagandha measurably moves thyroid hormones. NIH records small T4 increases in another small trial, and three case reports of thyrotoxicosis in women aged 32 to 73 that resolved on stopping.² Official guidance is that ashwagandha is not recommended for people with thyroid or autoimmune disorders, or for those about to have surgery.¹

The concrete risk: a woman on levothyroxine can have the blood results her dose is set by shifted by a supplement she did not think to mention.

3. Regulators are not settled on it

Denmark banned ashwagandha in 2023 following a national risk assessment covering liver toxicity and hormonal concerns. France’s food safety agency recommended against use in certain populations in 2024, including pregnant and breastfeeding women and people with endocrine disorders.² In the UK, the Food Standards Agency ran a call for evidence from July to September 2024 to support a toxicity risk assessment, naming effects on thyroid hormone levels, hypoglycaemic effects and potential liver toxicity among its concerns, and stating that no safe level for use in food supplements has been established in the UK.¹⁷ That assessment is a live process, not a settled ban.

Interactions and duration

NIH names four interacting drug classes explicitly: antidiabetes medications, antihypertensives, immunosuppressants and sedatives.² The reasons are straightforward — additive glucose-lowering, additive blood-pressure lowering, an ingredient marketed as immune-stimulating working against a drug intended to suppress the immune system, and additive sedation. Add thyroid medication for the reasons above.¹⁶ Ashwagandha should be avoided in pregnancy and while breastfeeding¹ — relevant because perimenopausal women can still conceive.

On duration: official guidance describes it as possibly safe when taken in the short term, up to three months, and states that evidence on safety over many months or years is lacking.¹² There is no long-term safety data for a supplement sold as daily maintenance through a transition lasting years.

What the leading menopause body says

The Menopause Society’s 2023 nonhormone therapy position statement does not recommend over-the-counter supplements and herbal remedies for vasomotor symptoms as a category, citing limited rigorous randomised trial data and a lack of government regulation to ensure purity and safety. Named botanicals on the not-recommended list include black cohosh, soy foods and extracts, wild yam, dong quai, evening primrose, maca, ginseng, chasteberry, milk thistle, omega-3 fatty acids and vitamin E.¹⁸

Ashwagandha is not named in the statement at all. That is worth stating precisely: the Society has not warned against ashwagandha specifically — it did not clear the bar for individual assessment, and it falls inside a category the Society does not recommend for hot flushes. What the statement does recommend is set out in hot flushes: what actually works.

Common questions

Does ashwagandha reduce hot flushes?

Three small randomised trials reported improvements in menopause symptom scores that include hot flushes, all conducted in India with the ingredient manufacturer supplying or funding the study.⁶⁷⁸ Official US guidance is that there is not enough evidence to say whether it helps menopause,¹ and The Menopause Society does not recommend supplements or botanicals for hot flushes as a category.¹⁸ Promising signals in a very small, industry-linked evidence base — not established relief.

How much would I need?

Both menopause trials using the Menopause Rating Scale gave 300 mg twice daily — 600 mg a day — of a root extract standardised to more than 5% withanolides.⁶⁷ Benefits across the wider literature appear greater at 500 to 600 mg a day.² If your product does not state its ashwagandha amount, you cannot tell what you are getting.¹³

Is it safe for my liver?

For most people taking it briefly, apparently — but the risk is not zero. LiverTox records around 23 published cases of liver injury since 2017, typically 2 to 12 weeks after starting, usually resolving within one to four months of stopping, with rare fatal cases or emergency transplants in people with existing cirrhosis.¹⁵ Reported doses were ordinary supplement amounts.²

I take levothyroxine. Can I take it?

This is the interaction to take seriously. A randomised trial in 50 people with subclinical hypothyroidism found 600 mg a day for eight weeks significantly lowered TSH and raised T3 and T4,¹⁶ and NIH records three case reports of thyrotoxicosis in women.² Official guidance advises against ashwagandha for people with thyroid or autoimmune disorders.¹ Speak to whoever manages your thyroid before starting.

My supplement says it lowers cortisol — will that fix my sleep and mood?

It does appear to lower measured cortisol. But the same 2025 meta-analysis that found a significant cortisol reduction found no significant effect on perceived stress.¹² And the link between cortisol and menopause symptoms is weaker than the marketing suggests — one longitudinal study found menopausal stage did not predict cortisol at all,¹⁰ and where cortisol did track hot flushes the researchers read it as a consequence of chronic sleep disturbance.¹¹

Bottom line

Ashwagandha’s menopause evidence is three small manufacturer-linked trials in about 280 women, all in India, none longer than 24 weeks, none independently replicated. The stress and sleep evidence is better but was gathered in different populations for different problems. The cortisol argument fails at the point it matters most: pooled trials show cortisol falling while perceived stress does not significantly change, and nobody has shown that lowering cortisol improves menopause symptoms. Then there is the practical problem — the trials used 600 mg a day of a specific standardised extract, and a blend that hides its ashwagandha inside a proprietary total tells you nothing about whether you are getting that. Add a documented liver signal, real thyroid effects, and an open UK safety review, and “natural, gentle, no side effects” is not a description anyone can honestly attach to it. A different risk profile, not no risk.

This article is for information only and is not medical advice. Speak to your GP or pharmacist before starting ashwagandha, particularly if you take thyroid, diabetes, blood pressure, sedative or immunosuppressant medication, or have a liver condition.

More from HerWellReport

• Hot flushes: what actually works, ranked by evidence
• Cortisol and menopause: what the evidence really shows
• Menopause supplements: what is actually in them
• MenoRescue review
• O Positiv MENO Review: The Capsule and the Gummy Aren’t the Same Dose