Chasteberry, Vitex agnus-castus

An Herb for the Gynecologist’s Toolbox

Chastetree, vitus-agnus-castus
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Chastetree (Vitex agnus-castus) has been used since ancient Greece and is thought to have many gynecologic uses due to some of the plants compounds similar to human sex hormones.  In medieval Europe, it was thought to reduce sexual libido and was used by clergymen, hence it’s other name of “monk’s pepper”.  The plant found it’s way to Germany and in the 1940-50’s; research took place supporting its use in menstrual disorders, without affecting sexual libido.

Irregular periods, premenstrual syndrome (PMS), and cyclic breast pain encompass a majority of the common gynecologic complaints in my daily practice.  Really, the only conventional pharmaceuticals available are hormones, in the form of birth control pills to regulate cycles or anti-depressants for the psychological symptoms.  For women who don’t need a contraceptive method, I find most want to avoid taking hormones.  Others with the emotional premenstrual symptoms fear the side effects of anti-depressants.

In an attempt to offer alternatives that are supported by current evidence and potentially with fewer side effects, I came across chastetree.  This plant sounded like a good alternative and I wanted to see if there was actual research to support its use for some of these common gynecologic issues.

At it’s mechanistic level it appears the main way chastetree works is by its effects on prolactin and progesterone.  By binding dopamine receptors in the brain it inhibits prolactin, which has been shown to reduce breast pain.  Additionally, it also seems to increase progesterone secretion, and that can help regulate the second half of the menstrual cycle (Du Mee 1993).

Compared to some of the side effects of the normal hormonal methods or anti-depressants that I often prescribe, the side effects described are mild.  These include gastrointestinal complaints, dizziness, headache, tiredness and dry mouth (Roemheld-Hamm 2005).

In other countries, herbal medicine seems to be much more accepted and many physicians in Germany prescribe chastetree formulations to their patients, so why can’t we?  Specifically, in the case of chastetree, the German Commission E, a group evaluating the use of herbs, has approved it for irregular cycles, PMS and breast pain (Blumenthal 2000).  Maybe it’s time that the United States researches and, if evidence suggests, embrace alternative methods for the health benefit of its citizens.  The bulk of research in the United States is conducted by pharmaceuticals and they have little to gain from herbal remedies (but that’s for another blog entry) so the little research that is out there comes from other countries or in some cases, from academic institutions.

So, what is out there in terms of research?  Very little randomized studies, but a couple that supports its use.

In one randomized study, after 3 months more than half of 170 women experienced a 50% or greater reduction in premenstrual symptoms (Schellenberg 2001). Another showed improvement in self-reported severity of PMS symptoms, with global improvement and overall benefit versus risk (p=0.001; NNT=4). In another trial, chastetree reduced symptoms of edema, constipation, irritability, depressed mood, anger, headache, and breast pain (Roemheld-Hamm 205).  Cyclic breast pain was the focus in another study that demonstrated a decrease compared to placebo after 3 menstrual cycles (Wuttke et al 1997).

Other vitamins may be as effective in helping with menstrual symptoms.  For instance, another study found that Vitamin B6 and Chasteberry both decreased symptoms by nearly 50%, but the sample size was small (Lauritzen et al 1997).

Another issue is that the studies use varying doses and formulations. Fruit extract dose is 20-40mg daily but I also came across doses of 240-500mg daily and higher doses (up to 1800mg daily) being used.  Extracts (40 drops daily) and tincture (35-45 drops three times a day) are also available.  In the United States there is a marketed product called Femaprin (325mg), which also contains Vitamin B (100mg) by Nature’s Way, which would likely be safest to recommend to patients.

Based on these findings and the fact that physicians in other countries recommend chastetree, I feel comfortable now making the recommendation for irregular periods, premenstrual symptoms, and cyclic breast pain.

Finally, another tool in my gynecology toolbox that can potentially benefit my patients!

 

REFERENCES:

1. Blumenthal M (2000).  German Federal Institute for Drugs and Medical Devices.  Commission E.  Herbal Medicine:  Expanded Commission E monographs.  1st ed, Newton, Mass:  Integrative Medicine Communications.

2. Du Mee C (1993).  Vitex agnus castus.  Aust J Med Herbalism; 5:63-65.

3. Lauritzen C, Reuter HD, Repges R, Bohnert KJ, Schmidt U.  Treatment of premenstrual tension syndrome with Vitex agnus castus.  Controlled double-blind study versus pyridoxine.  Phytomedicine 1997;4:183-9.

4. Roemheld-Hamm B (2005).  Chasteberry.  Am Fam Physician; 72,5:821-824.

5. Schellenberg R (2001).  Treatment for the premenstrual syndrome with agnus castus fruit extract: Prospective, randomized, placebo controlled study.  BMJ 322:134-7.

6. Wuttke W, Splitt G, Gorkow C, et al.  Treatment of cyclical mastalgia; Results of a randomized, placebo-conrolled, double-blind study [in German] Geburtshilfe Frauenheilkd 1997;57:569-74.

 

DISCLAIMER:  **Speak to your own gynecologist before starting any medication, as this product hasn’t been FDA approved.  Your personal physician should evaluate potential causes of your symptoms before recommending management.**

 

 

 

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