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

## TL;DR

This review explores how ashwagandha may help manage hormonal imbalances in PCOS and PMS by affecting stress, hormones, and metabolism.

## Contribution

The paper highlights ashwagandha's potential as a natural treatment for PCOS and PMS through its effects on hormonal and metabolic pathways.

## Key findings

- Ashwagandha may normalize gonadotropins and estradiol levels by modulating the HPA and HPG axes.
- It lowers cortisol and improves metabolic markers in preclinical PCOS models.
- Ashwagandha's neuropsychiatric effects may reduce PMS symptoms like anxiety and stress.

## Abstract

Background: Polycystic ovary syndrome (PCOS) and premenstrual syndrome (PMS) are among the most common hormonal diseases affecting women worldwide. Although multiple conventional treatments exist, they are often insufficient or poorly tolerated by the patients. Withania somnifera (WS) (ashwagandha) could provide a synergistic or alternative method of symptom management due to its endocrine, neuropsychiatric, and anti-inflammatory properties.

Aim of the study: This narrative review aims to evaluate the current evidence regarding the usefulness of Withania somnifera in aiding women’s hormonal balance, with a particular focus on its potential applications in PCOS and PMS.

Results: The current state of knowledge indicates that by modulating the hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-gonadal axes, normalization of gonadotropins and estradiol levels is potentially achievable with Withania somnifera. This, along with a well-documented lowering effect on cortisol, improvements in metabolic markers, and the restoration of ovarian function in preclinical PCOS models, shows therapeutic potential. Crucially, ashwagandha’s impact on androgen levels appears sex-specific, as it does not seem to elevate testosterone in women, unlike in male study groups. In PMS, ashwagandha’s neuropsychiatric properties, most likely associated with GABAergic signaling and HPA modulation, may be beneficial in lowering fatigue, anxiety, and stress reactivity. Some studies also indicate possible analgesic activity of Withania somnifera.

Conclusions: Ashwagandha rises as a strong candidate for supportive treatment for managing the symptoms of PCOS and PMS by means of combined hormonal, metabolic, and neuropsychiatric effects. However, as current evidence relies heavily on preclinical models and extrapolation from other populations, further large-scale, randomized clinical trials using standardized extracts are necessary to establish definitive therapeutic protocols and confirm its clinical efficacy and safety.