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Studies Show This Is An Effective Natural PMS Treatment

St. John’s wort is traditionally used to treat depression. Its antidepressant effect is not only recognized in modern medicine but also proven to be superior to that of Prozac as well as safer than prescription antidepressants. Because depression is a major component of premenstrual syndrome, St. John’s wort is one of the major herbs commonly prescribed for the condition. But this herb can do more than simply lift your mood. Read on to find out the active phytochemicals responsible for the efficacy of St. John’s wort, why it is effective and if it can be combined with chasteberry in the treatment of PMS.
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Medicinal Benefits of St. John’s Wort

St. John’s wort or Hypericum perforatum is also known as goatweed and rosin rose. This herb is native to Europe, Middle East and Asia.

The most common indication for St. John’s wort is in the treatment of depression. It is even approved for treating depression in Germany. This herb is usually given to children and adolescents suffering from mild depression because it is gentler and has fewer side effects than standard antidepressants.

St. John’s wort is also used to treat moderate to severe depression and even major depressive disorder.

A Cochrane review found St. John’s wort to be more effective than placebo for treating major depression. In addition, the review found the herb to be just as efficacious as standard antidepressants but with only 20 – 50% of their side effects.

A 2005 study published in the Journal of Clinical Psychopharmacology found St. John’s wort to be significantly more effective than the commonly prescribed antidepressant, Prozac.

Because of the significant effect of St. John’s wort on mood, the herb is also used in the treatment of conditions involving depression. Therefore, it is effective in the treatment of SAD (seasonal affective disorder), menopausal mood swings and PMS (premenstrual syndrome) symptoms.

Besides its therapeutic effect on the central nervous system, St. John’s wort also possesses other medicinal properties including serving as an antioxidant, anti-inflammatory, antibacterial and antiviral herb.

These other medicinal properties are especially useful when the herb is used in topical applications. Therefore, St. John’s wort is also applied on the skin to treat eczema, burns, wounds and even hemorrhoids.

Phytochemicals in St. John’s Wort
  • Hypericin and related compounds such as pseudohypericin and protohypericin
  • Hyperforin and related compounds such as adhyperforin
  • Flavonoids such as rutin, quercetin and epigallocatechin
  • Essential oils
  • Tannins

Dosage and Safety

St. John’s wort is available in oral dosage forms including capsules, tablets and liquid extract. In most studies, the 300 mg tablet of the herbal extract is used for treating depression and mood disorders.

This formulation is usually standardized to contain 3 – 6% of hyperforin and 0.12 – 0.3% of hypericin.

The usual recommendation is to take 1 tablet 1 – 3 times daily. Alternatively, a once-daily extended release formulation of St. John’s wort is also available in capsule form.

Studies indicate that it can take 3 – 4 weeks to see any benefits from St. John’s wort. Therefore, you may need to take it for a full month before making a decision about the efficacy of the herb. If you do decide to discontinue St. John’s wort, do not stop suddenly. Rather taper the dose by gradually lowering the amount you take every day.

Getting off St. John’s wort suddenly can worsen depression and cause other rebound symptoms.

Even though its medicinal activities are comparable to those of prescription antidepressants, St. John’s wort is generally well tolerated and causes only a few, mild side effects.

Common side effects of St. John’s wort include dizziness, confusion, sedation, hives, dry mouth, fatigue, restlessness, headache and gastrointestinal complaints.

One rare but often mentioned side effect of St. John’s wort is photosensitivity. This can present as visual sensitivity to light and increased sensitivity of the skin to sunlight.

Therefore, you may need to avoid direct sunlight and special UV lamps while taking this herbal preparation.

Because St. John’s wort increases the level and activity of serotonin in the brain, it can trigger a potentially life-threatening drug reaction when combined with drugs and other herbs that also affect serotonin in the same way.

To avoid this drug reaction, do not combined the herb with other antidepressants as well as stimulants, opioid analgesics, psychedelic drugs, lithium and precursors of serotonin such as the amino acid, tryptophan, and its metabolite, 5-HTP.

St. John’s Wort and PMS

Effect on Neurotransmitters

The primary reason why St. John’s wort is used in the management of PMS is to fight the depression associated with the condition. However, because the herb affects the activities of certain neurotransmitters in the brain, it can also provide other benefits for women with PMS.

It is clear that St. John’s wort has an antidepressant activity and compares favorably against prescription antidepressants such as Zoloft and Prozac.

However, scientists are not exactly certain how the herb improves mood. Based on the nature of its antidepressant effect and also observed drug interactions, it is almost certain that St. John’s herb works in similar ways to a class of antidepressants known as SSRIs (selective serotonin reuptake inhibitors).

This means that the active phytochemicals in St. John’s wort block the reuptake of serotonin from the gap between neurons. This singular action ensures the continual action of serotonin.

Serotonin is one of the major neurotransmitters involved in the regulation of mood. For this reason, it is sometimes described as a “feel-good” neurotransmitter.

Studies show that a number of bioactive constituents of St. John’s wort are responsible for this antidepressant action. Besides hyperforin and hypericin, researchers have demonstrated that the flavonoids and tannins in the herb can also help boost mood.

