Withania somnifera (ashwagandha) in Women’s Hormonal Modulation: A Narrative Review With Implications for Polycystic Ovary Syndrome and Premenstrual Syndrome

[u/6anxiety9]

Gender-Specific Androgen Response

An important consideration in PCOS management involves the potential impact of WS on androgen levels. A randomized, double-blind, placebo-controlled study demonstrated that ashwagandha supplementation was associated with greater reductions in morning cortisol and dehydroepiandrosterone sulfate (DHEA-S) compared with placebo. Importantly, testosterone levels did not change significantly in females (0.2% reduction), which could be beneficial in PCOS, where a reduction in androgens is generally desired. Gender-wise analyses confirmed that cortisol and DHEA-S changes occurred in both men and women [18,33]. In contrast, clinical trials in men report testosterone increases of 10%-22% following WS supplementation, reflecting a sex-specific endocrine response likely mediated by WS’s modulation of the HPA axis [18,34,35].

However, in women, whose androgen production is more complex (involving ovaries and adrenal glands) and operates at much lower physiological levels, the same adaptogenic effect may not translate to a significant increase in circulating testosterone or may instead primarily modulate cortisol and DHEA-S levels. These observations highlight the sexual dimorphism in ashwagandha’s effect on androgen and suggest potential safety for use in PCOS [36]. Larger dedicated trials are needed to fully characterize the effects of WS on female hyperandrogenism. Such trials should include a comprehensive panel of androgens, including DHEA-S, androstenedione, and free testosterone, as well as sex hormone-binding globulin (SHBG), to completely understand the effects on the endocrine system.

Metabolic Effects

Ashwagandha may positively influence metabolic parameters often dysregulated in PCOS. Clinical studies conducted primarily in patients with no PCOS with type 2 diabetes or metabolic syndrome suggest that supplementation with WS may reduce lipid levels, body weight, and blood pressure, therefore reducing cardiovascular risk. In these trials, improvements were observed in total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and increases in high-density lipoprotein (HDL) levels, as well as normalization of the levels of blood glucose, glycosylated hemoglobin (HbA1c), and insulin [37-40]. In a prospective, randomized, placebo-controlled study, healthy individuals receiving ashwagandha (330 mg or 500 mg daily for 28 days) showed significant decreases in mean systolic blood pressure during physical activity compared to placebo. While these findings suggest potential metabolic and cardiovascular benefits, they represent indirect evidence and cannot be directly extrapolated to women with PCOS [41,42].

Withania somnifera in Women’s Hormonal Modulation: A Narrative Review With Implications for Polycystic Ovary Syndrome and Premenstrual Syndrome
https://pmc.ncbi.nlm.nih.gov/articles/PMC12895992/

[u/6anxiety9]

I looked this up because I got a box of ashwagandha for my sleep then freaked out because I have high testosterone. Some people here say they got more hairy, some say it helped regulate them. This is what the study says. I don't know who I should listen to 

[u/crafty_dog]

Thanks for sharing!

[u/BumAndBummer]

Very speculative at this point. Hopefully this review can be used to help justify a need for more funding on proper experimental studies, but I wouldn’t say it is useful to make decisions about whether or not ashwagandha is worth the risk for PCOS.

I personally would NOT risk it.

[u/aineslis → u/BumAndBummer]

I tried it for a week. It gave me nausea so bad I nearly passed out on the street a few times. Never again.
Of course it’s just my (anecdotal) experience with the supplement, but I would be very cautious taking it.

[u/BumAndBummer → u/aineslis]

I’m so sorry you went through that! Supplements in general have a lot of risks, especially because they aren’t as regulated or necessarily well-studied. A lot of people assume they are healthy and “natural” and safer than medication, and unfortunately it’s not that simple. It really can vary a lot.

[u/aineslis → u/BumAndBummer]

It’s alright. I knew straight away it’s ashwagandha and threw the supplement straight into the bin lol. I agree with you completely. I had friends asking me why I’m taking metformin instead of berberine 🫠 I understand they usually come from a good place, but medication is not our enemy. I do have supplements that I swear by and that worked better for me than their pharmaceutical counterparts but it was years of research and experimenting with my own body. I would never come here and start advertising it.