Does ashwagandha help with memory loss during perimenopause?

Forgetting a word mid-sentence, walking into a room with no idea why, blanking on a name you know perfectly well: these are among the most distressing experiences of perimenopause for many women. The memory changes are real and they have a biological explanation. Estrogen supports memory and learning by maintaining acetylcholine signaling and promoting neuroplasticity in the hippocampus, the brain region most central to forming new memories. As estrogen fluctuates and ultimately declines, this support weakens. Ashwagandha works on two related pathways: protecting the hippocampus from cortisol damage, and supporting the cholinergic system that estrogen was helping maintain.

The cognitive evidence for ashwagandha is more promising than many people realize. A 2017 double-blind RCT in the Journal of Dietary Supplements found that 300 mg of ashwagandha root extract taken twice daily for 8 weeks significantly improved reaction time, task performance, and attention in healthy adults. A 2020 randomized controlled trial in Medicine found that the same protocol improved both immediate and general memory scores compared to placebo. These studies were not exclusively in perimenopausal women, but the mechanisms involved, including cortisol-related hippocampal protection and acetylcholine support, are directly relevant. The evidence is genuinely encouraging here, though it is not yet as robust as the evidence for pharmaceutical cognitive treatments.

Here is why perimenopause makes this mechanism especially important. Chronically elevated cortisol, which is common during the hormonal volatility of perimenopause, physically damages hippocampal neurons over time. The hippocampus is uniquely vulnerable to cortisol because it has a high density of cortisol receptors. When cortisol stays elevated for weeks or months, it can shrink hippocampal volume and impair the formation of new memories. Sleep disruption, which is also a hallmark of perimenopause, compounds this by reducing the overnight consolidation of memories. Ashwagandha's withanolides have demonstrated neuroprotective effects in animal studies, including reducing amyloid plaques and supporting axon and dendrite growth. Whether these effects translate to humans at the doses used in supplements is still being studied.

Human studies on ashwagandha and cognition have used 300 mg twice daily of a root extract standardized to withanolides (KSM-66 or Sensoril), taken for 8-12 weeks. The twice-daily dosing may be important for maintaining steady blood levels throughout the day. A single daily dose has also been used in some broader studies with modest benefit. Talk to your healthcare provider about the right dose for your situation. If memory changes are severe, sudden, or accompanied by confusion or personality changes, these need prompt medical evaluation and are beyond the scope of a supplement conversation.

Ashwagandha pairs well with omega-3 fatty acids (especially DHA) for brain health, since DHA supports neuronal membrane integrity through a different mechanism. Prioritizing sleep is arguably more important than any supplement for perimenopausal memory, since memory consolidation happens during sleep. Reducing alcohol is also significant, as even moderate alcohol worsens hippocampal function. If you take antidepressants, anxiolytics, sedatives, thyroid medication, or any medications affecting brain chemistry, discuss adding ashwagandha with your provider before starting.

Cognitive changes from ashwagandha tend to emerge gradually. Most trials saw meaningful results between 8-12 weeks. Some women notice improved focus and less word-searching before they notice clear memory improvements. The stress-reduction effects typically appear first (around 2-4 weeks), and the cognitive benefits seem to follow as cortisol comes down. If you are also sleep-deprived, addressing sleep in parallel will likely amplify any cognitive benefit.

Memory changes during perimenopause are usually a normal part of the transition, but some patterns do require medical evaluation. See a doctor if memory problems are affecting your ability to do your job or manage daily tasks, if they have worsened rapidly over weeks rather than months, if you are also experiencing personality changes, if you are losing track of time or place, or if someone who knows you well has flagged significant changes. These are not typical perimenopausal memory patterns and deserve professional assessment.

Rating your cognitive sharpness on a 1-10 scale each day, including a quick note on whether you had any memorable word-retrieval moments or blanks, gives you useful data. PeriPlan lets you log cognitive symptoms alongside sleep quality and stress so you can see whether those variables move together, which most women find they do. Tracking also helps you bring specific patterns to your provider rather than a vague sense that your memory is off.

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