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- PMS and Progesterone
- Herbal Remedies for PMS
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Manage PMS With Chaste Berry
Chasteberry is the most commonly recommended herb in the treatment of premenstrual syndrome. And there is good reason for that: it has been conclusively proven to help women with PMS and even approved as a drug for the condition in Germany. So how does chasteberry help PMS? What are the PMS symptoms improved by this herb? Is it safe? Can it be combined with other herbs used in the management of PMS? Read on to find out.
Chasteberry is the herbal remedy prepared from the berries of Chaste Tree (Vitex agnus-castus) which is also known as Vitex.
Chasteberry is used as a tonic herb for treating diseases of the reproductive system by the ancients and in modern traditional medicine. The leaves can also be used for the same purpose but they are less potent.
Specifically, the Romans and Greeks used this herb as an anaphrodisiac (hence its name: “chaste” berry). However, there are reports that it can also function as an aphrodisiac.
In modern medicine, chasteberry has been confirmed to be useful in the management of premenstrual syndrome (PMS) and mastalgia (breast pain). It is even approved as a drug in Germany for these purposes.
Besides PMS and cyclic mastalgia, chasteberry is also effective in the treatment of related conditions such as luteal phase defect and hyperprolactinemia. The herb may also help with excessive bleeding resulting from uterine fibroids and some of the symptoms of polycystic ovarian syndrome (PCOS).
The effectiveness of chasteberry in the treatment of PMS symptoms is believed to be derived from the actions of these phytochemicals on steroidal hormones, pituitary gland and opiate receptors in the central nervous system.
Even though a number of studies have confirmed that chasteberry can help with PMS, it is still not fully understood how the herb works. However, recent studies are shedding more light on the different aspects of the pharmacological actions of chasteberry extracts and its bioactive constituents.
Discussed below are the 3 major mechanisms by which chasteberry is believed to help women with PMS.
Chasteberry can affect the levels of ovarian hormones. The actual result of the effect of this herb on the 2 major ovarian hormones (progesterone and estrogen) depends on the dose in which it is given.
In doses in which it is found in herbal supplements, chasteberry extract lowers estrogen levels while raising progesterone level.
Studies have demonstrated that women with PMS usually have high levels of estrogen and lower-than-expected levels of progesterone. This imbalance in the estrogen-progesterone ratio results in a condition known as estrogen dominance.
By keeping progesterone level up especially during the luteal phase of the menstrual cycle, chasteberry can significantly reduce most of the symptoms of PMS.
The current school of thought about the development of PMS regard the syndrome to be the result of interactions between sex hormones (especially estrogen) and neurotransmitters in the central nervous system.
Therefore, lowering estrogen level and raising progesterone level can only improve PMS symptoms especially the ones involving emotional changes.
While researchers once believed that chasteberry raised progesterone levels and lowered estrogen levels by stimulating the release of luteinizing hormone (LH) and blocking the release of follicle stimulating hormone (FSH), recent evidences suggest that the herb works by a different, unknown mechanism.
A number of studies showed that high doses of chasteberry did not affect the levels of LH and FSH. But it does lower the level of prolactin.
Prolactin is a hormone released from the anterior pituitary gland. It is directly involved in the development and enlargement of breasts during pregnancy as well as in the initiation and maintenance of breast milk flow after childbirth.
Unfortunately, a high prolactin level during the luteal phase of the menstrual cycle also stimulates these changes in the breast.
Therefore, high prolactin level (hyperprolactinemia) is responsible for the breast tenderness and breast pain associated with PMS.
In low doses, chasteberry extract actually increases prolactin levels. However, in high doses chasteberry extract inhibits the release of prolactin.
Therefore, herbal preparations of chasteberry extract can help lower prolactin level.
One of the outcomes of lowering prolactin level is the increase in progesterone level. Therefore, the inhibition of prolactin release caused by chasteberry extract also raises progesterone level.
To lower prolactin level, certain phytochemicals in chasteberry extract bind to dopamine 2 receptors in the central nervous system.
The dopaminergic activities of chasteberry is intertwined with its effects on the pituitary gland and ovarian hormones.
The dopaminergic effect of chasteberry has been confirmed in both in vitro and in vivo studies.
The results of these studies indicate that the action of chasteberry in the dopamine system is responsible for the reduction in prolactin levels. To do this, chasteberry inhibits TRH (thyrotropin-releasing hormone) and prevents it from stimulating the release of prolactin.
The diterpenes in chasteberry are examples of dopaminergic compounds that suppress prolactin release.
However, the dopaminergic effect of chasteberry extends beyond simply reducing prolactin level. Dopamine, itself, is an important neurotransmitter in the regulation of mood. Therefore, chasteberry can also improve mood-related PMS symptoms.
A prospective but well-designed study investigating the use of chasteberry fruit extract in the treatment of PMS was published in the British Medical Journal in 2001.
For the randomized, placebo controlled study, the researchers recruited 178 women with PMS. A chasteberry fruit extract (Ze 440) was given to 86 of these women while the other 84 women were placed on placebo.
The study covered 3 menstrual cycles and the choice of treatment was randomized and double blind.
The results of the study showed that the chasteberry fruit extract was superior to placebo at reducing the following PMS symptoms: mood changes, irritability, anger, headache, bloating and breast engorgement.
In addition, the side effects reported for the herbal treatment were mild and comparable to those reported for placebo.
Therefore, the researchers concluded that the dry extract of chasteberry fruit was safe and effective in the treatment of PMS symptoms.
A 2012 study published in the journal, Acta Medica Iranica, also made the same investigation about the therapeutic efficacy of chasteberry extract for women with PMS.
