Does ashwagandha help with low libido during perimenopause?

Low libido during perimenopause is real, common, and has a clear biological explanation. As estrogen and testosterone both decline, the physiological drivers of sexual desire, arousal, and response all shift. But there is a second layer that gets less attention: cortisol. Chronically elevated stress hormones are one of the most reliable suppressors of libido at any age, and perimenopause is a period of sustained hormonal volatility that keeps cortisol running high. Ashwagandha addresses this second layer directly, and for some women, that makes a meaningful difference.

This is one of the areas where ashwagandha has the most direct clinical evidence for women. A 2015 randomized, double-blind, placebo-controlled trial published in BioMed Research International studied KSM-66 ashwagandha root extract in women aged 21-50 who reported sexual dysfunction. After 8 weeks, women taking 300 mg twice daily showed significant improvements in arousal, lubrication, orgasm, and satisfaction scores compared to placebo. Serum testosterone levels also improved slightly in the treatment group. A 2021 follow-up study in the same population confirmed similar findings. These are not perimenopausal-specific trials, but the mechanisms involved (cortisol suppression of sexual function, testosterone support) are directly relevant to this life stage.

Perimenopause creates a specific hormonal context that makes this mechanism particularly relevant. Testosterone, which is produced in the ovaries and adrenal glands, also declines through perimenopause. At the same time, elevated cortisol competes with testosterone production at the adrenal level and directly suppresses the brain regions involved in desire. The hypothalamus, which coordinates sexual response, is sensitive to both estrogen withdrawal and high cortisol input. Ashwagandha appears to lower cortisol output from the adrenals and may modestly support testosterone levels, which addresses both ends of this equation. It does not replace estrogen, which also affects vaginal tissue health, lubrication, and sensitivity.

Studies on ashwagandha and female sexual function have used 300 mg twice daily of KSM-66 root extract (600 mg total per day) for 8 weeks. This is among the best-studied dosing protocols for this specific outcome. Other ashwagandha forms and doses have been used in broader studies, typically 300-600 mg once daily. Talk to your healthcare provider about the right dose for your situation. If vaginal dryness or tissue changes are contributing to low libido, that is an estrogen-related issue that ashwagandha will not address and that has separate treatment options worth discussing.

Ashwagandha pairs reasonably with maca root for libido support, since maca appears to work on desire through a different pathway. However, layering supplements targeting the same system without guidance is not recommended. Reducing other libido suppressors matters as much as adding a supplement: alcohol, sleep deprivation, and certain antidepressants all independently lower desire. If you take SSRIs, SNRIs, blood pressure medications, or any hormonal contraceptives, discuss ashwagandha with your provider before adding it, since interactions have not been well studied.

If ashwagandha is going to help with libido, most of the clinical trials saw significant changes by 8 weeks. Some women notice shifts in stress and energy first (around 4 weeks), which then translates into improved interest in sex. If low desire has been present for years and is deeply rooted in relationship dynamics, body image, or mental health, a supplement is unlikely to be the primary solution. Addressing those layers alongside anything physical tends to produce the best outcomes.

Low libido in perimenopause usually does not require urgent medical attention on its own, but it is worth bringing up with your provider if it is affecting your relationship or wellbeing. There are validated medical options including low-dose testosterone therapy, topical estrogen for vaginal changes, and other non-hormonal approaches that go well beyond supplements. You deserve an honest conversation about all the options, not just the over-the-counter ones.

Tracking your desire, energy, and mood together can reveal patterns you would otherwise miss. A 1-10 daily rating for libido alongside sleep quality and stress levels often shows clear correlations. PeriPlan lets you log multiple symptoms each day so you can see whether improvements in sleep or stress precede changes in desire. That kind of personal data also makes your next provider conversation much more productive.

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