Ashwagandha and Maca for Menopause: What the Evidence Says

If menopause has left you wired at 3 a.m., flat by mid-afternoon, and less interested in intimacy than you used to be, you are far from alone. Reviews put the prevalence of sleep disturbance at roughly 35% to 60% after menopause. Night sweats wake many women up; stress and low mood then make it harder to fall back asleep. It is a loop, not a single symptom.

That loop is why two plants keep appearing in the same conversation. Ashwagandha is marketed for stress and sleep. Maca is marketed for energy, mood, and libido. Both have some human research behind them — and both have limits sellers rarely mention. This article separates what the evidence supports from what it does not, so you can discuss it with your doctor rather than guessing at a supplement shelf.

Neither herb substitutes for hormone therapy or prescribed treatment, and neither has been shown to restore estrogen reliably. What follows is evidence about symptoms, not about reversing menopause itself.

The chain: stress, sleep, and libido

These symptoms connect. A night sweat wakes you at 2 a.m. You lie awake worrying. The next day you are tired and irritable — and desire, which needs rest and a reasonably calm nervous system, drops down the priority list. Poor sleep also makes the next night’s flashes feel worse, because exhaustion lowers your tolerance for everything.

Where effects exist, they are indirect — and modest.

These symptoms can also mask thyroid disorders, anemia, depression, or sleep apnea — get new or worsening symptoms checked first.

Ashwagandha: what KSM-66 actually studied

Ashwagandha (Withania somnifera) is a shrub long used in Ayurvedic medicine. Most modern products use a root extract, and KSM-66 is the most-studied branded extract: a root-only extract standardized to at least 5% withanolides, the compounds thought to drive its effects. That detail matters, because results from KSM-66 trials do not automatically apply to a generic root powder, a leaf extract, or a gummy with undisclosed withanolide content.

The U.S. National Center for Complementary and Integrative Health (NCCIH) sums up cautiously: some ashwagandha preparations may be helpful for stress and insomnia, while the evidence for anxiety is unclear, and there is not enough evidence to judge most other claimed uses. Long-term safety has not been established.

Stress and cortisol

The most-cited KSM-66 trial is Chandrasekhar and colleagues (2012), a randomized, double-blind, placebo-controlled study in 64 adults with chronic stress. Participants took 300 mg of KSM-66 twice daily for 60 days. Serum cortisol fell by about 27.9% in the ashwagandha group versus about 7.9% with placebo, and perceived-stress scores improved more with ashwagandha than with placebo.

Two cautions belong next to that result. The participants were adults with chronic stress in general — not specifically menopausal women — so the finding supports a stress effect, not a menopause-specific one. And one small trial does not prove that any product on a shelf will repeat it. Later reviews pooling several small trials have generally found stress scores moving in a favorable direction, but with small samples and varied extracts. Honest grade: promising for stress, still preliminary overall.

Sleep

Sleep is where the KSM-66 evidence looks most consistent. Salve and colleagues (2019) ran a ten-week randomized, double-blind, placebo-controlled trial in 58 adults experiencing stress and anxiety, testing 250 mg and 600 mg of KSM-66 per day. Both doses were linked to better sleep quality and lower cortisol than placebo. A trial by Langade and colleagues (2020), over eight weeks, also found improved sleep measures, including sleep onset and morning alertness.

These were not large menopause trials, and they do not show ashwagandha stops night sweats or treats diagnosed insomnia.

What ashwagandha has NOT been shown to do for menopause

• Relieve hot flashes directly. No large, well-powered trial in menopausal women establishes ashwagandha as a hot-flash treatment. Any benefit is likely indirect — better stress and sleep making flashes easier to tolerate.
• Prove long-term safety. NCCIH is explicit: long-term safety has not been established. Most trials lasted only 8 to 12 weeks.
• Treat depression, anxiety disorders, or diagnosed insomnia. Trial participants had symptoms, not necessarily diagnoses, and the anxiety evidence remains unclear.
• Transfer across products. A gummy, a powder, and a standardized capsule are not the same intervention, even if the pack says “ashwagandha.”

Maca: a different plant, a thinner evidence base

Maca (Lepidium meyenii) is a root vegetable grown in the Andes, traditionally eaten as food and now sold as gelatinized powder, capsules, and gummies. Its menopause research is smaller, older, and more mixed than ashwagandha’s — and it deserves a lower evidence grade.

The best-known menopause work comes from Meissner and colleagues, who ran small randomized, double-blind, placebo-controlled crossover trials of a specific pre-gelatinized maca preparation (Maca-GO) in perimenopausal and early postmenopausal women. Sample sizes were small — about 18 women in one perimenopausal trial, and up to about 177 women across arms in a larger early-postmenopausal program — and treatment lasted up to four months. These trials reported reductions in menopausal symptom scores, including hot flashes and night sweats, alongside shifts in hormone measures such as estradiol and follicle-stimulating hormone.

A more recent, independent signal comes from a small trial published in the journal Menopause, in which 14 postmenopausal women took 3.5 grams of maca per day for six-week periods alternating with placebo. Anxiety and depression scores and sexual-dysfunction scores on the Greene Climacteric Scale were lower with maca than with placebo, while estrogen and androgen measures showed no meaningful change. The researchers described the findings as preliminary — and with 14 participants, that description is exactly right.

Fair summary: small trials, encouraging symptom scores, not yet replicated at scale — and “traditionally eaten” is not “proven safe as a concentrated supplement.”