In this randomized, placebo controlled, double-blind study, the researchers placed 62 women with PMS on chasteberry extract (40 drops per day for 6 days just before the start of menses) and 66 women on placebo.
The study period encompassed 6 menstrual cycles and the women were asked to rate their PMS symptoms before and after the treatment period.
The results of the study showed that the women receiving chasteberry extract experienced significant improvements in PMS symptoms (the same ones described for the first study) compared to the placebo group.
The researchers, therefore, concluded that chasteberry extract was an effective and well tolerated remedy for mild and moderate PMS.
As interest in chasteberry as a possible treatment for PMS grew, a number of herbal formulations came to market. Some of these were put through clinical trials to determine their efficacy. The 2 studies described below are examples of such chasteberry clinical trials.
The results of a multicenter clinical trial of the efficacy of the chasteberry extract, Ze 440, was published in the Archives of Gynecology and Obstetrics in 2000.
The researchers recruited 50 women with PMS and gave each of them 20 mg or 1 tablet of Ze 440 per day for 3 menstrual cycles.
The results showed that PMS symptoms were reduced at the end of the study.
In addition, these symptoms re-appeared when chasteberry treatment was stopped but, even then, they were less severe for another 3 menstrual cycles because chasteberry still provided some protection for that duration after it was stopped.
Out of the 43 participants who completed the trial, 38 of them rated the efficacy of Ze 440 highly (moderate to excellent). Furthermore, the 13 participants who were also taking oral contraceptives during the trial did not perform any different from those who were not on birth control pills.
In conclusion, the researchers found the chasteberry extract effective for treating PMS. They noted that the herbal product reduced symptoms rather than reduce the duration of PMS.
Another open clinic trial of chasteberry extract was done in Germany in the same year and published in the Journal of Women’s Health and Gender-Based Medicine.
For this study, 1,634 women with PMS were recruited and given the chasteberry extract for 3 menstrual cycles.
The study results showed that
The researchers, therefore, concluded that the chasteberry extract under consideration was just as effective and safe as other chasteberry products already studied.
A 2005 study published in Drug Safety: An International Journal of Medical Toxicology and Drug Experience reviewed past studies to determine the safety of chasteberry extract.
The reviewer gathered data from science journal databases; national and international drug regulatory bodies; and data from clinical trials undertaken by manufacturers of chasteberry extract products.
In their findings, the researchers concluded that data from clinical trials, surveys, postmarketing surveillance, other adverse drug reaction reporting schemes and manufacturers showed that the side effects of chasteberry are mild and reversible.
Identified side effects include headache, gastrointestinal discomfort, menstrual disorders, acne and skin rashes. No drug interactions were found.
In their opinion, the reviewers found chasteberry to be a safe herbal medicine.
Rather than using only chasteberry in the treatment of PMS, there are some benefits to combining the herb with other herbs proven to help with PMS. But do such combinations work?
A 2009 study published in the Journal of Alternative and Complementary Medicine investigated the benefits of combining chasteberry with St. John’s wort in the treatment of PMS symptoms.
For the study, the researchers recruited 14 menopausal women suffering from PMS-like symptoms.
Some experts have argued that some of the symptoms associated with menopause are so similar to PMS symptoms that they are likely caused by the same factors. Therefore, the researchers measured the effect of the herbal combination on PMS and menopausal symptoms such as depression, anxiety, craving and bloating.
While some of the participants received the herbal combination (as tablets given twice daily), the others got placebo. The study took 16 weeks and symptoms were accessed every 4 weeks.
The results of the study showed that the combination of chasteberry and St. John’s wort was superior to placebo for all the PMS symptoms tested but especially for anxiety and bloating.
The researchers concluded that the combination of herbs (and other natural supplements) may provide better results for women with PMS than single herbal therapies. They called for more studies into such combinations.
The importance of combined therapy with natural supplements for women with PMS was further highlighted by this 1997 study published in the journal, Phytomedicine.
In this randomized, controlled trial, the researchers recruited 175 women with PMS. While some of these participants were given chasteberry extract, the rest received vitamin B6. The treatment period covered 3 menstrual cycles.
The results of the study showed that 36.1% of the women placed on chasteberry were free of PMS symptoms at the end of 3 menstrual cycles. For the vitamin B6 group, 21.3% were symptom-free.
While these results can be interpreted to mean that chasteberry is superior to vitamin B6 for reducing PMS symptoms, the real conclusion is that both chasteberry and vitamin B6 can be combined to formulate a medicinal product that is more effective than either chasteberry or vitamin B6 alone.
The recommended dose of chasteberry extract depends on the potency of the particular product.
Usually, 20 mg of chasteberry fruit extract is recommended to be taken 1 – 3 times daily. Other recommended dosages are 40 drops every morning for the liquid extract of the herb and 35 – 45 drops three times daily for the tincture.
In one study, the effective dose of the standardized chasteberry extract (standardized to 6% of the ingredient known as agnuside) used was 4 mg per day.
Although there are no extensive safety studies for chasteberry, centuries of use in traditional medicine and widespread use in Germany have produced no reports of serious adverse effects.
Common side effects are mild and include dry mouth, gastrointestinal complaints, headache, dizziness and tiredness.
The most important contraindications for chasteberry are for pregnant and nursing mothers. Because the herb can reduce the production of prolactin, it can also inhibit breast development during pregnancy and breast milk flow after delivery.
Safety for children or people with liver problems has not been established. Therefore, this herb may not be given to young children and those with liver problems.
There are also no reports of significant drug interactions with this herb. However, considering the effect of the herb on the endocrine system, it is likely to interact with drugs that act on the pituitary gland.
In addition, because chasteberry acts on the dopaminergic system in the central nervous system, it may interact with drugs that also act there. Such drugs include medications used to treat Parkinson’s disease.
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