Abstract: Hawthorn (Crataegus pinnatifida) is a plant of the Rosaceae family and is widely distributed in China as one of the medicinal and edible plants. The fruits, leaves, seeds and roots of hawthorn could be used as medicine, extracts for medicinal and edible use due to its various medicinal and edible value. Because hawthorn is rich in flavonoids, polyphenols, organic acids, polysaccharides and other nutritional active ingredients, it has a variety of beneficial biological activities, such as lipid-lowering, antioxidant, anti-inflammatory, antitumor and intestinal flora regulation activities. Therefore, hawthorn has been widely used in the fields of medicine, functional foods and chemical industries. Microbial fermentation has the unique advantages of improving the sensory flavor of raw materials, enriching nutrients, and enhancing functional properties. It plays an important role in the processing and utilization of dual-purpose medicinal-edible materials like hawthorn. In recent years, with the continuous development of hawthorn deep processing technology, the application of microbial fermentation technology in hawthorn products has also been continuously deepened. This paper first briefly summarizes the types of hawthorn fermentation products, then introduces the fermentation strains and process characteristics of hawthorn fermented products, and finally concludes their active components and functional activities. The purpose of this review is to provide a reference for the utilization and deep processing of hawthorn fermented products and promote the development of the hawthorn industry.