Ginkgo Biloba for Women: Are There Special Considerations?
Ginkgo biloba is one of the best-selling herbal supplements in Europe, usually taken for memory, concentration and circulation. Women make up a large share of users, yet most marketing ignores questions that matter specifically to them: the menstrual cycle, pregnancy, menopause, contraception and the higher prevalence of conditions such as Raynaud's. Our editors review whether ginkgo works differently for women and what precautions apply.
Ginkgo in brief
Ginkgo biloba is an ancient tree species whose fan-shaped leaves are used to make standardised extracts. The most studied is EGb 761, standardised to about 24 per cent flavonoid glycosides and 6 per cent terpene lactones (ginkgolides and bilobalide), with ginkgolic acids reduced to very low levels because they can cause allergic reactions.
Ginkgo extracts are thought to improve microcirculation, reduce platelet aggregation through ginkgolide B's action on platelet-activating factor, and have antioxidant effects. These mechanisms underlie both its proposed benefits and its main safety concern, which is bleeding.
In the UK, some ginkgo products hold a Traditional Herbal Registration from the MHRA based on traditional use, while many others are sold as food supplements. Clinical trials have typically used 120–240 mg of standardised extract per day, in divided doses.
Large trials in older adults have been disappointing for some uses. The Ginkgo Evaluation of Memory study, involving more than 3,000 participants, found that ginkgo did not reduce the incidence of dementia. This is important context for any claim about memory.
Uses with particular relevance to women
Several conditions where ginkgo has been studied are more common in women or specific to them.
- Premenstrual syndrome: a French trial using EGb 761 reported reduced breast tenderness and fluid-related symptoms, and an Iranian placebo-controlled trial by Ozgoli and colleagues found improvements in overall PMS symptom scores.
- Raynaud's phenomenon: a small double-blind trial from Dundee by Muir and colleagues found fewer Raynaud's attacks per week with ginkgo than with placebo.
- Menopause and memory: Elsabagh and colleagues found only limited cognitive benefits in postmenopausal women after six weeks, mainly in certain attention and planning tasks.
- Antidepressant-related sexual difficulties: a trial by Meston and colleagues found that ginkgo alone did not outperform placebo, although it may have enhanced the effect of sex therapy.
These studies are generally small and short, and several have not been replicated. Ginkgo might offer modest relief for some women, but none of these uses is established enough to replace standard care.
Is there a difference between men and women?
There is little evidence that ginkgo is absorbed or metabolised very differently in women. Most pharmacokinetic studies have included both sexes without finding clinically meaningful differences.
What does differ is context. Women are more likely to take other supplements and medicines at the same time, such as hormonal contraception, hormone replacement therapy, antidepressants, iron or migraine treatments. Interactions therefore deserve particular attention.
Women are also more likely to have heavy menstrual bleeding or iron-deficiency anaemia. Because ginkgo can affect platelet function, there is a theoretical concern that it could worsen heavy periods, although this has not been well studied.
For female athletes, ginkgo has no proven performance benefit. Claims about improved blood flow to muscles or better altitude tolerance are not supported by consistent evidence.
Pregnancy, breastfeeding and contraception
Ginkgo should not be used during pregnancy. Its effects on platelets raise concerns about bleeding, particularly around labour and delivery, and there are insufficient safety data for the developing baby. Breastfeeding women should also avoid it.
Women trying to conceive should discuss any herbal supplement with their GP or midwife. As a precaution, many clinicians recommend stopping non-essential herbal products when planning pregnancy.
There is no strong evidence that ginkgo reduces the effectiveness of hormonal contraception. However, it is wise to tell your prescriber about any herbal supplement, as evidence for many herb–drug interactions is incomplete.
| Situation | Advice |
|---|---|
| Pregnancy | Avoid |
| Breastfeeding | Avoid |
| Heavy periods or bleeding disorder | Avoid unless advised by a doctor |
| Planned surgery or dental extraction | Stop in advance as advised by the clinical team |
| Hormonal contraception or HRT | No clear interaction; inform prescriber |
| Epilepsy | Use only with medical advice |
Side effects and interactions
At standard doses, ginkgo is usually well tolerated. Reported side effects include headache, dizziness, stomach upset, constipation and allergic skin reactions.
The most important concern is bleeding. A systematic review by Bent and colleagues identified case reports of spontaneous bleeding, including intracranial haemorrhage, in people taking ginkgo, sometimes with other blood-thinning medicines. Controlled trials have not shown a clear increase, but the potential consequences are serious enough to warrant caution.
Combinations to discuss with a pharmacist include warfarin and other anticoagulants, antiplatelet drugs such as aspirin and clopidogrel, non-steroidal anti-inflammatory drugs like ibuprofen, and SSRIs or SNRIs, which also affect platelet function. Ginkgo seeds and poorly processed extracts contain ginkgotoxin, which has been linked to seizures, so people with epilepsy should seek advice.
Choose standardised extracts from manufacturers with quality controls, as some products on the market have been found to be adulterated. Ginkgo is not prohibited in sport, but competing athletes should still use batch-tested supplements.
Editorial conclusions
Ginkgo biloba does not appear to work very differently in women, but women's health contexts — pregnancy, heavy periods, multiple medicines and conditions such as Raynaud's and PMS — make specific precautions important.
Evidence for PMS and Raynaud's is limited but somewhat encouraging; evidence for memory after menopause and dementia prevention is weak or negative.
Avoid ginkgo in pregnancy and breastfeeding, and check with a pharmacist if you take any medicine that affects bleeding or mood.
Our editorial team also suggests reading about bacopa monnieri for cognition, iron deficiency in female athletes and the side effects of rhodiola rosea.
References
- DeKosky ST, Williamson JD, Fitzpatrick AL, et al. Ginkgo biloba for prevention of dementia: a randomized controlled trial. JAMA. 2008;300(19):2253–2262.
- Ozgoli G, Selselei EA, Mojab F, Majd HA. A randomized, placebo-controlled trial of Ginkgo biloba L. in treatment of premenstrual syndrome. J Altern Complement Med. 2009;15(8):845–851.
- Muir AH, Robb R, McLaren M, Daly F, Belch JJF. The use of Ginkgo biloba in Raynaud's disease: a double-blind placebo-controlled trial. Vasc Med. 2002;7(4):265–267.
- Elsabagh S, Hartley DE, File SE. Limited cognitive benefits in stage +2 postmenopausal women after 6 weeks of treatment with Ginkgo biloba. J Psychopharmacol. 2005;19(2):173–181.
- Meston CM, Rellini AH, Telch MJ. Short- and long-term effects of Ginkgo biloba extract on sexual dysfunction in women. Arch Sex Behav. 2008;37(4):530–547.
- Bent S, Goldberg H, Padula A, Avins AL. Spontaneous bleeding associated with Ginkgo biloba: a case report and systematic review of the literature. J Gen Intern Med. 2005;20(7):657–661.
