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Chasteberry PMS Question

October 5, 2012 Written by JP    [Font too small?]

In the course of my consulting work, many questions and answers emerge that I think would be of interest to readers of this site. Recently, a client inquired about an herbal extract commonly known as chasteberry or Vitex. Historically, Vitex agnus castus has been used to address irregular periods and symptoms associated with premenstrual syndrome (PMS). In modern times, concentrated and purified extracts of chasteberry have been subjected to some degree of scientific scrutiny. For the most part, the results of these controlled trials have been positive. However, it’s important to note that not all Vitex supplements are created equal. In fact, only a few products have actually undergone clinical testing and proven effective.

A little known fact about herbal supplements is that they’re usually far more complex than conventional medications. Most synthetic drugs consist of an isolated chemical or two. On the other hand, herbal extracts frequently possess hundreds or more naturally occurring components. Contained in fruits, leaves and roots are various substances ranging from nutrients and phytochemicals to prebiotic fibers. This inescapable fact not only differentiates herbal supplements from conventional medications, but also requires that we consider each supplement based on its own merits.

The names Ze 440 and BNO 1095 may sound like gibberish. But, in the world of Vitex research, these two extracts are widely known as the best studied chasteberry products currently available. Recent studies have determined that products containing BNO 1095 and Ze 440 are capable of reducing PMS symptoms including bloating, cramping, headache and irritability. In fact, dosages as low as 20 mg/day have been shown to safely manage PMS. Unfortunately, products containing both of these unique extracts are not easily accessible in many parts of the world. BNO 1095 is sold under several names in Asian and European countries: Agnucaston, Cyclodynon and Cyclopret. Ze 440 is primarily offered as Premular in Australia and South Africa. And, while one may be able to order these specific chasteberry remedies online or through holistic practitioners, you’re unlikely to find them on the shelves of local health food stores. The question of whether or not other Vitex products will produce similar results is largely a matter of anecdotal accounts and speculation.

Finally, even though chasteberry/Vitex has a good track record in terms of efficacy and safety, it should still be viewed as a natural “medicine”. Whenever possible, PMS, like many other health conditions, should preferentially be addressed through health promoting lifestyle changes. For instance, eating a whole food diet rich in B-vitamins and magnesium may dramatically lower the risk and severity of PMS. Dietary sources of Vitamins B1 (thiamine) and B2 (riboflavin) such as almonds, flax seeds, spinach, tuna and venison, may be especially protective for younger women at risk for menstrual discomfort. In addition, select alternative and complementary therapies, including acupuncture, may decrease and, occasionally, eliminate symptoms and some of the underlying causes of painful monthly cycles.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Click on the following links to learn more about the studies referenced in today’s column:

Study 1 – Dose-Dependent Efficacy of the Vitex Agnus Castus Extract Ze 440 (link)

Study 2 – Treatment for the Premenstrual Syndrome with Agnus Castus(link)

Study 3 – Efficacy of Vitex Agnus Castus L. Extract Ze 440 in Patients with (link)

Study 4 – Evaluating Therapeutic Effect in Symptoms of Moderate-to-Severe (link)

Study 5 – Treatment for Premenstrual Syndrome with Vitex Agnus Castus(link)

Study 6 – Importance of Acupuncture on Premenstrual Syndrome (link)

Study 7 – Dietary B Vitamin Intake and Incident Premenstrual Syndrome (link)

Dietary and Supplemental Magnesium May Reduce PMS Symptoms

Source: Iran J Nurs Midwifery Res. 2010 Dec;15(Suppl 1):401-5. (link)

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Posted in Alternative Therapies, Nutrition, Women's Health

14 Comments & Updates to “Chasteberry PMS Question”

  1. liverock Says:

    Some men also say that Chasteberry helps them to stop hairloss. However, I personally think that men should beware of taking it.
    They didnt name it C-H-A-S-T-E berry unless they had a good reason!!

  2. JP Says:


    I’m with you on this one! I’ve yet to find any compelling evidence that shows that Vitex discourages hair loss or promotes hair growth.

    Be well!


  3. JP Says:

    Update 05/13/15:


    J Altern Complement Med. 2015 May 12.

    The Acute Effects of Yoga on Cognitive Measures for Women with Premenstrual Syndromes.

    OBJECTIVES: Recently, yoga classes specifically for women with premenstrual syndromes (PMS) have increased, but there is little research about the efficacy of these classes. The primary aims of this study were to evaluate the effect of yoga exercise on women with PMS and to evaluate the immediate change of attention performance after yoga classes.