On libido specifically: ashwagandha’s two small trials in women with sexual dysfunction found improved sexual-function scores with 300 mg twice daily for eight weeks, and maca’s 14-woman trial found lower sexual-dysfunction scores — but none of these were large general menopause trials. Desire in midlife is rarely a single-variable problem: sleep debt, vaginal dryness, relationship stress, mood, and medications all play a role, and vaginal symptoms usually need a conversation with your doctor about lubricants, moisturizers, or prescribed local options, rather than a capsule.

Gummy vs. capsule: does format matter?

Format matters less than standardization and dose. Capsules are what most clinical trials used: a capsule of a standardized root extract (for KSM-66, typically 300 mg twice daily in trials, or 600 mg total per day) is the closest match to the studied intervention. Gummies are easier to take, which helps consistency, but they often carry lower or undisclosed withanolide levels, plus added sugars. Trial maca doses were grams per day of a specific preparation, and a teaspoon of powder in a smoothie is not automatically the same thing.

Check the label for the extract name, amount per serving, and withanolide content (for ashwagandha); if none is stated, you are buying a promise, not a studied product. Third-party purity testing is a plus, since supplements are not verified for content before sale in the United States.

Give any trial 8 to 12 weeks and a stopping rule agreed with your doctor.

Safety: the thyroid warning, sedatives, and who should avoid these herbs

Thyroid medication. This is the most important warning for menopausal women, because thyroid disorders are common at this age and their symptoms overlap with menopause. Ashwagandha may affect thyroid hormone levels: in a small trial of 50 people with subclinical hypothyroidism, 300 mg twice daily for eight weeks lowered thyroid-stimulating hormone (TSH) and raised triiodothyronine (T3) and thyroxine (T4) compared with placebo. NCCIH advises against ashwagandha for people with thyroid disorders. If you take levothyroxine or another thyroid medicine, do not start ashwagandha without talking to the doctor who manages your thyroid, and never adjust your thyroid dose on your own.

Sedatives and sleep medicines. Ashwagandha can cause drowsiness and may add to the effects of sedatives, sleep medicines, and anti-anxiety medicines, increasing daytime sleepiness and fall risk. Tell your doctor and pharmacist about every sleep aid, including over-the-counter ones, before adding ashwagandha.

Other cautions. NCCIH notes ashwagandha is not recommended for people with autoimmune disorders or hormone-sensitive prostate cancer, and it should be avoided during pregnancy and while breastfeeding. Possible side effects include stomach upset, diarrhea, vomiting, and drowsiness. Rare cases of liver injury have been reported; stop and seek medical care if you develop yellowing of the skin or eyes, dark urine, or persistent upper-abdominal pain. Long-term safety is not established.

For maca, safety data are thinner, not proven clean — check all medicines with your doctor or pharmacist first, and bring the bottle so the label can be reviewed.

A practical way to think about it

Neither herb is a first-line menopause treatment; established options — lifestyle measures, non-hormonal prescriptions, and hormone therapy for suitable candidates — are for your doctor, not a supplement, to decide.

When to see a doctor

See a clinician promptly — and before starting either herb — if you notice:

• Bleeding after menopause (any vaginal bleeding once periods have stopped for 12 months)
• Severe or worsening hot flashes, night sweats, or sleep problems that do not improve
• Low mood, anxiety, or loss of interest that persists for weeks, or thoughts of harming yourself
• Fatigue, weight change, hair loss, or feeling unusually cold or hot — possible thyroid symptoms that overlap with menopause
• Yellowing of the skin or eyes, dark urine, or persistent upper-abdominal pain while taking any supplement
• You take thyroid medication, sedatives, antidepressants, blood-pressure or diabetes medicines, or immunosuppressants
• You are pregnant, breastfeeding, or trying to conceive

The bottom line

Ashwagandha for menopause rests mainly on stress and sleep evidence from small, short trials in stressed adults — promising, but not menopause-specific and not long-term proven. Maca rests on even smaller trials that still need large-scale replication. Neither replaces hormone care or reliably relieves hot flashes, and ashwagandha’s thyroid interaction makes it a poor do-it-yourself choice on thyroid medication. If drawn to either herb, choose a short, doctor-approved trial with a standardized product and a clear stopping rule.

Sources

1. National Center for Complementary and Integrative Health (NCCIH), “Ashwagandha: Usefulness and Safety” — https://www.nccih.nih.gov/health/ashwagandha
2. Mayo Clinic News Network, “Hormone therapy: Four things a Mayo Clinic women’s health specialist wants you to know” — https://newsnetwork.mayoclinic.org/discussion/hormone-therapy-four-things-a-mayo-clinic-womens-health-specialist-wants-you-to-know/
3. Cleveland Clinic, “Benefits of Ashwagandha and How Much To Take” — https://health.clevelandclinic.org/what-is-ashwagandha
4. Chandrasekhar K. et al., “A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults,” Indian Journal of Psychological Medicine, 2012
5. Salve J. et al., “Adaptogenic and anxiolytic effects of ashwagandha root extract in healthy adults: A double-blind, randomized, placebo-controlled clinical trial,” 2019
6. Langade D. et al., “Clinical evaluation of the pharmacological effect of ashwagandha root extract on sleep in healthy volunteers and patients with insomnia,” Journal of Ethnopharmacology, 2020
7. Meissner H.O. et al., Maca-GO trials in perimenopausal and early postmenopausal women, summarized in: “Not All Maca Is Created Equal: A Review of Colors, Nutrition, Phytochemicals, and Clinical Uses,” Nutrients, 2024 — https://www.mdpi.com/2072-6643/16/4/530
8. Sleep disturbance in the menopausal transition: narrative review, PMC — https://pmc.ncbi.nlm.nih.gov/articles/PMC11901009/

This article is for general information only and is not medical advice. Talk to your doctor before starting any supplement, especially if you take thyroid medication, sedatives, or other prescription medicines.