In addition, studies show that serotonin is not the only neurotransmitter influenced by St. John’s wort.

The herb also inhibits the uptake (or clearance) of dopamine and noradrenaline from nerve junctions. Both dopamine and noradrenaline are also important to mood and cognitive performance.

By enhancing their activities in the brain, St. John’s wort improves mental clarity and mood. Therefore, the herb can be especially effective in the treatment of PMS-related mood changes, depression, irritability, insomnia and impaired cognitive functioning.

The influence of this herb on neurotransmitters also goes a little further. Studies show that the hyperforin in St. John’s wort has affinity for the transporters of glutamate and GABA (gamma aminobutyric acid).

It is unclear what additional effects hyperforin may have by binding to these transporters but knowing that glutamate is an excitatory neurotransmitter while GABA is an inhibitory neurotransmitter, it is safe to conclude that St. John’s wort does more than simply lift the mood; it most likely stabilizes mood by promoting a balance between these two types of neurotransmitters.

Effect on Estrogen

The effect of St. John’s wort on estrogen is little known and not commonly considered in the discussion of PMS therapy.

Even then it can be quite significant. In fact, it is significant enough to inform the warning that women taking contraceptive pills should refrain from also taking St. John’s wort.

The herb increases the activity of the liver enzymes making up the cytochrome P450 system. Therefore, it speeds up the breakdown of estrogen and especially estradiol, the bioactive form of estrogen.

While this herb-drug interaction can reduce the contraceptive efficacy of birth control pills, it can also reduce the level of estrogen naturally produced in the body. Therefore, St. John’s wort can help reverse estrogen dominance, a condition that affects women with PMS.

The onset and severity of PMS have been linked to high estrogen levels (compared to progesterone levels) during the luteal phase of the menstrual cycle.

In addition, estrogen interacts with the neurotransmitters in the brain to trigger emotion-type PMS symptoms.

Therefore, lowering estrogen levels is a desirable outcome of St. John’s wort actions in the treatment of PMS.

Studies on St. John’s Wort and PMS

St. John’s Wort as an Antidepressant

A number of well-designed studies and meta-analyses have been done to investigate the efficacy and safety of St. John’s wort as an antidepressant. The vast majority of such studies came to the conclusion that the herb was both safe and effective in the treatment of mild and moderate depression.

This 2005 study published in the Journal of Clinical Psychopharmacology compared the efficacy of St. John’s wort to those of placebo and fluoxetine (Prozac) in the treatment of major depressive disorder.

For this study, the researchers recruited 135 patients with major depressive disorder. Then they allowed a single-blind, 1 week washout period to allow the past drugs the patients were taking to be removed from their bloodstreams.

Thereafter, the participants were randomly given placebo, 20 mg/day of fluoxetine or 900 mg/day of St. John’s wort extract.

The results of the study showed that St. John’s wort was not only superior to placebo but also fluoxetine as an antidepressant. In addition, the researchers found the herb to be safe and well tolerated.

Is St. John’s Wort Effective in PMS Therapy?

One of the best studies to investigate the usefulness of St. John’s wort in the treatment of PMS is this 2010 study published in the journal, CNS Drugs.

The randomized, double-blind, placebo-controlled study involved 36 women with mild PMS.

First the women were placed on placebos for 2 menstrual cycles and then while some continued on placebo for another 2 months, the rest were switched to 900 mg/day of a St. John’s wort extract (standardized to 0.18% hypericin and 3.38% hyperforin).

Then the researchers allowed another washout period of 1 menstrual cycle before switching the placebo group to St. John’s wort extract and vice versa.

The study showed that St. John’s wort performed better than placebo. The researchers concluded that daily treatment with the herb was more effective than placebo for most of the common behavioral and physical symptoms of PMS.

They suggested that a longer treatment duration was required to determine whether St. John’s wort was effective for pain and mood-related PMS therapy.

This study is significant not only because it found St. John’s wort effective for women with PMS but also because it identified that the best results are obtained from taking the herb for longer. It seems then that the medicinal benefits of St. John’s wort is cumulative because it takes time for the bioactive phytochemicals to build up in the body to therapeutic levels.

St. John’s Wort + Chasteberry for PMS

St. John’s wort is far from being the only herb proven to help with PMS symptoms. Another equally proven and safe herb for PMS is chasteberry or Vitex.

If both herbs are quite effective for this condition, is there a benefit to combining them? This study published in 2009 in the Journal of Alternative and Complementary Medicine indicated that such an herbal combination was quite effective.

Although the subjects of the study were perimenopausal women (14), the researchers measured improvements in PMS-like symptoms. Such symptoms have been previously suggested to have more in common with PMS than menopause.

In this double-blind, placebo-controlled, randomized study, the researchers gave each of the women either placebo or the combination of chasteberry and St. John’s wort twice daily.

At the end of 16 weeks, the results showed that the herbal combination was superior to placebo at improving all the PMS symptoms measured especially for anxiety and bloating. Furthermore, the researchers observed that the herbal combination performed better the longer it was taken.

This study supports the combination of St. John’s wort and chasteberry, the 2 herbs with the best supports from clinical trials, in the treatment of PMS.





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