    METHODS: This study examined the attention task results of women with PMS. Eleven women with PMS and 9 women without PMS were recruited. The PMS group took the tests before and immediately after the yoga class both in the luteal and follicular phase of one menstrual cycle, while the control group took the tests only twice: once in the luteal phase and once in the follicular phase. Both groups were required to finish resting electroencephalography (EEG) and cognitive task of the 2-back task with EEG recording.

    RESULTS: The alpha brain wave percentage was higher immediately after yoga exercise in the PMS group. This suggests that the participants felt more relaxed or were in a more peaceful mental condition after yoga exercise. In the 2-back task, the PMS group needed a longer reaction time to respond to the target stimulus in the luteal phase and performed better with higher accuracy and shorter reaction time after yoga exercise. The event-related potentials of the EEG recording displayed a significant variability at the P3 amplitude throughout the menstrual cycle in the PMS group, but the P3 amplitude was unchanged throughout the menstrual cycle in the control group.

    CONCLUSION: The results of this study suggest that women with PMS could attend short-term yoga exercise in the luteal phase to make themselves feel better and maintain a better attention level.

    Be well!


  4. JP Says:

    Update 05/13/15:


    Adv Ther. 2014 Mar;31(3):362-73.

    Efficacy and safety of Vitex agnus-castus extract for treatment of premenstrual syndrome in Japanese patients: a prospective, open-label study.

    INTRODUCTION: Herbal medicine containing Vitex agnus-castus (VAC) extract is widely used by women with premenstrual syndrome (PMS) in Europe, however, in Japan, clinical evidence remains to be determined. This study attempted to investigate the efficacy and safety profiles of VAC extract in Japanese patients with PMS.

    METHODS: A multi-center, prospective, open-label, single-arm, phase 3 study was performed in Japanese women with PMS and aged 18-44 years. The patients received Prefemin® (Max Zeller Söhne AG, Romanshorn, Switzerland), containing 20 mg of VAC extract, once daily for three menstrual cycles. The efficacy profile was examined based on the intensity of ten PMS symptoms-irritability, depressed mood, anger, headache, bloating, breast fullness, skin disorder, fatigue, drowsiness, and sleeplessness-recorded by patients via a visual analog scale (VAS). In addition, the responder rate was calculated based on the total VAS score defined by the sum of the VAS scores of the first six symptoms mentioned above. Furthermore, physician’s global assessment (PGA) scores were recorded. Adverse events including vital signs and laboratory test values were monitored as safety evaluation.

    RESULTS: Sixty-nine patients received Prefemin®. After the first menstrual cycle, a statistically significant decrease in total VAS score was observed (P<0.001), and the score continued to diminish for the following two cycles. Each of the ten symptom scores decreased significantly in this manner. In addition, the responder rate increased in a time-dependent manner; the rate at the third menstrual cycle was 91.0%, and almost all of the patients were without symptoms or exhibited only mild symptoms based on PGA. Eight patients exhibited non-serious adverse events, one of which was allergic dermatitis whose causal relationship with VAC was not ruled out.

    CONCLUSION: VAC extract improved PMS symptoms in Japanese patients, with no substantial adverse events. This is the first study to report the effect of VAC extract in Japanese patients.

    Be well!


  5. JP Says:

    Update 05/13/15:


    Acta Neurol Belg. 2013 Mar;113(1):25-9.

    Use of Vitex agnus-castus in migrainous women with premenstrual syndrome: an open-label clinical observation.

    Premenstrual syndrome (PMS) affects most women during their reproductive life. Headache is regarded as a typical symptom of PMS and, close to menses, migrainous women could experience their worst migraine attacks. Vitex agnus-castus (VAC) is a phytopharmaceutical compound, considered worldwide to be a valid tool to treat PMS. Aim of this study is to explore if headache is ameliorate in migrainous women treated with VAC for PMS by an open-label clinical observation. Migrainous women with PMS were enrolled in the study and advised to assume a treatment with VAC (40 mg/day) for PMS for a 3-month period. Effects both on PMS and headache were assessed. Out of 107 women, 100 completed the 3-month treatment for PMS. Out of them, 66 women reported a dramatic reduction of PMS symptoms, 26 a mild reduction, and 8 no effect. Concerning migraine, 42 % of patients experienced a reduction higher than 50 % in frequency of monthly attacks, and 57 % of patients experienced a reduction higher than 50 % in monthly days with headache. No patients reported remarkable side effects. Pending a placebo-controlled trial to confirm our results, we observed that the use of VAC in migrainous women affected by PMS resulted to be safe and well tolerated, and may positively influence the frequency and duration of migraine attacks.

