Topical witch hazel is generally considered safe to use during pregnancy, and major medical organizations including the American College of Obstetricians and Gynecologists (ACOG) specifically recommend it for common pregnancy complaints like hemorrhoids. That said, there are a few important distinctions: topical use on your skin is very different from drinking it, and the formulation you choose matters.
What ACOG Says About Witch Hazel
ACOG directly recommends applying witch hazel pads to hemorrhoids during pregnancy to relieve pain and reduce swelling. This is one of the few over-the-counter remedies that appears in their official guidance for pregnant women, which gives it a stronger endorsement than most natural products receive. Cleveland Clinic echoes this recommendation, advising pregnant patients to apply witch hazel to hemorrhoids for itching and pain relief.
That said, formal safety studies on witch hazel during pregnancy are limited. The endorsement from ACOG is based on its long track record of topical use and the fact that very little of what you apply to your skin enters your bloodstream in meaningful amounts. If you have specific concerns, your OB can weigh in on your particular situation.
Topical Use vs. Oral Use
The safety picture changes dramatically depending on how you use witch hazel. Topical application (pads, wipes, creams, or liquid dabbed onto skin) is the only form recommended during pregnancy. Drinking witch hazel or taking it as an oral supplement is not recommended for anyone, and especially not during pregnancy.
Witch hazel contains compounds called tannins that can cause nausea, vomiting, and constipation in oral doses above 1 gram. In larger amounts, tannins may cause liver damage if they’re absorbed in significant quantities. Witch hazel water sold at drugstores is explicitly not intended for internal use.
Common Pregnancy Uses
Hemorrhoids are the most well-supported reason to reach for witch hazel during pregnancy. Up to half of pregnant women develop hemorrhoids, particularly in the third trimester, and witch hazel pads offer a simple way to manage the discomfort. You can use pre-soaked pads (like Tucks) or apply liquid witch hazel to a cotton pad and hold it against the area. Cleveland Clinic notes that witch hazel wipes can be used as needed, up to six times per day.
Some women also use witch hazel as a facial toner for pregnancy-related acne or oily skin, since hormonal shifts can trigger breakouts. Witch hazel acts as a mild astringent, temporarily tightening skin and reducing oiliness. It can also soothe minor skin irritation and inflammation. For postpartum recovery, many hospitals send new mothers home with witch hazel pads for perineal soreness.
Watch for Alcohol Content
Standard drugstore witch hazel (the liquid sold in bottles) is a distillate that typically contains 14 to 15 percent alcohol, with the remaining 85 to 86 percent being witch hazel water. This alcohol concentration is fine for topical use on intact skin, but it can sting on irritated or broken skin and may cause drying if you use it repeatedly on your face.
If you’re using witch hazel on sensitive areas like hemorrhoids or broken skin, look for alcohol-free formulations. Many witch hazel pads and wipes designed for hemorrhoid relief are already alcohol-free. Check the label: if you see “witch hazel distillate” as the main ingredient with alcohol listed, that’s the standard version. Products labeled “alcohol-free” use a witch hazel extract processed without the distillation step that introduces ethanol.
For facial use during pregnancy, alcohol-free versions are also gentler. Pregnancy skin tends to be more reactive, and the drying effect of alcohol-based formulas can trigger your skin to produce even more oil in response.
How to Use It Safely
For hemorrhoid relief, soak a cotton pad with witch hazel or use a pre-made witch hazel pad. Gently press it against the area and hold for a minute or two. You can do this up to six times a day as needed. Some women find it helpful to chill the pads in the refrigerator first, since the cold adds extra relief.
For facial use, apply witch hazel to a cotton pad and swipe it over clean skin once or twice daily. Follow with a moisturizer, especially if you’re using a formula that contains alcohol. If you notice increased redness, dryness, or irritation after a few days, scale back or switch to an alcohol-free version.
One caution worth noting: a PMC review on topical products during pregnancy flagged that some natural remedies marketed for swelling relief, including witch hazel, may carry risks depending on their formulation and what other ingredients are included. Stick with simple, single-ingredient witch hazel products rather than complex herbal blends, and avoid any product that combines witch hazel with ingredients you haven’t verified as pregnancy-safe.