Japan's fifth premier in as many years also leads a minority government and has a bulging in-tray, not least a scheduled visit by US President Donald Trump next week.
The former heavy metal drummer and Margaret Thatcher admirer became head of the Liberal Democratic Party (LDP) on October 4, but its coalition collapsed days later.
This forced Takaichi to form an alliance with the reformist, right-leaning Japan Innovation Party (JIP), which was signed on Monday.
She was approved by parliament as prime minister on Tuesday and was due formally to take office later in the day when she meets the emperor.
EU chief Ursula von der Leyen congratulated Takaichi for "making history" as Japan's first woman premier.
Takaichi had promised a cabinet with "Nordic" levels of women, up from two under predecessor Shigeru Ishiba. The record for Japan is five.
But she named only two other women in her 19-strong cabinet, with Satsuki Katayama in charge of finances and the Japanese-American Kimi Onoda taking on the economic security portfolio.
Japan ranked 118 out of 148 in the World Economic Forum's 2025 Global Gender Gap Report. Around 15 percent of lower house MPs are women.
Takaichi has said she hopes to raise awareness about women's health struggles and has spoken candidly about her own experience with menopause.
But she is seen as socially conservative, opposing revising a 19th-century law requiring married couples to share the same surname, and wants the imperial family to stick to male-only succession.
"I'd be happy if we saw more policies from a woman's perspective: support for childcare, and help for women returning to work after having children," student Nina Terao, 18, told AFP in Nara.
Yu Uchiyama, political science professor at the University of Tokyo, described Takaichi's appointment as "epoch-making".
But "just because she has become the first woman prime minister doesn't mean we will move more toward the direction of DEI (diversity, equity and inclusion)," he told AFP.
Being in a minority in both houses of parliament, the new coalition will need support from other parties to push through legislation.
Takaichi's many challenges include Japan's declining population and the flatlining economy.
"Prices have gone up, and it's tough," said Nara pensioner Satoe Tominaga, saying she was "50-50" about Takaichi.
"Honestly, I mostly shop at 100-yen ($0.66) stores now," the 77-year-old told AFP.
- US, regional ties -
The new premier handed the foreign minister role to Toshimitsu Motegi, who was credited with handling trade ties with Trump's first administration.
The US president wants Tokyo to stop Russian energy imports and boost defence spending.
Details of Japan's mooted $550 billion in investments in the US, as part of its latest trade deal with Washington, remain unclear.
Takaichi previously said that "Japan is completely looked down on by China", and that Tokyo must "address the security threat" posed by Beijing.
But she has since toned down her rhetoric, and last week stayed away from the Yasukuni shrine that honours Japan's war dead, long a flashpoint in Tokyo's regional ties.
China's foreign ministry on Tuesday urged Tokyo to "honour its political commitments on major issues including history and Taiwan".
China and Japan are key trading partners, but friction over territorial rivalries and military spending has frayed ties in recent years.
Japan hosts around 54,000 US military personnel and the close ally of Washington is part of the Quad group, along with Australia and India, which is seen as a counter to Beijing.
Indian Prime Minister Narendra Modi also congratulated Takaichi, saying that "our deepening ties are vital for peace, stability, and prosperity across the Indo-Pacific and beyond".
Takaichi will also be under pressure to restore the fortunes of the LDP after a string of poor election results that cost Ishiba his job.
Smaller parties gaining support include the populist Sanseito, which calls immigration a "silent invasion".
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