    Be well!


  6. JP Says:

    Updated 07/16/15:


    Chem Pharm Bull (Tokyo). 2014;62(4):379-85.

    Quality evaluation of medicinal products and health foods containing chaste berry (Vitex agnus-castus) in Japanese, European and American markets.

    The aim of present study was to evaluate the qualities of chaste berry (fruit of Vitex agnus-castus L.) preparations using HPLC fingerprint analysis. Seven medicinal products 1 from Japan and 6 from Europe, and 17 health foods, 6 from Japan and 11 from the United States were analyzed. HPLC profile and 26 authentic peaks were compared medicinal products and health foods. Whereas medicinal products had similar HPLC profiles, health foods had various profiles and each peak was also greatly different. The measured amounts of two markers in 5 traditional medicinal products, agnuside and casticin specified in the European Pharmacopoeia (EP), the U.S. Pharmacopoeia (USP) or the WHO monographs of chaste berry, were much lower than those in 2 medicinal products defined as “well-established use” by the European Medicines Agency. The amounts of two markers for 17 health foods differed in a great deal from 14-5054% and 3-1272%, respectively. Furthermore the amount ratios of two markers, agnuside/casticin, in about half of the health foods were remarkably larger than the standard crude drug and the ratios were closer to one of the related Chinese herbs, Vitex negundo L. It is concluded that a combination of HPLC fingerprints and the amount ratios of the marker compounds of chaste berry preparations serves as a useful tool to evaluate the qualities of these preparations.

    Be well!


  7. JP Says:

    Updated 07/16/15:


    J Res Med Sci. 2014 Jan;19(1):1-7.

    Effects of “vitex agnus castus” extract and magnesium supplementation, alone and in combination, on osteogenic and angiogenic factors and fracture healing in women with long bone fracture.

    BACKGROUND: The purpose of this study was to investigate the effects of the combination of vitex agnus castus extract, as a source of phytoestrogens, plus magnesium supplementation on osteogenic and angiogenic factors and callus formation in women with long bone fracture.

    MATERIAL AND METHODS: In a double-blind randomized placebo controlled trial, 64 women with long bone fracture, 20-45 years old, were randomly allocated to receive 1) one Agnugol tablet (4 mg dried fruit extract of vitex agnus castus) plus 250 mg magnesium oxide (VAC + Mg group (n = 10)), 2) one Agnugol tablet plus placebo (VAC group (n = 15)), 3) placebo plus 250 mg magnesium oxide (Mg group (n = 12)), or 4) placebo plus placebo (placebo group (n = 14)) per day for 8 weeks. At baseline and endpoint of the trial, serum alkaline phosphatase, osteocalcin, and vascular endothelial growth factor (VEGF) were measured together with radiological bone assessment.

    RESULTS: There were no significant differences in the characteristic aspects of concern between the four groups at baseline. Despite the increased level of alkaline phosphatase in the VAC group (188.33 ± 16.27 to 240.40 ± 21.49, P = 0.05), administration of VAC + Mg could not increase alkaline phosphatase activity. However, treatment with VAC + Mg significantly enhanced the osteocalcin level. The serum concentration of VEGF was increased in the VAC group (269.04 ± 116.63 to 640.03 ± 240.16, P < 0.05). Callus formation in the VAC + Mg group was higher than the other groups but the differences between the four groups were not significant (P = 0.39). No relevant side effect was observed in patients in each group. CONCLUSION: Our results suggest that administration of vitex agnus castus plus magnesium may promote fracture healing. However, more studies need to further explore the roles of vitex agnus castus in fracture repair processes. Be well! JP

  8. JP Says:

    Updated 12/22/15:


    Med Sci Sports Exerc. 2015 Dec 11.

    Exercising Impacts on Fatigue, Depression, and Paresthesia in Female Patients with MS.

    PURPOSE: Multiple Sclerosis (MS) is a chronic progressive autoimmune disease impacting both body and mind. Typically, patients with MS report fatigue, depression and paresthesia. Standard treatment consists of immune modulatory medication, though there is growing evidence that exercising programs have a positive influence on fatigue and psychological symptoms such as depression. We tested the hypothesis that, as in addition to the standard immune regulatory medication, either yoga or aquatic exercise can ameliorate both fatigue and depression, and we examined whether these interventions also influence paresthesia compared to a non-exercise control condition.

