Adaptogens for Perimenopause and Menopause Symptoms: What Is Known
What small trials and reviews report for ashwagandha, maca and ginseng in perimenopause and menopause, what NIH and NHS say, and the limits of "hormone support" claims.
Content last updated . This page has not been medically reviewed.
Safety first. Natural products can cause side effects and interact with medicines. Read who should be careful, by situation before you use anything on this page.
The question
Many products promise "hormone support" or relief from hot flashes, night sweats and mood changes in perimenopause (the years leading up to the last period) and menopause. This page reports what research on three adaptogen herbs found. It is not a treatment guide: symptoms that disrupt life deserve a conversation with a clinician. See Perimenopause and menopause: symptoms and options for the full picture.What official sources say
The UK's NHS says that if you have symptoms of perimenopause or menopause you should talk to a doctor, nurse or pharmacist about hormone replacement therapy (HRT) and other options. [1] It says herbal remedies such as red clover and black cohosh are sometimes sold for these symptoms, but there is very little evidence to show how well they work, or how safe they are. [1] It adds that some herbal remedies may cause serious side effects when taken with other medicines. [1] That page names those two herbs, not the adaptogens below. NIH says there is not enough evidence to determine whether ashwagandha helps with menopause. [2] For other herb claims see black cohosh, soy, red clover and "hormone balance" claims.What research found, by herb
| Herb and form | What the source found | Strength of evidence | Population and form |
|---|---|---|---|
| Withania somnifera (ashwagandha) root extract | In 100 women with climacteric symptoms, scores on a menopause rating scale fell more than with placebo over 8 weeks, and the extract group had higher estradiol and lower FSH and LH. [3] | Promising but limited | Perimenopausal women; one root extract; hormone results are biomarkers |
| Ashwagandha root extract | A placebo-controlled trial of 60 women aged 45 to 55 for 56 days reported fewer hot flash events and lower menopause rating scores. [4] | Promising but limited | Small, short, one extract |
| Ashwagandha root extract | In 66 postmenopausal women over 12 weeks at one center in India, sleep quality and menopausal symptom scores improved more than with placebo; bone density did not differ. [5] | Promising but limited | Single center |
| Lepidium meyenii (maca) root | A systematic review found four randomized trials and described limited evidence, too few and small to draw firm conclusions; it said safety has not been proved. [6] | Insufficient evidence | Maca-based interventions versus placebo |
| Panax ginseng and other ginseng types | A review of 15 placebo-controlled trials found most had bias concerns; pooled results showed fewer hot flashes and symptoms, but no effect on sexual function, hormones or endometrial thickness. [7] | Mixed | Mixed ginseng types; includes Korean red ginseng |
Where hormone levels are reported, a change in a blood hormone is a lab marker, not the same as feeling better. The trials above come from the abstracts we read; funding was not described there.
Why "balance" is not a measured result
The sources we read do not define "hormone balance" as a measurable outcome. The trials above measured symptom scores and individual blood hormones. A separate guide covers adaptogens for women and the maca guide.Frequently asked questions
Do adaptogens help hot flashes?
Some small trials of ashwagandha root extract and a review of ginseng trials reported fewer hot flashes, but the trials were small and short and many had bias concerns. [4][7]
Is maca proven for menopause?
No. A systematic review found four trials and called the evidence limited; it said safety has not been proved. [6]
Do adaptogens "balance hormones"?
The sources we read measured symptom scores and individual hormones, not "balance." In a meta-analysis of 23 ashwagandha trials, cortisol and testosterone in men changed but estradiol did not, and the authors noted heterogeneity. [9]
Is ashwagandha safe in menopause?
NIH says it may be safe in the short term (up to 3 months), long-term safety is unknown, and it has interactions and cautions that a pharmacist or clinician should review. [2]
What do health services recommend first?
The NHS advises talking to a doctor, nurse or pharmacist about HRT and other options. [1]
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Safety and who should ask first
- Ashwagandha: NIH says it should be avoided during pregnancy and not used while breastfeeding, is not recommended before surgery or for people with autoimmune or thyroid disorders, and might interact with medicines for diabetes and high blood pressure, sedatives and thyroid medicines. [2] NIH reports rare liver injury cases. [2]
- Asian ginseng: NIH lists insomnia as the most common side effect and says it may interfere with blood clotting and might lower blood sugar. [8]
- Maca: the review said safety has not been proved. [6]
- For hormone therapy, antidepressants or other medicines, interactions with these herbs are not described in the sources we read; ask a pharmacist. See how interactions work.
- New or severe symptoms are worth a clinician visit rather than a supplement trial.
References
- Treatment for menopause and perimenopause (NHS; page last reviewed 19 May 2026). Read 2026-10-23.
- Ashwagandha: Usefulness and Safety (NCCIH, NIH; last updated March 2023). Read 2026-10-23.
- Ashwagandha root extract on climacteric symptoms in perimenopause, J Obstet Gynaecol Res 2021 (PubMed 34553463). Read 2026-10-23.
- Ashwagandha root extract for menopausal symptoms, randomized placebo-controlled study, Front Reprod Health 2025 (PubMed 41561822). Read 2026-10-23.
- Withania somnifera root extract in postmenopausal women (sleep, body composition, symptoms), Menopause 2026 (PubMed 42742071). Read 2026-10-23.
- Maca (Lepidium meyenii) for treatment of menopausal symptoms: a systematic review, Maturitas 2011 (PubMed 21840656). Read 2026-10-23.
- Using ginseng for menopausal women's health care: a systematic review of randomized placebo-controlled trials, Complement Ther Clin Pract 2022 (PubMed 35691259). Read 2026-10-23.
- Asian Ginseng: Usefulness and Safety (NCCIH, NIH). Read 2026-10-23.
- Hormonal Modulation with Withania somnifera: systematic review and meta-analysis of randomized controlled trials, Planta Medica 2026 (PubMed 41740946). Read 2026-10-23.