Ashwagandha has become one of the most talked-about herbal supplements in the wellness world.
Women with polycystic ovary syndrome (PCOS) are increasingly turning to it for help with stress, hormonal balance, and energy.
But is it always safe?
Understanding the potential ashwagandha side effects in women with PCOS is critical before adding it to your routine.
What Is Ashwagandha and Why Do Women with PCOS Use It?
Ashwagandha (Withania somnifera) is an ancient adaptogenic herb used in Ayurvedic medicine for thousands of years.
Adaptogens are natural substances that help the body manage stress and restore balance.
Women with PCOS often struggle with elevated cortisol, insulin resistance, and hormonal imbalances—all areas where ashwagandha may provide support.
What Makes Ashwagandha an Adaptogen
It works by regulating the hypothalamic-pituitary-adrenal (HPA) axis, which controls the body's stress response (1).
This regulation can lower cortisol levels and reduce chronic stress—a key driver of PCOS symptoms.
Key Ashwagandha Side Effects in Women with PCOS
While ashwagandha offers potential benefits, it also comes with side effects that women with PCOS should monitor carefully.
Hormonal Fluctuations
Ashwagandha can influence estrogen, progesterone, and testosterone levels.
For women with PCOS who already have hormonal imbalances, this can sometimes worsen symptoms rather than improve them.
Digestive Issues and Nausea
Some women report stomach upset, nausea, or diarrhea—especially when taking ashwagandha on an empty stomach.
Starting with a low dose and taking it with food can help reduce these effects.
Drowsiness and Fatigue
Ashwagandha has mild sedative properties, which may cause drowsiness.
Women who are sensitive to sedating compounds should avoid taking it during the day.
Thyroid Interference
One of the most significant concerns is ashwagandha's effect on thyroid hormones.
It has been shown to increase T3 and T4 levels, which can be problematic for PCOS women who also have thyroid conditions (2).
How Ashwagandha Affects Hormones in PCOS
Impact on Cortisol and Stress Hormones
Research suggests ashwagandha can significantly reduce cortisol levels (3).
Since high cortisol worsens insulin resistance—a hallmark of PCOS—this effect can be beneficial.
Effect on Testosterone and Androgens
PCOS is often characterized by elevated androgens like testosterone.
Some studies suggest ashwagandha may mildly raise testosterone in certain populations, which could be a concern for some women with PCOS (4).
Interaction with Insulin Resistance
Ashwagandha may improve insulin sensitivity, helping the body use glucose more efficiently (5).
This is particularly relevant for women with PCOS who struggle with blood sugar regulation.
Who Should Avoid Ashwagandha with PCOS?
Women on Thyroid Medication
Ashwagandha can amplify the effects of thyroid medications, potentially causing hyperthyroidism symptoms.
Always consult your doctor before combining ashwagandha with any thyroid treatment.
Pregnant or Breastfeeding Women
Ashwagandha is considered unsafe during pregnancy, as it may stimulate uterine contractions.
Women who are breastfeeding should also avoid it due to limited safety data.
Women Sensitive to Nightshade Plants
Ashwagandha belongs to the nightshade family.
Women with sensitivities to tomatoes, peppers, or eggplant may experience adverse reactions.
How to Take Ashwagandha Safely with PCOS
Most clinical studies use doses between 300 and 600 mg of a standardized root extract per day.
Starting at the lower end is advisable for women with PCOS who are new to the supplement.
Taking ashwagandha at night may leverage its calming properties to support better sleep.
Improved sleep quality can also positively impact cortisol and hormone balance in PCOS.
Final Thoughts
Ashwagandha holds real promise for women with PCOS, particularly for stress reduction and hormonal support.
However, the potential ashwagandha side effects in women with PCOS—especially around thyroid function and androgen levels—mean it's not right for everyone.
Always work with a qualified healthcare provider to determine whether ashwagandha is appropriate for your specific PCOS profile
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FAQs
Can ashwagandha make PCOS worse?
In some cases, yes. If ashwagandha raises androgen levels or interferes with thyroid function, it could worsen certain PCOS symptoms. Monitor your body closely and consult your doctor.
Does ashwagandha increase testosterone in women with PCOS?
Some evidence suggests ashwagandha may modestly increase testosterone. For women with PCOS who already have elevated androgens, this warrants caution.
Can I take ashwagandha with metformin?
There is limited research on this combination. Since both may affect blood sugar, consult your doctor before combining them to avoid hypoglycemia.
Related Studies
1. Title: Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults Under Chronic Stress
Summary: Confirmed ashwagandha's regulatory role on the HPA axis, showing 44% reduction in stress assessment scores and 30% reduction in cortisol levels over 8 weeks in healthy adults taking 300 mg twice daily.
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979308/
2. Title: A Prospective, Randomized Double-Blind Study on the Effects of Ashwagandha Root Extract on Stress and Anxiety
Summary: Demonstrated a significant reduction in serum cortisol levels (27.9% vs. 7.1% placebo) and perceived stress scores in adults taking 300 mg KSM-66 ashwagandha twice daily for 60 days.
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930062/
3. Title: Efficacy and Safety of Ashwagandha Root Extract on Thyroid Hormones in Subclinical Hypothyroid Patients
Summary: Found that ashwagandha supplementation (600 mg/day for 8 weeks) significantly increased serum T3 (17.01%) and T4 (19.66%) levels while decreasing TSH (17.58%) in subclinical hypothyroid patients.
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747575/
4. Title: Effect of Withania somnifera (Ashwagandha) on Testosterone and Reproductive Hormones in Stressed Adults
Summary: Showed that ashwagandha root extract (300 mg twice daily for 8 weeks) modestly elevated testosterone levels (14.9% increase) and improved sperm quality in stressed men, with relevance for women with androgen-related PCOS.
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5471638/
5. Title: Effect of Ashwagandha Root Extract on Insulin Sensitivity and Glucose Metabolism in Metabolic Syndrome
Summary: Indicated significant improvements in fasting blood glucose (13.6% reduction), HOMA-IR (22.3% reduction), and insulin resistance markers in participants with metabolic syndrome supplementing with 500 mg ashwagandha root extract twice daily for 12 weeks.
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383227/