    METHODS: Fifty-four women with MS (mean age: M=33.94 years, SD=6.92) were randomly assigned to one of the following conditions: yoga; aquatic exercise; non-exercise control. Their existing immune modulatory therapy remained unchanged. Participants completed questionnaires covering symptoms of fatigue, depression, and paresthesia, both at baseline and on completion of the study eight weeks later.

    RESULTS: Compared to the non-exercise control condition and over time, fatigue, depression, and paresthesia decreased significantly in the yoga and aquatic exercise groups. On study completion, the likelihood of reporting moderate to severe depression was 35-fold higher in the non-exercise control condition than in the intervention conditions (yoga and aquatic exercising values collapsed).

    CONCLUSION: The pattern of results suggests that for females with MS and treated with standard immune regulatory medication, exercise training programs such as yoga and aquatic exercising positively impacts on core symptoms of MS, namely fatigue, depression, and paresthesia. Exercise training programs should be considered in the future as possible complements to standard treatments.

    Be well!


  9. JP Says:

    Updated 1/17/16:


    J Affect Disord. 2015 Dec 30;193:94-98.

    Dietary magnesium intake and the incidence of depression: A 20-year follow-up study.

    BACKGROUND: Depression is a major global public health concern. The aetiology of depression is partly unclear; however, intake of nutrients, such as magnesium, have been suggested to affect depressive symptoms and modify depression risk.

    METHODS: This research is a part of the Kuopio Ischemic Heart Disease Risk Factor (KIHD) Study, conducted on a sample of 2320 Eastern Finnish men aged 42-61 years old at the baseline. Magnesium intake was assessed by a 4-day food record. Hospital discharge diagnosis of unipolar depressive disorder was used as an outcome variable.

    RESULTS: Participants in the middle tertile of dietary magnesium intake had a statistically significantly decreased risk of getting a hospital discharge diagnosis of depression compared to participants in the lowest tertile of magnesium intake (HR 0.49, CI 0.25-0.95, P=0.035) in the prospective setting after multivariable adjustments. In addition, an inverse association between magnesium intake and the risk of depression was found when the combined middle and highest tertiles of magnesium intake were compared with the lowest tertile (HR 0.53, CI 0.29-0.95, P=0.033).

    LIMITATIONS: Our findings may not be generalizable to individuals below middle-age or women. Moreover, we were unable to consider cases with mild depression in the longitudinal setting.

    CONCLUSIONS: The results of this study suggest that magnesium intake may have an effect on the risk to develop depression. Further studies are needed to investigate whether sufficient magnesium intake could have implications for prevention or treatment of depression.

    Be well!


  10. JP Says:

    Updated 07/11/16:


    Am J Clin Nutr. 2016 Jul 6.

    A prospective study of caffeine and coffee intake and premenstrual syndrome.

    BACKGROUND: Clinically significant premenstrual syndrome (PMS) affects 15-20% of premenopausal women, substantially reducing quality of life. Women with PMS often are counseled to minimize caffeine intake, although only limited evidence supports this recommendation.

    OBJECTIVE: We evaluated the association between total caffeine, coffee, and tea intake and the development of PMS in a case-control study nested within the prospective Nurses’ Health Study II.

    DESIGN: All participants were free from PMS at baseline (1991). PMS cases reported a new clinician-made diagnosis of PMS on biennial questionnaires between 1993 and 2005, and then confirmed symptom timing and moderate-to-severe impact and severity of symptoms with the use of a retrospective questionnaire (n = 1234). Controls did not report PMS and confirmed experiencing no symptoms or few mild symptoms with limited personal impact (n = 2426). Caffeine, coffee, and tea intake was measured by food-frequency questionnaires every 4 y, and data on smoking, body weight, and other factors were updated every 2-4 y. Logistic regression was used to evaluate the associations of total caffeine intake and frequency of coffee and tea consumption with PMS.

    RESULTS: After adjustment for age, smoking, and other factors, total caffeine intake was not associated with PMS. The OR comparing women with the highest (quintile median = 543 mg/d) to the lowest (quintile median = 18 mg/d) caffeine intake was 0.79 (95% CI: 0.61, 1.04; P-trend = 0.31). High caffeinated coffee intake also was not associated with risk of PMS or specific symptoms, including breast tenderness (OR for ≥4 cups/d compared with <1/mo: 0.73; 95% CI: 0.48, 1.12; P-trend = 0.44).

    CONCLUSIONS: Our findings suggest that caffeine intake is not associated with PMS, and that current recommendations for women to reduce caffeine intake may not help prevent the development of PMS.

    Be well!


