Does ginkgo biloba help with perimenopause symptoms?

Ginkgo biloba has the most credible evidence for cognitive symptoms, specifically brain fog, poor concentration, and memory lapses, which are among the most commonly reported and underappreciated complaints during perimenopause. Its evidence for other perimenopausal symptoms is weaker, and it carries serious drug interaction risks that every woman needs to understand before using it.

Ginkgo biloba leaf extract contains four main types of active compounds: ginkgolides, which inhibit platelet-activating factor and thin the blood; bilobalide, which has neuroprotective properties; flavonoids, which act as antioxidants; and terpenoids, which improve microcirculation. The most well-documented effect is improved cerebral blood flow. Multiple studies, including several randomized controlled trials, have shown that standardized ginkgo extract increases blood flow to the brain and improves cognitive function, particularly in people with reduced cerebral circulation.

This mechanism is directly relevant to perimenopause. Estrogen plays a key role in maintaining cerebral blood flow, supporting production of brain-derived neurotrophic factor (BDNF), and sustaining acetylcholine receptor density in memory-related brain regions. As estrogen declines during perimenopause, cerebral blood flow decreases and acetylcholine signaling weakens. Ginkgo addresses the blood flow component of this, which is why some women notice improvements in mental clarity during perimenopause specifically. It does not replace estrogen's broader neuroprotective role, but it may partially compensate for the vascular piece.

In healthy adults without cognitive impairment, ginkgo's benefits for cognition are modest and inconsistent across studies. The evidence is somewhat stronger in people with vascular cognitive impairment or reduced cerebral circulation, which is a better model for the estrogen-withdrawal brain than studies in young adults. A Cochrane review found limited evidence for ginkgo in healthy older adults, so it is important not to overstate what it can deliver.

Ginkgo also has a weak estrogenic activity, which has been found in some laboratory and animal studies. Whether this translates into meaningful benefit for hot flashes or other estrogen-sensitive symptoms in humans is unclear. If you have a history of estrogen-sensitive conditions such as breast cancer, uterine cancer, endometriosis, or uterine fibroids, discuss this potential estrogenic activity with your oncologist or provider before using ginkgo.

Studies have most commonly used the standardized EGb 761 extract, dosed at 120 to 240 mg per day, standardized to 24% flavonol glycosides and 6% terpene lactones. Effects on cognition tend to require 6 to 12 weeks of consistent use before noticeable changes occur. Talk to your healthcare provider about the right dose for your situation.

Beyond cognition, some women ask about ginkgo for mood, anxiety, or sleep. The evidence here is much thinner. A few small trials have explored ginkgo for anxiety and found modest benefits, but these studies are not specific to perimenopause and have significant methodological limitations. For sleep, there is very limited evidence. Anecdotally, some women report better sleep while taking ginkgo, possibly as a secondary effect of reduced nighttime anxiety or improved brain circulation, but this has not been studied rigorously. Be cautious about expecting ginkgo to address these symptoms specifically.

It is also worth noting that ginkgo comes in leaf extract form, standardized supplements, and teas. Ginkgo teas made from whole dried leaves contain much lower and less standardized amounts of active compounds. The clinical evidence for ginkgo is based on standardized extracts, not teas, and the two should not be assumed equivalent. Ginkgo seeds are toxic and must never be consumed. Only use products made from the leaf extract.

Now the critical safety information. Ginkgo biloba significantly inhibits platelet aggregation and acts as a blood thinner. If you take warfarin, aspirin, clopidogrel, other blood thinners, or NSAIDs like ibuprofen or naproxen, do not use ginkgo biloba without talking to your provider first. The combination can increase bleeding risk significantly. Ginkgo can also interact with SSRIs (there are reports of serotonin syndrome risk with the combination), MAOIs, and anticonvulsant medications such as carbamazepine or valproate. This is not a supplement to take casually if you are on any of these medications.

If mood symptoms such as depression or anxiety are among your concerns, discuss all supplements with your prescribing provider before combining them with antidepressants.

See your doctor if cognitive symptoms are severe, came on suddenly, are getting progressively worse, or are accompanied by word-finding difficulties beyond typical forgetfulness. Sudden or rapidly worsening cognitive changes need medical evaluation to rule out causes other than perimenopause.

The PeriPlan app (https://apps.apple.com/app/periplan/id6740066498) lets you log brain fog and other cognitive symptoms daily so you can spot whether patterns shift over time and track whether a supplement like ginkgo seems to coincide with clearer thinking after several weeks of use.

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