Ashwagandha has become one of the most studied herbs in complementary medicine, especially among modern women. The trend of natural health care is growing strongly, leading to the need to find solutions from traditional medicine.
Women face work pressure, sleep disorders, endocrine disorders, and chronic stress. Ashwagandha can affect the endocrine, nervous, and immune systems, opening up the potential to support physiological balance and improve overall health.
Ashwagandha may benefit women, but possible side effects deserve careful attention.
Common Side Effects in Women
Women widely use ashwagandha to support overall health, but tolerance can lead to various physiological reactions. These effects often appear early and reflect the body's homeostatic adjustment to the powerful bioactives in the root.
Digestive discomfort
Some women experience gastrointestinal discomfort such as nausea, diarrhea, or epigastric cramps. These reactions are related to stimulating intestinal motility and increased gastric secretion, directly affecting the digestive system.
Fatigue and drowsiness
Ashwagandha has mild sedative properties, which can cause fatigue and drowsiness. The body responds by reducing central nervous system activity, altering energy levels throughout the day.
Mild headaches and dizziness
Some women report mild headaches and dizziness. This may be due to changes in cerebral blood flow and autonomic regulation, causing a transient feeling of heaviness in the head.
Hormonal Effects of Ashwagandha
Ashwagandha exerts a multifaceted effect on the endocrine system; by modulating the HPA axis and interacting with endocrine glands, the active ingredients in the root alter hormone levels and physiological responses according to individual physiological states. Clinical studies and reviews report significant hormonal changes, leading to different clinical effects.
Impact on menstrual cycles
Ashwagandha affects estrogen, progesterone, and reproductive axis communication indices (FSH, LH), manifesting as reducing premenopausal symptoms and improving sleep quality in some women; small clinical data suggest a benefit in perimenopause.
Thyroid function (TSH, T3, T4)
Ashwagandha increases T3/T4 and decreases TSH in human trials with mild hypothyroidism, manifesting as a stimulation of thyroid activity. There have also been rare reports of thyrotoxicosis/thyroiditis following use, suggesting that individual responses should be monitored.
Reproductive health
Effects on sex hormones as manifested by changes in hormone and sexual function; studies have noted improvements in sexual function and some pro-reproductive markers, suggesting that ashwagandha may directly affect the endocrine environment of the ovaries and reproductive axis.
Risks During Pregnancy and Breastfeeding
Ashwagandha contains withanolides, a group of active compounds that can cause uterine contractions and alter hormonal balance, thereby creating significant risks during pregnancy and breastfeeding. These effects require absolute caution when women are in this particularly sensitive period.
Pregnancy risks
The uterotonic activity of ashwagandha can stimulate the uterus, increasing the risk of premature contractions. Experimental studies have shown that this drug directly affects the stability of the embryo and can lead to miscarriage.
Breastfeeding concerns
During breastfeeding, the biological compounds in ashwagandha can be excreted in breast milk. This has the potential to affect the central nervous system of the newborn, as well as the immature endocrine and immune development of the child.
Interaction with Medications Commonly Used by Women
Ashwagandha's pharmacological interactions occur through multiple mechanisms—hepatic enzyme regulation, endocrine axis alterations, and central nervous system effects—creating a complex clinical picture when combined with medications.
Birth control pills
Some analyses suggest that ashwagandha may be safely combined with hormonal contraceptives in the short term, but clinical data are limited, and follow-up is needed.
Thyroid medications
In some trials, ashwagandha has been associated with increased T3/T4 and decreased TSH, potentially altering levothyroxine efficacy and requiring monitoring of thyroid hormone levels.
Antidepressants / Anxiolytics
The sedative and monoamine oxidase effects of ashwagandha may enhance the sedative effects or interact with the serotonin mechanisms of some antidepressants; individual interaction evaluation is necessary.
Antihypertensive and Antidiabetic medications
Ashwagandha may lower blood pressure and blood glucose, leading to a synergistic effect with antihypertensive and antidiabetic medications; regular monitoring of these is recommended.
Long-Term Safety Concerns
Long-term use of ashwagandha produces significant changes in biological systems, not only at the level of symptoms but also at the molecular level. Long-term effects reflect endocrine, immune, and metabolic regulation, which may provide benefits but also carry risks that require close monitoring.
Hepatic considerations
Some clinical reports have noted drug-induced liver injury (DILI) associated with ashwagandha, manifested by jaundice, elevated liver enzymes, and acute hepatitis. The mechanism may involve cell-mediated immune responses and hepatic metabolism of the active ingredient.
Hormonal balance
Ashwagandha maintains a long-term effect on the HPA and thyroid-gonadal axes. Initial increases in cortisol may be modulated over time, but prolonged hormonal fluctuations can potentially affect menstrual cycles, thyroid function, and reproductive health.
