Withania somnifera in Women's Hormonal Modulation: A Narrative Review With Implications for Polycystic Ovary Syndrome...

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.

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.

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.

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.