Ginkgo for PMDD: does it work?

No trial has tested ginkgo biloba in women with a confirmed PMDD diagnosis. PMDD requires at least five symptoms, one of them a mood symptom, confirmed by daily ratings over two cycles, a stricter bar than most supplement trials use. You can read how that diagnosis works on our PMDD page.

Every ginkgo trial recruited women with PMS instead, the more common pattern of symptoms that ease once bleeding starts. Results within those PMS trials are mixed.

• A 1993 French trial of 165 women found ginkgo eased breast tenderness and mood symptoms more than placebo.
• A 2009 Iranian trial of 90 women found a larger improvement in the ginkgo group (23.68%) than the placebo group (8.74%), but the trial didn't report whether that gap was statistically significant, so it's hard to credit ginkgo itself for the difference.

A 2009 systematic review of herbs and supplements for PMS and PMDD described the ginkgo evidence as preliminary. No trial has compared ginkgo directly with SSRIs or CBT, the treatments with the strongest support for PMDD.

Overview articles often group ginkgo with chasteberry, saffron and vitamin B6 as options worth trying for PMS, but appearing on a list isn't the same as having trial support. If PMS rather than PMDD is your situation, the separate trial evidence is on our ginkgo for PMS page.

Here's what the two placebo-controlled trials and the review papers found.

Sample sizes were modest (165 and 90 women), and only the French trial reported a named, standardized extract (EGb 761) throughout. That makes it hard to know what gave the 1993 result its edge over placebo, and whether a different brand or dose would do the same.

No trial has been repeated with larger numbers or today's reporting standards. The two placebo-controlled trials disagree on the central question: whether ginkgo beats placebo at all, or whether both groups simply improve with time and attention.

There's no doctor-set dose for PMDD, since no guideline covers ginkgo for this diagnosis. The two PMS trials used:

• 40 mg of standardized leaf extract, three times a day (120 mg total), from day 16 of the cycle through day 5 of the next period
• A standardized extract called EGb 761, dosed across the same luteal window, in the earlier French trial

Both trials timed ginkgo to the luteal phase only, the one to two weeks before the period, instead of every day of the cycle. If you're considering it, a doctor or pharmacist can check it against anything else you take, since ginkgo affects bleeding, covered below.

Both trials measured results after two full menstrual cycles of daily, luteal-phase dosing. Neither reported a faster effect, so one cycle probably isn't enough to tell if it's doing anything.

Track your symptoms daily while you try it. The DRSP chart is the same format researchers used in these trials, so it gives you an honest before-and-after comparison instead of a guess based on memory.

The Iranian trial is also a reminder that placebo groups improve too, often because women track symptoms more closely and make small changes along the way. If two cycles pass with no change beyond that, it's worth talking to a doctor about options with stronger evidence instead.

Ginkgo was generally well tolerated in the PMS trials, with side effects similar to placebo. Across the wider research on ginkgo's pharmacology, the most commonly reported effects are:

• Headache
• Mild stomach upset
• Dizziness
• Allergic skin reactions, rarely

The bigger concern is bleeding. Ginkgo's active compounds, including ginkgolides, inhibit platelet activating factor, which is part of how blood clots. That's a mild effect on its own, but it adds up if you're also taking aspirin, warfarin or another blood thinner.

Skip ginkgo, or check with a doctor first, if any of these apply:

• You take a blood thinner or aspirin, or have a bleeding disorder
• You have surgery or a dental procedure scheduled soon
• You're pregnant or breastfeeding; there's no safety data either way
• You're already on an SSRI or other medication your doctor hasn't cleared it with

Ginkgo supplements also aren't standardized the way a medication is. Extract strength varies by brand, so what worked in a trial using a measured dose of EGb 761 may not match what's on a shelf near you.

Ginkgo's evidence is too thin to rely on alone. For PMDD specifically, the approaches with stronger backing are SSRIs (which some women take only in the luteal phase), certain hormonal contraceptives, and CBT. Our PMDD treatment page walks through how doctors weigh those options.

For the moment itself, when you're mid-cycle and not sure what's hormones and what's a real problem, Niyora is a PMS and PMDD support app. Its Moon feature lets you write down what happened, see it from another angle, calm down, and draft a reply you can hold for 20 minutes before you send anything.

A PMDD specialist can help you build a plan around more than one supplement, especially if ginkgo alone isn't enough.