Does ashwagandha help with night sweats during perimenopause?

Waking up at 2 or 3 a.m. drenched in sweat, your heart pounding and your sheets soaked, is one of the most disruptive experiences of perimenopause. Night sweats are essentially hot flashes that happen during sleep. They are triggered by the same hypothalamic thermostat dysfunction that causes daytime flashes, amplified by the body's overnight cortisol rhythm. During perimenopause, cortisol levels that should be at their lowest in the early hours can spike irregularly, triggering temperature dysregulation right when you are trying to stay asleep. Ashwagandha does not replace estrogen, but its effect on the HPA axis and cortisol may reduce the frequency and intensity of these overnight surges.

As with daytime hot flashes, direct clinical evidence specifically linking ashwagandha to reduced night sweats is limited. The most relevant trial is a 2021 double-blind RCT published in the Journal of Obstetrics and Gynaecology Research, which used KSM-66 ashwagandha root extract (600 mg daily) in menopausal women for 8 weeks. The treatment group showed significant improvements in overall menopausal symptom scores including vasomotor symptoms. Participants in studies on ashwagandha and sleep quality also report less nighttime waking, which may overlap with reduced overnight sweating events. The evidence here is promising but not definitive, and night sweats that are severe and frequent are likely to respond better to hormone therapy or prescription non-hormonal options.

Night sweats specifically have a connection to cortisol that makes ashwagandha mechanistically relevant. Cortisol follows a circadian rhythm: it should be lowest between midnight and 4 a.m. and peak in the morning. During perimenopause, this rhythm can become dysregulated, with cortisol spiking in the middle of the night. These nighttime cortisol surges are thought to contribute to the nocturnal temperature disruptions that cause night sweats, beyond the baseline estrogen-withdrawal effect. Your thyroid also plays a role: thyroid dysfunction, which is more common in perimenopause, can cause night sweats independently, and ashwagandha has some evidence supporting thyroid hormone balance. If thyroid irregularity is in the picture, this is worth investigating with your provider.

Studies examining ashwagandha for vasomotor symptoms and sleep have used 300-600 mg daily of KSM-66 or Sensoril root extract. Some research uses split dosing with part of the dose taken in the evening, which may be particularly relevant for overnight cortisol regulation. Evening timing may also support ashwagandha's mild sleep-promoting effect. Trials have run for 8-12 weeks. Talk to your healthcare provider about the right dose and timing for your situation. If thyroid testing has not been done recently, it may be worth requesting since thyroid imbalance can both cause night sweats and respond to ashwagandha through a different mechanism.

For night sweats specifically, a few environmental and lifestyle factors have strong evidence: keeping the bedroom cool (ideally 65-68 degrees Fahrenheit), using moisture-wicking bedding, avoiding alcohol within three hours of sleep, and limiting caffeine after 2 p.m. These reduce flash triggers regardless of any supplement. Ashwagandha can be one layer of a broader approach but works best alongside these changes. If you take thyroid medication, sedatives, or antidepressants, discuss adding ashwagandha with your provider before starting, as it may affect thyroid hormone levels and has mild sedative properties.

Night sweat changes from ashwagandha tend to emerge within 6-10 weeks of consistent use. Some women report earlier shifts in sleep depth and middle-of-the-night waking frequency before noticing changes in sweat intensity. Tracking both is useful. If night sweats are your primary complaint and they are severe, the evidence for ashwagandha producing dramatic relief is modest. Managing expectations and combining it with sleep hygiene measures will give you a more accurate test of its effect.

Night sweats do need medical evaluation when they are so severe that you need to change your clothing or bedding multiple times per night; when they persist alongside unexplained weight loss, swollen lymph nodes, or fever; or when they appear very suddenly rather than gradually alongside other perimenopausal changes. These patterns can indicate infections, lymphoma, or other conditions that are unrelated to perimenopause and need proper diagnosis. Night sweats that are clearly perimenopausal but destroying your sleep quality are also worth a frank conversation with your provider about more aggressive treatment options.

Log your night sweats as part of a nightly check-in: how many events, rough severity on a 1-10 scale, and whether they caused you to get up or change. PeriPlan makes this kind of daily symptom logging easy, and reviewing it over 8 weeks gives you real signal about whether anything you are doing is actually helping. Four weeks of baseline data before starting any supplement gives you a comparison point that is genuinely useful.

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