Considered trying ashwagandha for your PCOS symptoms? Ashwagandha is an adaptogen used in Eastern Medicine to help with stress levels. As people with PCOS tend to have increased levels of stress, can this ancient shrub help with symptoms?
Discover the evidence for ashwagandha for PCOS and whether it is worth supplementing with.
What is PCOS?
PCOS is a common endocrine disorder affecting approximately 1 in 10 people in the UK. Symptoms of PCOS include irregular periods, acne or oily skin, excess hair growth on the face, chest and back and a loss of hair on the head.
Many people turn to alternative medicine or herbal, holistic approaches to managing symptoms of PCOS including ashwagandha.
What is ashwagandha?
Ashwagandha is a shrub that grows across Asia and Africa. It is considered an adaptogen in Eastern and holistic Medicine. Adaptogens are herbs, roots and other plants (including mushrooms) which are thought to help our bodies manage stress. Other adaptogens include maca, American ginseng and lion’s mane.
Ashwagandha is also known as Indian ginseng or winter cherry.
How does ashwagandha work?
The popularity of herbal medicine is continuing to grow as people look for “natural” solutions to improve their health and wellbeing. Many of these ingredients like ashwagandha have been used for thousands of years and have a long history of traditional use. But, safety and efficacy have not been clearly established via clinical trials for the majority of adaptogens. And ashwagandha is no different.
A lot of the evidence we do have is from animal studies, and the small number of human studies often have low participant numbers and are short-term. More research is required to understand the use and safety of adaptogens like ashwagandha.
Ashwagandha and stress
Ashwagandha is thought to work by temporarily impairing HPA axis activity. The hypothalamic-pituitary-adrenal axis is the main stress response system. It is the link between perceived stress and the body’s physiological reaction to stress. An activated HPA increases the amount of cortisol secreted.
Cortisol is known as the “stress” hormone as it keeps the body in a state of high alert whilst increasing blood glucose levels, impairing insulin secretion and reducing the immune response.
Ashwagandha benefits for PCOS
As mentioned above, ashwagandha is thought to work by reducing HPA axis activity. Reduced HPA axis activity reduces the amount of cortisol (a stress hormone).
People with PCOS are not only more likely to have elevated levels of cortisol but also tend to be more sensitive to the effects of stress. Increased cortisol levels are linked to higher androgen levels and increased blood glucose levels because of the impact on the insulin sensitivity of the cells.
Hyperandrogenism (i.e. high levels of androgens like testosterone) is a factor in PCOS diagnosis and is linked to symptoms like acne, excess hair growth and hair loss on the head.
Whilst there have been no studies on the impact of ashwagandha on PCOS, some studies have shown that ashwagandha may reduce stress levels due to the moderating effect on the HPA axis. Although, these studies use small numbers of participants and are short-term. More research of higher quality is required to understand the impact of ashwagandha on PCOS in particular.
How to take ashwagandha
If you chose to take ashwagandha it is important to have a good understanding of the current evidence, the reported side effects and counter-indications. Always speak to your healthcare provider before trying a new supplement or medication.
There is no optimal therapeutic dose for ashwagandha. The amount used in studies varies and more research is required to understand optimal potency, efficacy and safety in humans. Generally, ashwagandha is used by adults in doses of up to 1000mg daily for up to three months.
If you choose to take ashwagandha, speak to a healthcare professional prior to use and follow the manufactures instructions when using.
Powder or tablets?
As long as the percentage of active ingredients is the same, whether you take ashwagandha in powder or tablet form, the benefits will be similar. Ashwagandha can have a bitter taste so some people prefer to take it in powder form to mask the taste. It can also be more convenient to take it in capsule or tablet form.
Ashwagandha side effects
Generally, ashwagandha is considered safe if used in small doses for up to three months. The long-term safety of ashwagandha is unknown.
