Chasteberry (Vitex agnus-castus) as a tool for helping with PMS / premenstrual syndrome

This systematic review and meta-analysis of 25 studies found Vitex agnus-castus effective in relieving cyclic mastalgia breast-pain intensity and lowering elevated serum prolactin (via dopaminergic activity), with a moderate effect size favouring it over placebo and non-inferiority to pharmaceutical comparators.

This meta-analysis of three CONSORT-compliant double-blind RCTs (520 women) found women taking well-characterised Vitex agnus-castus preparations were 2.57 times more likely to experience remission of premenstrual syndrome symptoms than those on placebo.

This systematic review and meta-analysis of 14 RCTs found a large pooled effect of Vitex agnus castus on total premenstrual syndrome symptoms versus placebo, while cautioning that high risk of bias and heterogeneity mean the effect is likely overestimated.

This systematic review of eight randomised controlled trials found all positive for Vitex agnus castus extract in treating premenstrual syndrome and premenstrual dysphoric disorder, concluding it is a safe and efficacious alternative.

Vitex agnus-castus L. (chaste tree; chasteberry) is a popular herbal treatment, predominantly used for a range of female reproductive conditions in Anglo-American and European practice. The objective of this systematic review was to evaluate the evidence for the efficacy and safety of Vitex extracts from randomised, controlled trials investigating women's health.Eight databases were searched using Latin and common names for Vitex and phytotherapeutic preparations of the herb as a sole agent, together with filters for randomised, controlled trials or clinical trials. Methodological quality was assessed according to the Cochrane risk of bias and Jadad scales, as well as the proposed elaboration of CONSORT for reporting trials on herbal interventions.Thirteen randomised, controlled trials were identified and twelve are included in this review, of which eight investigated premenstrual syndrome, two premenstrual dysphoric disorder, and two latent hyperprolactinaemia. For premenstrual syndrome, seven of eight trials found Vitex extracts to be superior to placebo (5 of 6 studies), pyridoxine (1), and magnesium oxide (1). In premenstrual dysphoric disorder, one study reported Vitex to be equivalent to fluoxetine, while in the other, fluoxetine outperformed Vitex. In latent hyperprolactinaemia, one trial reported it to be superior to placebo for reducing TRH-stimulated prolactin secretion, normalising a shortened luteal phase, increasing mid-luteal progesterone and 17β-oestradiol levels, while the other found Vitex comparable to bromocriptine for reducing serum prolactin levels and ameliorating cyclic mastalgia. Adverse events with Vitex were mild and generally infrequent. The methodological quality of the included studies varied, but was generally moderate-to-high. Limitations include small sample sizes in some studies, heterogeneity of conditions being treated, and a range of reference treatments.Despite some methodological limitations, the results from randomised, controlled trials to date suggest benefits for Vitex extracts in the treatment of premenstrual syndrome, premenstrual dysphoric disorder and latent hyperprolactinaemia. Further research is recommended, and greater transparency in reporting for future trials.

This review describes how dopaminergic compounds in Vitex agnus-castus (notably diterpene clerodadienols) bind D2 receptors and suppress prolactin release, explaining the herb's clinically demonstrated benefit on premenstrual mastodynia and other premenstrual-syndrome symptoms.

Background Vitex agnus castus (VAC), also known as chaste tree, is a plant from the Mediterranean area, Crimea, and central Asia. Its fruit has been used for more than 2500 years as phytotherapic agent. In the last century, VAC has been mostly used for the treatment of premenstrual syndrome (PMS), menstrual irregularities, fertility disorders, and symptoms of menopause. Since some degree of hyperprolactinaemia may be observed in patients with such disorders, VAC effects on hyperprolactinaemia have been assessed in a small number of studies and in some patient series or single case reports. It has been postulated that the diterpenes contained in VAC extract may interact with dopamine D2 receptors (D2R) and inhibit prolactin release via dopamine D2R activation in the anterior pituitary. Most of the published papers focus on the use of VAC for the management of PMS or infertility. However, due to its action on D2R, VAC could have a role in the treatment of mild hyperprolactinaemia, including patients with idiopathic hyperprolactinaemia, microprolactinoma, drug-induced hyperprolactinaemia, or polycystic ovary syndrome. Methods We have reviewed and analysed the data from the literature concerning the use of VAC extracts in patients with hyperprolactinaemia. Results Some evidence suggests a possible role of VAC for the management of hyperprolactinaemia in selected patients, though in an inhomogeneous way. However, there are not any large randomized controlled trials supporting the same and the precise pharmacological aspects of VAC extract in such a clinical setting still remain obscure. Conclusion It appears that VAC may represent a potentially useful and safe phytotherapic option for the management of selected patients with mild hyperprolactinaemia who wish to be treated with phytotherapy. However, larger studies of high quality are needed to corroborate it.

In a real-world cohort of 1700 women with menstrual cycle disorders, three-month treatment with Vitex agnus-castus products substantially reduced irregular cycles, breast tenderness and menstrual pain and improved quality of life, with a favourable safety profile.