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Introduction: Menstrual irregularities, including oligomenorrhea, menorrhagia, polymenorrhea, and dysmenorrhea, significantly affect women’s reproductive and psychological health. Ashokarishta, a classical polyherbal Ayurvedic formulation with Saraca asoca as its chief ingredient, has been traditionally prescribed for gynecological disorders. Despite its centuries-long use, systematic evaluation of its clinical efficacy remains crucial. Methods: A systematic review was conducted by screening Ayurvedic classical texts (Bhaishajya Ratnavali, Charaka Samhita, Ashtanga Hridaya) for references to Ashokarishta. Electronic databases including PubMed, Scopus, Web of Science, and Google Scholar were searched (2000–2025) using keywords: “Ashokarishta,” “Saraca asoca,” “Ayurveda,” “menstrual irregularities,” and “dysmenorrhea.” Clinical trials, observational studies, pharmacological experiments, and review articles were included. Data were synthesized thematically, integrating Ayurvedic concepts and modern biomedical findings. Results: Classical texts describe Ashokarishta as stree-rogahara (alleviator of gynecological disorders), promoting uterine health, balancing doshas, and regulating menstrual flow. Modern pharmacological studies reveal Ashoka bark’s phytoestrogenic, anti-inflammatory, analgesic, and antioxidant properties. Clinical evidence supports its efficacy in reducing menorrhagia, dysmenorrhea, and irregular cycles, with improvements in hemoglobin levels and quality of life. Combination studies indicate enhanced outcomes when integrated with lifestyle modifications. However, data heterogeneity and limited large-scale randomized controlled trials restrict conclusive evidence. Discussion: Ashokarishta demonstrates a strong concordance between classical claims and modern findings. Its clinical benefits may be attributed to hormonal modulation, uterotonic effects, and improved endometrial function. More robust, well-designed trials are needed to validate its standardized dosage, safety, and long-term efficacy.

KEYWORDS: Ashokarishta, Ayurveda, Menstrual irregularities, Saraca asoca, Women’s health.