Abstract: Leonurus japonicus Houtt. is a traditional Chinese medicine widely used in the field of obstetrics and gynecology. Modern pharmacological studies have shown that Leonurus japonicus Houtt. contains a variety of active components, such as alkaloids, diterpenoids, flavonoids, and other compounds. These components possess pharmacological actions relevant to obstetrics and gynecology, including regulating uterine contraction and relaxation, combating endometritis, repairing the endometrium, alleviating endometriosis, controlling preeclampsia, and demonstrating anti-cervical cancer, anti-endometrial cancer, anti-primary ovarian insufficiency, and anti-polycystic ovary syndrome effects. In clinical practice, Leonurus japonicus Houtt. can be used either alone or in combination with other drugs to enhance therapeutic efficacy. This review aims to summarize the pharmacological actions and clinical applications of Leonurus japonicus Houtt. to support its modernization in traditional Chinese medicine and to better leverage its potential in the treatment of obstetric and gynecological diseases.