Piper betle L., belonging to Piperaceae family, known as a traditional herbal medicinal plant and used for several health benefits in Asian countries. Currently, demand for its products such as herbal drugs, medicines, and natural herbal formulations has increased. The beneficial effects of betel leaves and its products have traditionally exploited for the treatment of several diseases like bad breath, cuts, injuries, inflammations, cold cough, indigestion, etc. Till now, a broad range of bioactive compounds including polyphenols, terpenes, etc., has been identified from the extracts and essential oil (EO) of betel leaves. The structural and functional characterization of the extract and EO bio-actives has been derived by various advanced standard methods. Most of the health-related benefits of betel leaves have been associated with their bioactive phenolic compounds. The extract of this highly perishable product can be used in organic synthesis, food, and beverage industry, pharmaceuticals, etc., to the environmental issues. The present review provides information on extraction techniques, identification of bioactive compounds, and their biological activities. That apart, information on processing, preservation, and health benefits along with their mechanisms has also been added.