Large dosages of ashwagandha over time may contribute to side effects like stomach pain, diarrhoea, nausea and vomiting. More severe side effects are rarely reported but include liver problems like severe liver failure.
Who shouldn’t try ashwagandha?
Ashwagandha should not be taken by pregnant people or those breastfeeding. There is some evidence that ashwagandha may cause miscarriages.
Those with autoimmune diseases like multiple sclerosis, lupus or rheumatoid arthritis should avoid using ashwagandha. This is because the herb may cause the immune system to be more active, contributing to symptoms.
Ashwagandha should also be avoided for two weeks before any surgery because of its potential to slow down the central nervous system.
If you are taking medication, check with your doctor or healthcare team before trying ashwagandha to ensure there are no contraindications.
Ashwagandha may contribute to increased thyroid hormone levels. If you have a thyroid condition then avoid ashwagandha.
The long-term safety of using ashwagandha is unknown.
Which medicines interact with ashwagandha?
Various medicines including immunosuppressants, sedative medications such as benzodiazepines and CNS depressants, thyroid hormone medication, medications for diabetes and medications for high blood pressure interact with ashwagandha. If you are taking any of these medications then do not take ashwagandha.
Speak to your doctor or healthcare professional if you have any questions about whether you can take ashwagandha.
FAQ: ashwagandha for PCOS
There is no best time of day to take ashwagandha. You can choose when to take the adaptogen at a time that suits you. Some people find that ashwagandha can lead to an upset stomach if taken on an empty stomach, so you may prefer to consume it in the evening or after a meal.
Unfortunately, there isn’t enough evidence to conclusively say whether ashwagandha is bad or good for PCOS. More research is needed but it has been suggested that ashwagandha helps to reduce the activity of the HPA axis. The HPA axis is a system that regulates stress in the body. People with PCOS tend to have higher stress levels and increased stress may contribute to PCOS symptoms. So, theoretically, ashwagandha may be beneficial for PCOS but more evidence is required.
Ashwagandha may be linked to reduced blood glucose levels. Inositol is an insulin sensitiser which means it reduces blood glucose levels too. Therefore, taking ashwagandha and inositol together may cause hypoglycemia. Ashwagandha and inositol should not be taken together unless advised by your healthcare professional.
Ashwagandha may help with hair loss because one major contributor to hirsutism is stress. Ashwagandha is theorised to reduce stress levels by reducing the activity of the HPA axis. As people with PCOS tend to have higher stress levels, this may help with common PCOS symptoms linked to stress like hirsutism and may improve hair loss.
Reportedly, ashwagandha can reduce the amount of cortisol (a stress hormone) throughout the body. Stress can impact the duration, regularity and intensity of the menstrual cycle. Therefore, ashwagandha may increase the heaviness of periods.
Ashwagandha is theorised to reduce the amount of cortisol (stress hormone) in the body. So, if you have elevated cortisol then ashwagandha may help “balance” this. More evidence is needed to understand the mechanism of ashwagandha and how it affects hormones.
Key takeaways: ashwagandha for PCOS
People with PCOS are often looking for holistic approaches to symptom management. Ashwagandha is an adaptogen typically used in Eastern Medicine practices and is a traditional stress reliever in countries like India. It has been theorised that ashwagandha may help symptoms of PCOS because of its HPA-moderating potential. But more research is required to understand the impact of ashwagandha for PCOS and care should be taken to understand the risks and contraindications. Always speak with a healthcare professional before trying a new supplement.
Founder and Editor | Registered Associate Nutritionist
Founder of Be The Collective LTD [The PCOS Collective & The Endo Collective] Alex Okell ANutr is a London-based reproductive health nutritionist with experience in research, private practice and digital media. She holds a Master’s degree in Nutrition from King’s College London and has co-authored papers with the University of Cambridge, King’s College London, The Food Foundation and the Food Standards Agency. Alex offers 1:1 PCOS support in our virtual PCOS clinic.