Does dong quai help with perimenopause symptoms?

Dong quai (Angelica sinensis) is one of the most widely used herbs in Traditional Chinese Medicine for women's health, and it comes up frequently in conversations about perimenopause relief. The honest answer is that the scientific evidence for dong quai in perimenopause is thin, and the herb carries several meaningful safety concerns that you should know before considering it.

Dong quai contains several active compounds. Ferulic acid has anti-inflammatory and antioxidant properties. Phthalides act as smooth muscle relaxants, which may explain traditional use for cramping and tension. Coumarins, a class of compounds with significant blood-thinning activity, give dong quai its anticoagulant properties. The herb also contains weak phytoestrogens that can interact with estrogen receptors, though this estrogenic activity is considerably milder than what is seen in herbs like red clover or black cohosh.

The research on dong quai for menopause symptoms is limited and largely disappointing. A Cochrane systematic review found insufficient high-quality evidence to recommend dong quai alone for menopausal symptoms. A notable randomized controlled trial by Hirata et al. (1997) compared dong quai to placebo and found no significant difference in hot flash frequency or vaginal cell changes. Most studies showing any benefit have used dong quai in combination formulas with other herbs, making it impossible to isolate dong quai's specific contribution. The traditional use context is also important: in Chinese medicine, dong quai is almost never used as a standalone herb but rather as part of carefully balanced formulas, often combined with herbs that modify or moderate its effects. If you are interested in traditional herbal medicine for perimenopause, working with a licensed practitioner of Traditional Chinese Medicine who can prescribe a customized formula may give you a safer and more evidence-consistent approach than taking isolated dong quai supplements off the shelf.

If you have or have had a hormone-sensitive condition such as breast cancer, endometriosis, or uterine fibroids, discuss this supplement with your healthcare provider before using it. The weak estrogenic activity, even though mild, warrants caution in these situations.

The blood-thinning risk deserves its own emphasis. Dong quai's coumarin content makes it a meaningful anticoagulant. If you take warfarin, aspirin, or any blood thinners, do not use dong quai. The combination can dangerously increase bleeding risk. This also applies before any surgical procedure. Tell your healthcare provider and pharmacist about all herbs you are using.

Dong quai also contains psoralen compounds that are photosensitizing. Prolonged sun exposure while taking dong quai increases your risk of sunburn and skin reactions. Use sunscreen and protective clothing if you are spending time outdoors while using this herb.

Do not use dong quai during pregnancy. It has a long history of traditional use as a uterine stimulant, and its safety in pregnancy has not been established in modern research. Breastfeeding women should also avoid it. If you are still having periods during perimenopause and there is any possibility of pregnancy, this is an additional reason to discuss dong quai with your healthcare provider before using it.

Talk to your healthcare provider about the right approach for your situation. Standard doses used in traditional practice and some clinical trials have ranged considerably, and dosing is complicated by the fact that standardization of dong quai products varies widely. There is no established effective dose for menopause symptoms.

If you try dong quai, give it several weeks of consistent use while tracking your symptoms carefully. But go in with realistic expectations. The existing evidence does not strongly support meaningful symptom relief from dong quai alone for most perimenopausal symptoms. For women looking for herbal support with a stronger evidence base, black cohosh has more clinical trial data for hot flashes and has been studied more rigorously than dong quai as a standalone herb.

See a doctor if your perimenopause symptoms are significantly disrupting your daily life, if you notice unusual bleeding or bruising while using this herb, or if you experience skin reactions after sun exposure. Effective, well-studied treatments for perimenopause symptoms exist, including hormone therapy and non-hormonal prescription options, and no herbal supplement should delay access to those conversations.

The PeriPlan app (https://apps.apple.com/app/periplan/id6740066498) lets you log symptoms daily so you can spot whether patterns shift over time, giving you real data to evaluate any supplement trial.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.