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Ashwagandha (Withania somnifera) is an herb that has garnered attention for its potential benefits, including support for stress and mood [1]. For women navigating the complexities of midlife and perimenopause, understanding how ashwagandha interacts with their unique health profile is important.
While generally considered safe for many, certain health conditions and medications can make ashwagandha an inappropriate choice. This article will outline key ashwagandha contraindications and situations where caution is advised, providing evidence-based information for perimenopausal women.
Autoimmune Conditions and Ashwagandha
Ashwagandha is recognized for its immunomodulatory properties, meaning it can influence the activity of the immune system [2]. For individuals with autoimmune conditions such as rheumatoid arthritis, lupus, Hashimoto’s thyroiditis, or multiple sclerosis, this immune system modulation could potentially be a concern. The herb may stimulate immune activity, which could theoretically exacerbate symptoms in some autoimmune disorders [2].
Therefore, women with diagnosed autoimmune conditions should approach ashwagandha with significant caution. It is always recommended to consult with a healthcare provider before considering ashwagandha supplementation if you have an autoimmune disorder, to discuss potential interactions and ensure it aligns with your specific health management plan.
Thyroid Conditions: A Note of Caution
Research suggests that ashwagandha may influence thyroid hormone levels [3]. Some studies indicate it could potentially increase thyroid hormone production [3]. While this might be seen as beneficial for individuals with underactive thyroid function (hypothyroidism), it poses a potential risk for those with overactive thyroid (hyperthyroidism) or those already taking thyroid hormone medication.
For women in perimenopause, where thyroid function can sometimes fluctuate, monitoring is key. If you have a known thyroid condition or are on thyroid medication, it is essential to discuss ashwagandha use with your doctor. Regular thyroid hormone level checks would be prudent to ensure no adverse effects or interactions with existing treatments occur [3].
Medication Interactions to Be Aware Of
Ashwagandha has the potential to interact with certain medications due to its physiological effects [2]. Women in perimenopause often take various medications for conditions related to this life stage or pre-existing health concerns. Understanding these potential interactions is vital.
Specifically, ashwagandha’s reported sedative properties could enhance the effects of central nervous system depressants, such as sedatives, anti-anxiety medications, and even alcohol [2]. This could lead to increased drowsiness or impaired coordination. Additionally, given its potential to influence blood sugar levels [4], ashwagandha might interact with diabetes medications, potentially leading to hypoglycemia. Its noted effects on blood pressure [4] also suggest caution for those on blood pressure-lowering medications, as it could lead to an additive effect. Furthermore, as it may influence immune function [2], it could theoretically interact with immunosuppressant drugs. Always disclose all medications and supplements to your healthcare provider before starting ashwagandha.
Pregnancy, Breastfeeding, and Ashwagandha
While perimenopause marks a transition beyond typical childbearing years, the possibility of pregnancy, though less common, still exists for some women in early perimenopause. For pregnant or breastfeeding individuals, ashwagandha is generally not recommended due to a lack of sufficient safety data [2].
There is not enough research to definitively establish the safety of ashwagandha for the developing fetus or infant. Therefore, out of an abundance of caution, it is best to avoid ashwagandha during pregnancy and while breastfeeding [2]. Always consult with a healthcare professional for guidance on any supplements during these sensitive periods.
Upcoming Surgery and Ashwagandha
Individuals scheduled for surgery should typically discontinue ashwagandha use at least two weeks beforehand [2]. This recommendation stems from the herb’s potential effects on the central nervous system, which could interact with anesthesia and other medications used during and after surgery. Its potential influence on blood sugar and blood pressure [4] could also complicate surgical procedures and recovery.
Discussing all supplements, including ashwagandha, with your surgical team well in advance of any planned procedure is crucial to ensure your safety and optimal surgical outcomes.
Liver Conditions and Potential Concerns
Although rare, there have been isolated reports of liver enzyme elevation associated with ashwagandha use, particularly at high doses or in sensitive individuals [2]. While the evidence is not extensive, individuals with pre-existing liver conditions or compromised liver function should exercise caution and consult with their healthcare provider before using ashwagandha.
Your doctor can help determine if ashwagandha is appropriate for you and advise on any necessary monitoring of liver function.
References
- Effects of Withania somnifera (Ashwagandha) on Stress and the Stress- Related Neuropsychiatric Disorders Anxiety, Depression, and Insomnia. Current neuropharmacology, 2021
- Withania somnifera (L.) Dunal (Ashwagandha): A comprehensive review on ethnopharmacology, pharmacotherapeutics, biomedicinal and toxicological aspects. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie, 2021
- Can Ashwagandha Benefit the Endocrine System?-A Review. International journal of molecular sciences, 2023
- Ashwagandha (Withania somnifera)-Current Research on the Health-Promoting Activities: A Narrative Review. Pharmaceutics, 2023
These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease. Content is for informational purposes only and is not medical advice; consult a qualified healthcare provider before starting any supplement. As an Amazon Associate we earn from qualifying purchases.

