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Limited evidenceWomen's health

Dong Quai

Dong quai (Angelica sinensis) is marketed as a "female ginseng" for hot flashes and menstrual complaints, but the one well-designed placebo-controlled trial of dong quai alone found it no better than placebo. It also contains photosensitizing coumarins and may interact with warfarin.

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What the science says

  • Does not relieve menopausal hot flashes as a single herb Limited evidence

    The definitive trial (Hirata 1997) randomized 71 postmenopausal women to 4.5 g/day of dong quai root extract or placebo for 24 weeks. Hot flash counts fell about 25-30% in both groups with no difference, and there was no change in endometrial thickness, vaginal maturation index, or estradiol — i.e. no detectable estrogenic activity. Positive results in the literature almost always come from multi-herb formulas where dong quai is one of six or more ingredients, so the effect cannot be attributed to dong quai.

  • No good evidence for dysmenorrhea or "blood tonic" anemia claims Limited evidence

    Traditional use for painful periods and as a "blood builder" rests on animal work and uncontrolled reports. Dong quai contains essentially no bioavailable iron in meaningful amounts, and no adequately powered RCT has shown it raises hemoglobin or reduces menstrual pain versus placebo in humans.

  • Ferulic acid and ligustilide are real bioactives, but only demonstrated in vitro and in animals Limited evidence

    Pharmacological reviews document antiplatelet, vasorelaxant and anti-inflammatory effects of ligustilide, ferulic acid and Angelica polysaccharides in cell and rodent models. None of these has been translated into a controlled human outcome, and the antiplatelet activity is more of a safety signal than a benefit.

Dosage & safety

Studied doseTrials and traditional practice use 3-6 g/day of dried root, or roughly 4.5 g/day of root equivalent in extract form, taken in divided doses. Commercial capsules are typically 500-600 mg of powdered root (often 2-3 capsules daily), which is well below the studied amount. There is no established standardization marker, so ligustilide and ferulic acid content varies widely between products.
SafetyContains furanocoumarins that cause photosensitivity — sunburn risk rises with high doses. Coumarin content plus antiplatelet activity means a genuine bleeding risk: case reports describe markedly elevated INR in patients on warfarin who added dong quai, and it should be stopped roughly two weeks before surgery. Avoid in pregnancy (traditional uterine-stimulant use, no safety data) and while breastfeeding. Because it is often sold for "hormone balance," women with estrogen-sensitive cancers frequently ask about it; while the Hirata trial found no estrogenic effect, safety in that setting is untested. Also avoid with heavy menstrual bleeding or bleeding disorders.

How to take it

TimingDivided doses across the day, as in traditional practice.
With food?With food.
Worth knowingUse sun protection while taking it — the furanocoumarins make skin burn more easily — and stop about two weeks before any surgery.

Interactions

With medications

  • warfarin and other anticoagulants

    Dong quai contains coumarins and has antiplatelet activity; case reports describe markedly raised INR after it was added. do not combine

  • photosensitising drugs (doxycycline, some diuretics, retinoids)

    Its furanocoumarins add to drug-induced sun sensitivity. use strong sun protection or avoid the combination

  • tamoxifen and other hormonal cancer therapy

    It is marketed for "hormone balance" and its safety in oestrogen-sensitive disease is untested. do not use during hormonal cancer treatment without your oncologist

With other supplements

  • ginkgo, garlic, high-dose fish oil and other bleeding-risk supplements

    Antiplatelet effects add up. avoid stacking, and stop them all about two weeks before surgery

Well-established interactions only — this is not a complete list. Always tell your doctor and pharmacist what you take.

Frequently asked questions

Does dong quai help with hot flashes?

Dong quai on its own did not relieve menopausal hot flashes in the definitive trial (limited evidence): 71 postmenopausal women took 4.5 g/day or placebo for 24 weeks, and hot flashes fell equally in both groups. Positive results usually come from multi-herb formulas, so the effect cannot be attributed to dong quai.

Is dong quai estrogenic?

The main dong quai trial found no detectable estrogenic activity: there was no change in endometrial thickness, vaginal maturation index or estradiol after 24 weeks. Its safety in estrogen-sensitive cancers is untested, so do not use it during hormonal cancer treatment without your oncologist.

Can I take dong quai with warfarin?

No: dong quai contains coumarins and has antiplatelet activity, and case reports describe markedly raised INR in people on warfarin who added it. Avoid stacking it with other bleeding-risk supplements, and stop about two weeks before surgery.

What are the side effects of dong quai?

Dong quai contains furanocoumarins that make skin burn more easily, so use sun protection, and it carries a genuine bleeding risk. Avoid dong quai in pregnancy, while breastfeeding, and with heavy menstrual bleeding or bleeding disorders.

Scientific references

Where to buy

NOW Foods, Dong Quai, 520 mg, 100 Veg Capsules

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