Immune modulation
The immunomodulatory effects of ashwagandha in long-term treatment may alter the chronic inflammatory response and influence the course of autoimmune disease. This raises the need for regular hematological and immunological monitoring.
Who Should Be Cautious
Ashwagandha affects the immune system and endocrine axis through multiple molecular mechanisms, producing cytokine and hormone fluctuations depending on each individual's dose and clinical status. These variations clearly define groups of women who should be cautious before initiating therapy.
Autoimmune diseases
Women with autoimmune diseases such as Hashimoto's or systemic lupus erythematosus are likely to experience altered immune responses and should be evaluated for flare risk.
Thyroid disorders
Patients with hypothyroidism or those taking levothyroxine should have their TSH, T3, and T4 tested, as ashwagandha has been shown to increase T3/T4 and decrease TSH in clinical studies.
Liver disease
Women with chronic liver disease or a history of liver injury should have their liver enzymes monitored when taking ashwagandha due to reports of liver injury associated with this product.
Medication interactions
Women taking antihypertensives, antidiabetic agents, or sedatives should be evaluated for pharmacological interactions and blood pressure, blood glucose, and sedation levels monitored when coadministered.
Safe Usage Guidelines
To use ashwagandha safely, rely on clinical evidence, monitor biological function, and choose a proven product. The treatment regimen should consider medical history, current medications, and individual treatment goals.
Recommended dosage
Common clinical doses range from 250–600 mg/day as a standardized root extract; many trials use 300 mg twice daily (KSM-66) or Sensoril preparations at 125–250 mg/day.
Start low & monitor
Start at a low dose (125–250 mg/day) and assess symptoms after 2–4 weeks; with long-term use or a history of liver disease or thyroid disorders, baseline laboratory tests (LFTs; TSH, T3, T4) and periodic monitoring are required.
Product quality
Choose products with third-party testing (USP, NSF, ConsumerLab) and prioritize standardized extracts; look for independent reports before purchasing.
When to Seek Medical Help
Taking ashwagandha may cause a clinical reaction that requires immediate medical evaluation; early recognition protects liver function, hemodynamic status, and the central nervous system.
Warning signs
The appearance of jaundice, dark urine, generalized itching (pruritus), severe nausea, or severe abdominal pain is a sign that requires intervention. Altered consciousness, fainting, or hypotension requires emergency medical care.
Liver-related symptoms
Liver injury from ashwagandha usually begins after 2–12 weeks with a cholestatic or mixed pattern; monitor AST/ALT, bilirubin, and INR when clinically symptomatic.
Monitoring & Tests
Order LFTs (AST, ALT), bilirubin, TSH/T3/T4, and assess blood glucose/blood pressure if taking thyroid medication, hypoglycemic medication, or antihypertensive medication; adjust combination medications in consultation with a physician.
Pregnancy & Breastfeeding
Pregnant or lactating women exposed or experiencing symptoms should seek medical attention immediately; safety data and excretion in breast milk are limited.
Conclusion
Ashwagandha exerts far-reaching effects on women's health through the endocrine, immune, and nervous systems. Potential benefits always come with risks that must be clearly identified and closely monitored.
Women at different biological stages may experience a variety of reactions from the digestive, endocrine, and hepatobiliary systems. Medical advice plays a central role in optimizing efficacy and minimizing complications.
→Discover when the best time to take ashwagandha is to enhance safety and effectiveness.
Frequently Asked Questions (FAQs)
- Does Ashwagandha Affect the Menstrual Cycle? – Yes. It may influence female sex hormones and the hypothalamic–pituitary–ovarian axis, altering cycle length or flow. Some women experience reduced PMS symptoms, while others notice changes in their periods.
- Is Ashwagandha safe to take with birth control pills? – Interactions are not well studied. Because Ashwagandha may affect hormone balance and liver enzymes, women using contraceptives should consult a doctor before combining them.
- Does Ashwagandha Cause Liver Side Effects? – Rare cases of drug-induced liver injury (DILI) have been reported, marked by jaundice, fatigue, and elevated liver enzymes. Women with liver conditions should monitor function regularly when taking it.
- Does Ashwagandha Help Manage Stress and Anxiety? – Yes. As an adaptogen, it regulates the HPA axis, reduces cortisol levels, and improves resilience. Studies show benefits for anxiety relief, better sleep, and sharper focus when used in the right dose.
- Is Ashwagandha suitable for pregnant or lactating women? – No. It may stimulate uterine contractions during pregnancy and pass into breast milk during lactation, potentially affecting infants. Use should be avoided in these stages.
