Ashwagandha for Sleep and Menopausal Symptoms

A popular herb for stress and sleep shows promise in menopause

STUDY: Obhrai S et al, Menopause 2027

STUDY TYPE: Randomized, double-blind, placebo-controlled trial

FUNDING: Sandu Pharmaceuticals Ltd. (India); tablets only

Background

Menopause brings disrupted sleep, weight gain, and psychological symptoms. Ashwagandha is an adaptogen that increases serotonin, modulates stress hormones (HPA axis), and raises testosterone.

Ashwagandha has approximately 37 placebo-controlled trials supporting its role for stress-related symptoms like insomnia, anxiety, and cognition. In women, it improved sexual function in a few small trials. This small trial tested it in menopause.

The Study

• 66 postmenopausal women (ages 45-65) in India; 63 completed 12 weeks (33 ashwagandha, 30 placebo).
• Randomized to ashwagandha root extract, 600 mg/day, or identical placebo, taken nightly.
• Primary outcomes: sleep quality (PSQI), menopausal symptoms (Menopause Rating Scale), and body fat by DXA.

Results

Sleep quality improved far more with ashwagandha: PSQI scores fell 5.0 points versus 0.6 with placebo (P < 0.001, effect size 0.80). The percentage with reports of poor sleep fell from 82% to 12% on the herb.

Menopausal symptoms fell 8.2 points versus 1.1 (P < 0.001, effect size 0.78), past the threshold for clinical meaning. Body fat fell 0.6% with ashwagandha while placebo patients gained slightly (P < 0.001, effect size 0.63). Quality of life improved broadly; bone density didn’t change.

Side Effects

None. Monthly liver, kidney, thyroid, and blood counts showed no problems, but there are rare reports of thyroid changes and liver injury on ashwagandha.

Limitations

Small, single-center trial (63 completers) with three co-primary outcomes and no correction for multiple comparisons; 12 weeks is too short to judge bone effects.

Practice Implications

1. Herbs like ashwagandha are difficult to standardize. I recommend the Sensoril extract, which has more safety and efficacy data than most preparations.
2. Other researched extracts include Somin-On, KSM-66, Shoden, and Witholytin.
3. Adaptogens offer an alternative to benzodiazepines for stress-related symptoms. I cover them in the upcoming Carlat Fact Book on Complimentary and Alternative Medicine in Psychiatry.

—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report

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