Does ashwagandha help menopause symptoms?

Our verdict: Limited evidence — one positive trial, not yet independently confirmed.

Unlike several menopause supplements where trials consistently show no benefit over placebo, ashwagandha (Withania somnifera) actually has a real randomized trial behind it with a positive result. That makes it worth a genuinely different conversation than, say, black cohosh — but one positive trial still isn't the same as settled, guideline-reviewed evidence.

What the trial actually found

An 8-week, randomized, double-blind, placebo-controlled trial gave 100 women with climacteric (perimenopause) symptoms either a placebo or 300 mg of ashwagandha root extract twice daily; 91 completed the study. Compared with placebo, the ashwagandha group showed:

• A statistically significant reduction in total Menopause Rating Scale (MRS) score (p<0.0001), across psychological, somato-vegetative, and urogenital symptom domains
• A statistically significant reduction in menopause-specific quality of life (MENQoL) scores (p<0.0001)
• A significant increase in serum estradiol and significant reductions in FSH and LH (the pituitary hormones that rise as ovarian estrogen production declines)
• No significant change in testosterone between groups

The researchers concluded ashwagandha root extract "can be a safe and effective option to relieve mild to moderate climacteric symptoms".

Why we're not calling this "proven" yet

This is a real, reasonably well-designed trial — randomized, double-blind, and placebo-controlled, which puts it well above testimonial-level evidence. But our evidence grading isn't based on any single trial, however well it's designed: it's based on the overall weight of evidence a treatment has accumulated, including independent replication and review by clinical guideline bodies.

On that broader measure, ashwagandha hasn't yet cleared the bar. The Menopause Society's 2023 position statement on non-hormone therapies does not recommend over-the-counter supplements and herbal remedies generally for vasomotor symptoms, a conclusion driven by a pattern across the supplement category of individual trials showing benefit that don't hold up under independent replication or larger follow-up studies. We can't yet say whether ashwagandha specifically will follow that same pattern or buck it — that's exactly why we're grading it Limited rather than treating one positive trial as the final word.

What to check before trying it

• Medication interactions: ashwagandha can interact with thyroid medication, sedatives, and immunosuppressants — tell your doctor if you're on any of these
• Dose used in the trial: 300 mg twice daily of a standardized root extract; products vary widely in concentration and standardization
• It's not evaluated for safety in pregnancy or with hormone-sensitive conditions in this trial, so discuss your full health history first

If you want options with a larger, independently reviewed evidence base for hot flashes specifically, see our does it work? evidence checker or explore non-hormonal prescription options.