Dong Quai (Angelica sinensis): Menstrual & Menopause Herb — Honest Evidence Review
⚡ 60-Second Summary
Dong quai (Angelica sinensis, also called dang gui or "female ginseng") is one of the most widely used herbs in traditional Chinese medicine for menstrual disorders, menopause symptoms, and "blood tonification." Its active compounds include coumarins (mildly phytoestrogenic and anticoagulant), ferulic acid (anti-inflammatory, smooth-muscle relaxant), and psoralens (photosensitizers).
The honest evidence picture: Despite centuries of TCM use, high-quality Western RCTs are very few and results are disappointing for standalone menopause use. The most rigorous trial found no benefit over placebo. TCM typically uses dong quai in multi-herb formulas, not alone.
Critical risks: Warfarin interaction (documented bleeding complications), photosensitivity (psoralens), uterotonic effect (contraindicated in pregnancy), and hormone-sensitive condition caution.
What is dong quai?
Angelica sinensis is a perennial plant in the Apiaceae family native to China, Korea, and Japan. The dried root (dang gui, 当归) has been a foundational herb in traditional Chinese medicine for over 2,000 years, most often prescribed for gynecological conditions — irregular menstruation, dysmenorrhea (painful periods), amenorrhea, and perimenopausal symptoms. It is also used as a blood tonic (enriching blood and improving circulation in TCM theory).
Western interest has grown largely because of the herb's potential for a natural approach to menopause, but the Western clinical evidence base — particularly for isolated dong quai — is far thinner than marketing claims suggest.
Key bioactive compounds
- Coumarins (osthole, psoralen, bergapten): Phytoestrogenic (weak estrogen receptor binding), antispasmodic (smooth muscle relaxation), and anticoagulant properties. The anticoagulant coumarin content is the basis for the warfarin drug interaction.
- Ferulic acid: Anti-inflammatory; inhibits platelet aggregation; may relax uterine smooth muscle, explaining the antidysmenorrheal traditional use. Also found in many grains and fruits.
- Psoralens (furanocoumarins): Photosensitizers — absorb UV light and can cause phototoxic burns and pigmentation changes upon sun exposure.
- Essential oil (ligustilide, butylidenephthalide): Antispasmodic and mild sedative in animal models; likely contributes to smooth-muscle relaxation effects.
- Polysaccharides: Mild immunomodulatory activity in preclinical studies.
What the evidence shows
1. Menopause symptoms — disappointing standalone results
The landmark Western RCT is Hirata et al. (1997, JAMA): a 24-week double-blind, placebo-controlled trial of dong quai monotherapy (4.5 g/day standardized root) in 71 postmenopausal women. Result: no significant difference from placebo in hot flash frequency, menopausal symptom scores (Kupperman Index), or vaginal cell maturation. The authors concluded that dong quai does not behave as a phytoestrogen in clinical conditions.
Important caveat: traditional TCM uses dong quai as one component in multi-herb formulas such as Dang Gui Bu Xue Tang or Si Wu Tang. The single-herb Western paradigm may not translate the traditional clinical model appropriately. Multi-herb trials (Chinese-language literature) generally show positive results, but methodological quality and translation issues limit interpretation.
2. Menstrual regulation and dysmenorrhea
Traditional use and mechanistic data (ferulic acid, smooth-muscle relaxation, uterine motility modulation) support a plausible effect for dysmenorrhea. No adequately powered Western RCT exists. Chinese-language trials report positive results but design quality is variable.
3. Blood tonification (TCM indication)
In TCM theory, dong quai enriches blood (nourishes xue) and promotes circulation. These concepts do not map cleanly to Western physiology. Some polysaccharide fractions stimulate erythropoiesis in animal models, but human hematological data are absent.
Forms and dosing
| Form | Typical dose | Notes |
|---|---|---|
| Dried root powder (capsule) | 3–6 g/day in divided doses | Most common Western supplement form. Coumarin and psoralen content varies by origin and processing. |
| Standardized extract | 500–1000 mg/day | Often standardized to ferulic acid content. More reproducible than raw powder. |
| TCM decoction / multi-herb formula | Individualized by TCM practitioner | Traditional use; combined with complementary herbs. Closest to traditional context. |
| Tincture | 2–4 mL (1:5 tincture) 2–3× daily | Alcohol extraction; coumarins and ferulic acid well extracted. Monitor anticoagulant risk. |
Safety and side effects
- GI effects: Nausea, belching, diarrhea at higher doses
- Photosensitivity: Psoralens can cause phototoxic reactions (burns, blisters, pigmentation) upon UV exposure. Avoid prolonged sun exposure; use SPF 30+ sunscreen while supplementing.
- Bleeding risk: Anticoagulant coumarin content increases bleeding risk — particularly relevant if on warfarin, aspirin, or NSAIDs
Pregnancy — CONTRAINDICATED
Dong quai is contraindicated in pregnancy. Ferulic acid and other components stimulate uterine contractions (uterotonic), posing risk of miscarriage or preterm labor. Avoid during breastfeeding as well.
Hormone-sensitive conditions
Although human evidence for clinically meaningful estrogenic activity is lacking, the theoretical phytoestrogenic mechanism means caution is warranted in women with estrogen-sensitive breast, uterine, or ovarian cancer, or endometriosis. Discuss with your oncologist or gynecologist before use.
Drug interactions
- Warfarin (and other anticoagulants/antiplatelets): Well-documented case reports of elevated INR and bleeding complications. Avoid concurrent use. If use is unavoidable, INR must be closely monitored.
- Estrogen therapy / oral contraceptives: Theoretical additive phytoestrogenic effect; monitor if using HRT or OCP.
- CYP1A2 substrates: Ferulic acid may inhibit CYP1A2 enzyme — possible interaction with drugs metabolized by this pathway (theophylline, some antidepressants).
Who might use it — and who should not
| Possible candidates (with realistic expectations) | Should NOT use |
|---|---|
| Women seeking traditional TCM support for menstrual irregularity alongside a licensed TCM practitioner | Pregnant or breastfeeding women |
| Adults using multi-herb TCM formulas where dong quai is one component | Anyone on warfarin or other anticoagulants |
| Women looking for complementary support for mild perimenopausal symptoms (with realistic expectations of modest benefit) | People with hormone-sensitive cancers (breast, uterine, ovarian) |
| Anyone with high sun exposure without SPF protection |
Frequently asked questions
Does dong quai work for menopause hot flashes?
Based on the best available Western RCT (Hirata 1997, JAMA), standalone dong quai does not significantly reduce hot flash frequency compared to placebo. It may be more effective as part of traditional TCM combination formulas, but high-quality evidence in that context is also lacking.
Does dong quai interact with warfarin?
Yes — this is a well-documented, clinically serious interaction. Dong quai's coumarin content enhances warfarin's anticoagulant effect. Case reports document bleeding complications. Avoid this combination entirely.
Can dong quai cause photosensitivity?
Yes. Psoralens (furanocoumarins) in dong quai are UV-sensitizing compounds. Use sun protection and minimize prolonged sun exposure while supplementing.
Is dong quai safe during pregnancy?
No — it is contraindicated. Uterotonic compounds can stimulate contractions and risk miscarriage or preterm labor.
Is it the same as wild angelica?
No. Angelica sinensis (dong quai) is distinct from European angelica (Angelica archangelica) and other species. They share some coumarin chemistry but have different traditional uses and different clinical data.
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Disclaimer: This information is for educational purposes only and should not replace medical advice. Always consult a qualified healthcare provider before starting any supplement, especially if you have a medical condition, are pregnant, or take prescription medications. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.