From the Guidelines
Ashwagandha is not recommended as a first-line treatment for vasomotor symptoms of menopause, as the evidence is limited and there are more effective alternatives available. The most recent and highest quality study, published in 2020 1, suggests that mind-body interventions, physical training, and cognitive behavioral therapy are effective non-pharmacological treatment options for menopausal symptoms. For hot flushes, valid alternatives include venlafaxine, oxybutynin, gabapentin, and clonidine.
Some key points to consider:
- Hormone replacement therapy is contraindicated in patients with hormone-sensitive cancers, and ashwagandha may have hormonal effects that could be harmful in these cases.
- Phytotherapeutic drugs, including ashwagandha, have not been shown to be effective in improving menopausal symptoms, and possible drug interactions must be considered.
- The use of ashwagandha may be associated with side effects such as digestive upset or drowsiness, and it should be used cautiously in women with certain medical conditions or taking certain medications.
In terms of treatment options, the following are recommended:
- Mind-body interventions, such as cognitive behavioral therapy, for menopausal symptoms
- Venlafaxine, oxybutynin, gabapentin, or clonidine for hot flushes
- Melatonin for sleep disturbances
- Hormone-free lubricants for vaginal dryness and soreness
It is essential to consult with a healthcare provider before starting any new treatment, especially if you have underlying health conditions or take other medications. They can help you determine the best course of treatment for your specific situation and ensure that you receive the most effective and safe care.
From the Research
Vasomotor Symptoms of Menopause
- Vasomotor symptoms, such as hot flashes, are common menopausal symptoms 2
- Hormone therapy is currently the only FDA-approved treatment for hot flashes, but not all women desire or are candidates for hormone therapy 2
Alternative Therapies
- Nonhormonal therapies, such as antidepressants, gabapentin, and clonidine, can be effective for relieving vasomotor symptoms 2
- Dietary herbal supplements, such as soy and black cohosh, have demonstrated mixed and inconclusive results in placebo-controlled trials 2
- Ashwagandha root extract has been found to be safe and effective in reducing climacteric symptoms in perimenopausal women 3
Ashwagandha and Menopause
- A randomized, double-blind, placebo-controlled study found that ashwagandha supplementation was associated with a significant reduction in total menopause rating scale score and improved quality of life in perimenopausal women 3
- Ashwagandha intake was also associated with a significant increase in serum estradiol and a reduction in serum FSH and LH compared to the placebo 3
- Another study found that ashwagandha root extract was safe and well-tolerated in healthy adults, with no significant adverse effects reported 4
Treatment Options
- A comprehensive treatment algorithm for vasomotor symptoms should consider symptom severity and integrate lifestyle modifications and complementary therapies with prescription treatment regimens 5
- Selective estrogen receptor modulators (SERMs) are an increasingly important therapeutic modality for the treatment of estrogen-responsive target tissues, including vasomotor symptoms 6