Ashwagandha in menopause: stress, sleep, hot flashes and safety
Ashwagandha is an herb from Ayurvedic medicine that some small trials suggest may ease stress and improve sleep. Evidence for menopause symptoms is very limited, and it is linked to rare liver injury and thyroid changes.
Stop and see a doctor promptly if you notice yellow skin or eyes, dark urine, belly pain, a racing heart, shaking or unusual weight loss while taking ashwagandha.
What it is
Ashwagandha (Withania somnifera) is an evergreen shrub from India, Africa and the Middle East. It has been used for thousands of years in Ayurvedic medicine.2
Supplements usually use the root, sometimes with leaf. It is often promoted as an adaptogen, meaning a herb said to help the body cope with stress.1
What the research shows
Stress and anxiety. A 2021 review of 7 studies with 491 adults, all in India, found less stress and anxiety than with placebo. Later trials were mostly small, with 54 to 130 people.1
Sleep. A 2021 analysis of 5 studies with 372 adults found a small benefit for sleep. It was larger in people with insomnia.1
Menopause. One trial in India gave a branded root extract or placebo to 100 women aged 45 to 55 for 8 weeks. Of the 91 who finished, the ashwagandha group reported fewer hot flashes and better mood.3
The authors called these results preliminary.3 The NIH center for complementary health says there is not enough evidence to know whether ashwagandha helps menopause symptoms.2 The Menopause Society's 2023 review of nonhormone treatments did not assess it.4
Many studies are small and use different products, which makes results hard to compare.2
Safety and who should be careful
Ashwagandha may be safe for up to about 3 months. Long-term safety is not known. Common side effects include stomach upset, diarrhea, nausea and drowsiness.1,2
Liver. Rare cases of liver injury have been linked to ashwagandha supplements. Some happened in people who already had liver disease.1,2
Thyroid. It may raise thyroid hormone levels. A few people developed an overactive thyroid that settled after stopping. The NIH center does not recommend it for people with thyroid or autoimmune conditions.1,2
It should be avoided in pregnancy and while breastfeeding. It is not recommended before surgery.2
It may interact with medicines for diabetes, blood pressure, thyroid and seizures, and with sedatives and immune-suppressing drugs.2
A doctor or pharmacist can check whether it interacts with any medicines or other supplements you take.
How it is available
Ashwagandha is sold over the counter as a supplement in many countries, but rules differ. Denmark banned it in 2023. In 2024, France's food safety agency advised some groups, including pregnant women and people with hormone disorders, not to use it.1
In the US, supplements are not approved by the FDA before they go on sale. Makers are responsible for safety and labeling, so quality can vary between brands.2
The bottom line
Ashwagandha has some small trials suggesting benefits for stress and sleep. For menopause symptoms, there is only one small trial, and it needs to be repeated.1,3
The safety concerns, including rare liver injury and thyroid effects, mean it is not a harmless choice.2 This matters more if you have a thyroid condition, liver problems or take regular medicines.
For mood and sleep in menopause, CBT has stronger evidence. Talk to a doctor before trying ashwagandha.
What it is used for: evidence rated
| Option | Evidence | What the research shows |
|---|---|---|
| Stress and anxiety | Several small trials, mostly in India, found less stress and anxiety than placebo.1 | |
| Sleep problems | An analysis of 5 studies with 372 adults found a small benefit, mainly in people with insomnia.1 | |
| Hot flashes | One preliminary 8-week trial of 100 women reported fewer hot flashes; it has not been repeated.3,2 |
Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.
Related
Sources
- Ashwagandha: Is it helpful for stress, anxiety, or sleep? NIH Office of Dietary Supplements (2025)
- Ashwagandha: Usefulness and Safety, NIH National Center for Complementary and Integrative Health
- Ashwagandha root extract shows efficacy for menopausal symptoms, NutraIngredients (2021), reporting Gopal et al., J Obstet Gynaecol Res
- The 2023 nonhormone therapy position statement of The North American Menopause Society, Menopause (2023)