NUNM students have many opportunities to explore topics, research and areas of practice that interest them. From broad elective choices to research study participation and self study, our students choose the doctor they want to become. Here, Vileka Fisher, naturopathic doctoral student, shares her research and perspectives on the how Vitex agnus-castus, or chaste tree berry, can curb PMS and PMDD symptoms.
Aunt Flo, the crimson tide, moon time—even if we have a creative or cutesy euphemism for menstruation, it doesn’t make menses any easier for those of us who still have one. Sometimes the days leading up to menses are just as bad or even worse than menses itself! Approximately 75-80% of women experience at least one symptom of premenstrual syndrome (PMS), which can be a constellation of behavioral changes, physical changes, and/or emotional changes a few days before menstruation begins. PMS symptoms may include fatigue, insomnia, anxiety, depression, irritability, mood swings, muscle tension/cramping, headache, mastalgia (breast pain), sensitivity to cold, acne, bloating, and abdominal pain. Symptoms that interfere with daily activities or cause distress may indicate that someone has Premenstrual Dysphoric Disorder (PMDD), which is a more severe form of PMS.
PMS/PMDD are usually treated with lifestyle interventions first. These lifestyle interventions can include increasing daily exercise, stress management, and decreasing alcohol and caffeine consumption. But if lifestyle changes do not alleviate symptoms, then anti-depressants and oral contraceptives are typically prescribed. However, those prescriptions do not work well for everyone, and many people wish to avoid the side effects associated with these medications.
Vitex agnus-castus, also known as chasteberry, chaste tree berry, or monk’s pepper, is a small deciduous tree native to the Mediterranean and Western Asia. The fruit (berry) of this tree has traditionally been used for addressing complaints related to female hormones and menstruation. Historically, monks sworn to celibacy would chew on the berries in hopes that it would decrease their libido. However, Vitex is no longer used for that purpose (don’t worry, it won’t interfere with your libido!).
The general action of Vitex is the balancing of female sex hormones estrogen and progesterone and their interaction with the pituitary gland, which is responsible for releasing follicular stimulating hormone (FSH) and luteinizing hormone (LH). Both FSH and LH play important roles in menstruation. More FSH is secreted during the follicular phase prior to ovulation (the midway point of a menstrual cycle), and more LH is secreted after ovulation during the luteal phase. PMS/PMDD symptoms manifest at the end of the luteal phase, right before menses begins. Vitex, through a variety of its own phytochemicals like flavonoids, diterpenes, and glycosides, is able to modulate these hormones in addition to neurotransmitters, activation of the body’s internal opioid system, and other pathways related to pain and inflammation.
Several studies support the use of Vitex to modulate hormones that can contribute to PMS/PMDD and other reproductive conditions like polycystic ovarian syndrome (PCOS), mild hyperprolactinemia (producing too much breast milk), mastalgia/mastodynia (breast pain) amenorrhea (absences of menses), and oligomenorrhea (infrequent menses). A systematic review done in 2017 analyzed the use of Vitex versus placebo or active treatment of PMS or PMDD in eight different studies. In three of the studies Vitex was compared to fluoxetine (an anti-depressant) and pyridoxine (vitamin B6). All five studies that compared Vitex to placebo found Vitex to be superior to placebo. In comparing Vitex to pyridoxine and fluoxetine, the authors found Vitex to be superior to pyridoxine in alleviating PMS symptoms but found that fluoxetine was more effective in alleviating psychological symptoms.
Another systematic review and meta-analysis completed in 2017 evaluated seventeen randomized controlled trials of Vitex versus fluoxetine, oral contraceptives, magnesium, or pyridoxine for the treatment of PMS or PMDD. Vitex did better than magnesium, pyridoxine, St. John’s Wort, Vitamin E, and significantly improved all PMS-related symptoms. Compared to fluoxetine and oral contraceptives, the efficacy of Vitex was no different, meaning it worked just as well. Additionally, the participants who received Vitex reported fewer adverse effects (some participants experienced headache and nausea) than those who received fluoxetine or oral contraceptives. However, the investigators of this review indicated the need for higher quality trials, because not all of the trials had the same duration (at least three menstrual cycles), used the same diagnostic criteria for PMDD, or were well designed in general. Despite their call for more randomized controlled trials, the investigators concluded that Vitex should be offered to people with PMS or PMDD who either do not want or cannot use prescription medications.
As wonderful as Vitex may sound for addressing the symptoms of PMS and PMDD, this herb is not meant for everyone. Because of its effects on female hormones, it cannot be taken during lactation, pregnancy, or if pregnancy is suspected. This herb also takes a few cycles before it is effective and is therefore not a “quick fix.” Theoretically, Vitex could make hormonal birth control or other forms of hormonal prescriptions, like hormonal replacement therapy, less effective. Vitex may also interact with pharmaceuticals that block the action of the neurotransmitter dopamine.
If you or someone you know struggles with PMS or PMDD, please consult a licensed practitioner familiar with the condition and treatment options. Naturopathic physicians are trained to treat a wide variety of conditions, including PMS and PMDD, and receive specialized medical education that includes standard therapies like pharmaceutical prescribing and traditional therapies like botanical medicine.
- Cerqueira R, Frey B, Leclerc E, and Brietzke E. Vitex agnus-castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Arch Womens Ment Health. 2017;20: 713-719.
- Jang S, Kim D, Choi M. Effects and treatment methods of acupuncture and herbal medicine for premenstrual syndrome/premenstrual dysphoric disorder: a systematic review. BMC Complementary and Alternative Medicine. 2014, 14:11.
- Godfrey A and Saunders P. Principles and Practices of Naturopathic Botanical Medicine—Volume 1: Botanical Medicine Monographs. Toronto, ON: CCNM Press Inc; 2010.
- Rafieian-Kopaei M and Movahedi M. Systematic review of premenstrual, postmenstrual and infertility disorders of Vitex Agnus Castus. Electronic Physician. 2017;9(1):3685-3689. doi: http://dx.doi.org/10.19082/3685.
- Mirghafourvand M, Mohammad-Alizadeh-Charandabi S, Ahmadpour P, and Javadzadeh Y. Effects of Vitex agnus and Flaxseed on cyclic mastalgia: A randomized controlled trial. Complement Ther Med. 2016;24:90-95.
- Verkaik S, Kamperman A, Van Westrhenen R, and Schulte P. The treatment of premenstrual syndrome with preparations of Vitex agnus castus: A systematic review and meta-analysis. Am J Obstet Gynecol. 2017;217(2):150-166.
- Tilgner, Sharol. Herbal Medicine from the Heart of the Earth. 2nd edition. Wise Acres LLC; Pleasant Hill, OR: 2009.
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