Does ashwagandha help with heart palpitations during perimenopause?

Heart palpitations are common during perimenopause, but they should never be casually attributed to hormones and left uninvestigated. That said, once cardiac causes have been ruled out, the hormonal mechanism is real: estrogen normally has a stabilizing effect on the autonomic nervous system and on cardiac ion channels. When estrogen fluctuates, the sympathetic nervous system (the fight-or-flight side) can become overactive, and adrenaline surges can trigger the racing or skipping sensations many women describe. Elevated cortisol, which often accompanies the perimenopause transition, compounds this by further stimulating sympathetic output. Ashwagandha may reduce cortisol and adrenaline-driven palpitations by calming HPA axis overactivity, but this is a secondary role at best, and cardiac evaluation must come first.

There are no clinical trials that have tested ashwagandha specifically for palpitations in perimenopausal women. The relevant research shows that ashwagandha reduces cortisol and lowers sympathetic arousal, which are two of the contributors to non-cardiac palpitations. A 2012 study in the Indian Journal of Psychological Medicine found cortisol reductions of around 28% with 300 mg twice daily of KSM-66 over 60 days. Ashwagandha also has some evidence for reducing resting heart rate in athletic populations and improving heart rate variability, a marker of autonomic nervous system balance. Both of these effects are mechanistically relevant to palpitations driven by sympathetic overactivation. However, the evidence is indirect, and it would be misleading to present ashwagandha as a treatment for palpitations. At most, it may reduce one contributing factor if stress and cortisol are clearly involved.

Perimenopause disrupts the autonomic nervous system in ways that are specific to estrogen withdrawal. Estrogen helps regulate vagal tone (the parasympathetic counterbalance to the sympathetic nervous system) and modulates the sensitivity of cardiac adrenergic receptors. As estrogen drops, vagal tone often decreases, meaning the parasympathetic brake on heart rate becomes less effective. This leaves the heart more reactive to adrenaline spikes. Hot flashes are often accompanied by palpitations precisely because both are triggered by the same hypothalamic-autonomic dysregulation. Thyroid function adds another variable: subclinical hyperthyroidism or even the thyroid fluctuations that can accompany perimenopause may produce palpitations independently of estrogen. Ashwagandha's thyroid-stimulating properties are generally relevant for hypothyroid fatigue, but they could theoretically worsen palpitations in someone whose thyroid is already running high. This makes thyroid status particularly important to check before using ashwagandha for palpitations.

Studies showing cortisol and autonomic effects have used 300 mg of KSM-66 twice daily or 240 to 600 mg of Sensoril once daily. Heart rate variability improvements in athletic trials used similar doses over 8 to 12 weeks. Taking ashwagandha with food improves absorption. Talk to your healthcare provider about the right dose for your situation, and specifically mention that you are taking it for palpitations. This is a symptom category where provider involvement is not optional before starting supplementation.

Magnesium glycinate is among the better-studied supplements for palpitations related to autonomic dysfunction and electrolyte imbalance, and it may pair reasonably with ashwagandha for cortisol-driven palpitations. Avoid caffeine and alcohol, which both directly increase palpitation frequency. Do not combine ashwagandha with thyroid medications without monitoring, and do not add it alongside beta-blockers, antiarrhythmic medications, or other heart medications without explicit provider guidance. If you take any prescription medications, check with your provider before adding this supplement.

If cortisol and sympathetic overactivation are contributing to palpitations, some reduction in frequency or intensity may appear within four to six weeks as ashwagandha calms HPA axis activity. However, palpitations often have multiple triggers, and supplement effects in this area are modest at best. Do not stop any prescribed cardiac medication or delay medical evaluation because a supplement seems to be helping.

See a doctor before starting any supplement for heart palpitations. A new onset of palpitations during perimenopause warrants an ECG and likely a 24-hour Holter monitor to rule out arrhythmias, including atrial fibrillation, which increases in prevalence in this age group. Palpitations accompanied by chest pain, shortness of breath, fainting, or extreme fatigue need emergency evaluation. Even if your palpitations feel minor, they should be documented and evaluated medically before any supplement is considered. Palpitations that occur at rest, that wake you from sleep, or that have a regular irregular rhythm deserve particular attention.

Once your provider has cleared you of cardiac concerns, track your palpitations by noting frequency per day, duration, and what you were doing when they occurred. Rate their intensity on a 1 to 10 scale daily. Do this for two weeks before starting ashwagandha and continue for six to eight weeks after. The PeriPlan app can help you track them alongside your cycle phase and sleep quality, which often reveals whether your palpitations cluster around estrogen-drop events or high-stress days. That pattern is useful information to bring back to your doctor.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.