Ashwagandha for Perimenopause: Stress, Sleep, and Hormones
Ashwagandha is a well-researched adaptogen that may ease stress, improve sleep, and support hormonal balance in perimenopause. Here is what to know.
What Is Ashwagandha and Why Is It Relevant to Perimenopause
Ashwagandha (Withania somnifera) is a plant used in Ayurvedic medicine for centuries, classified as an adaptogen: a substance that helps the body adapt to and recover from physical and psychological stress. It has been studied in modern clinical trials for its effects on cortisol levels, stress response, sleep quality, energy, and reproductive hormones. During perimenopause, when the body is managing major hormonal shifts alongside the stresses of midlife, adaptogens like ashwagandha are of particular interest. The research base is more substantial than for many herbal supplements, making it one of the better-supported options for women seeking non-pharmaceutical support during this transition.
Ashwagandha and Cortisol Regulation
The adrenal glands produce cortisol, the primary stress hormone, and chronically elevated cortisol can worsen many perimenopausal symptoms including insomnia, weight gain, anxiety, and fatigue. During perimenopause, when the ovaries produce less oestrogen, the adrenal glands become an increasingly important source of sex hormones, so their health and function matter more than before. Ashwagandha has been shown in multiple randomised controlled trials to significantly reduce serum cortisol levels in adults with chronic stress. One well-cited trial found a 28 percent reduction in cortisol in the ashwagandha group compared to placebo over 60 days. This cortisol-lowering effect underlies many of ashwagandha's broader benefits.
Ashwagandha and Sleep Quality
Sleep disruption is one of the most distressing aspects of perimenopause for many women. Elevated cortisol in the evening, combined with night sweats and anxiety, creates a cycle of poor sleep that affects mood, cognition, and physical health. Ashwagandha has been studied specifically for sleep and found in clinical trials to reduce the time it takes to fall asleep, increase total sleep time, and improve self-reported sleep quality in adults with insomnia. The active compounds in ashwagandha, including withanolides, appear to interact with GABA receptors, which are involved in calming nervous system activity. Taking ashwagandha in the evening is a common approach for sleep support.
Ashwagandha and Hormonal Balance
Some clinical studies have investigated ashwagandha's effect on reproductive hormones in women. A 2021 trial in women experiencing stress-related sexual dysfunction found that ashwagandha supplementation significantly improved lubrication, arousal, orgasm, and overall sexual satisfaction compared to placebo, alongside reductions in cortisol and improvements in hormone levels including testosterone. Another study in perimenopausal women found improvements in menopause symptom scores, including hot flash frequency and mood. While ashwagandha is not a hormonal treatment and cannot replace HRT where that is indicated, its influence on the stress-hormone axis appears to have downstream effects on reproductive hormone balance.
Ashwagandha and Thyroid Function
The thyroid and adrenal glands are closely connected, and adrenal stress can suppress thyroid function. Because hypothyroidism shares many symptoms with perimenopause including fatigue, weight gain, brain fog, and low mood, distinguishing the two can be challenging. Some research has found that ashwagandha supports thyroid hormone levels, particularly T3 and T4, in people with subclinical hypothyroidism. However, because ashwagandha can influence thyroid function, women with a thyroid condition or who take thyroid medication should consult their GP before using it, as dosage adjustments may be needed. For women without thyroid issues, this thyroid-supportive effect is generally considered a benefit rather than a concern.
Dosage, Forms, and What to Look For
Ashwagandha is available as root powder, standardised extracts in capsule form, and liquid tinctures. The most researched form is a standardised root extract with a specified withanolide content, typically 5 percent. Branded extracts such as KSM-66 and Sensoril have been used in multiple clinical trials and are reliable options to look for on product labels. Doses used in research generally range from 300 to 600 mg of standardised extract per day. Starting with a lower dose and assessing tolerance over two to four weeks is sensible. Some women take it daily, while others cycle it, taking it for six to eight weeks and then taking a break, to prevent tolerance from developing.
Safety, Side Effects, and When to Avoid It
Ashwagandha is generally well tolerated in healthy adults at recommended doses. The most common side effects are mild digestive discomfort, which is reduced by taking it with food. Rare cases of liver injury have been reported, though these are thought to involve adulterated or very high-dose products rather than standard supplementation. Ashwagandha should be avoided during pregnancy, as it has traditionally been used to stimulate uterine contractions. Women who are breastfeeding, have autoimmune conditions, or take immunosuppressant or thyroid medications should seek medical advice before using it. For most perimenopausal women without these contraindications, ashwagandha has a good safety profile when purchased from reputable suppliers.
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