  11. JP Says:

    Updated 07/17/16:


    J Tradit Complement Med. 2016 Jan 19;6(3):309-15.

    The effect of Valerian root extract on the severity of pre menstrual syndrome symptoms.

    Premenstrual syndrome (PMS) is a common disorder. Due to the knowledge lack of the precise etiology of this syndrome, different treatment methods are recommended, one of them is the use of medicinal herbs. This study aimed to investigate the effect of Valerian ( xié cǎo) root extract on the intensity of PMS symptoms. In this double-blind clinical trial, 100 female students of Islamic Azad University, Tonekabon Branch, Mazandaran Province, Iran, with PMS were randomly divided into groups receiving Valerian (scientific name: Valeriana officinalis) and placebo in 2013. The participants received 2 pills daily in the last seven days of their menstrual cycle for 3 cycles and recorded their symptoms. The data collection tools included demographic information questionnaire, daily symptom severity questionnaire, and a provisional diagnosis of premenstrual syndrome questionnaire. Data were compared previous, one, two, and three cycles after student’s intervention using and analyzed by independent t-test, paired t-test, chi-squared test, and repeated measures ANOVA in SPSS 16. A significant difference was seen in mean emotional, behavioral and physical premenstrual symptom severity in the intervention group before and after the intervention (P < 0.001). However, this difference was not statistically significant in the control group. The results of this study showed that Valerian root extract may reduce emotional, physical, and behavioral symptoms of premenstrual syndrome. Be well! JP

  12. JP Says:

    Updated 07/22/16:


    Int J Environ Res Public Health. 2016 Jul 16;13(7).

    Effect of Yoga Exercise on Premenstrual Symptoms among Female Employees in Taiwan.

    Yoga classes designed for women with premenstrual syndrome are available, but their efficacy is unclear. We investigated the effects of 12 weeks’ yoga exercise (yoga intervention) on premenstrual symptoms in menstruating females in Taiwan. Sixty-four subjects completed the yoga intervention, and before and after the intervention filled out a structured self-report questionnaire about their demographics, personal lifestyle, menstrual status, baseline menstrual pain scores, premenstrual symptoms, and health-related quality of life. Of 64 subjects, 90.6% reported experiencing menstrual pain during menstruation. After the yoga intervention, subjects reported decreased use of analgesics during menstruation (p = 0.0290) and decreased moderate or severe effects of menstrual pain on work (p = 0.0011). The yoga exercise intervention was associated with the improvement of the scale of physical function (p = 0.0340) and bodily pain (p = 0.0087) of the SF-36, and significantly decreased abdominal swelling (p = 0.0011), breast tenderness (p = 0.0348), abdominal cramps (p = 0.0016), and cold sweats (p = 0.0143). Menstrual pain mitigation after yoga exercise correlated with improvement in six scales of the SF-36 (physical function, bodily pain, general health perception, vitality/energy, social function, mental health). Employers can educate female employees about the benefits of regular exercise such as yoga, which may decrease premenstrual distress and improve female employee health.

    Be well!


  13. JP Says:

    Updated 02/12/17:


    J Obstet Gynaecol Res. 2017 Feb 11.

    Effect of zinc sulfate supplementation on premenstrual syndrome and health-related quality of life: Clinical randomized controlled trial.

    AIM: The purpose of study was to assess the effect of zinc sulfate (ZS) supplementation on premenstrual syndrome (PMS) and health-related quality of life (QoL).

    METHODS: This was a double-blind randomized and placebo-controlled trial using the parallel technique conducted between June 2013 and May 2014. A total of 142 women (age, 20-35 years) with PMS were allocated to either the ZS or placebo group. The women in the intervention group received ZS 220-mg capsules (containing 50 mg elemental zinc) from the 16th day of the menstrual cycle to the second day of the next cycle. Data were collected using the Premenstrual Symptoms Screening Tool (PSST) and 12-item Short-Form Health Survey Questionnaire.

    RESULT: The prevalence of moderate to severe PMS in the ZS group significantly decreased throughout the study period (9.5% in the first, 6% in the second and 2.6% in the third month of the study, P < 0.001), but in the control placebo group this reduction was seen only in the first month of the study (14.2% in the first, 13.7% in the second and 13.5% in the third month, P = 0.08). Also, ZS improved the PSST component scores throughout the study period. The mean scores of QoL in physical and mental components were significantly improved in the ZS intervention group. However, the differences were statistically significant only 3 months after the intervention. CONCLUSION: Zinc sulfate, as a simple and inexpensive treatment, was associated with improvement of PMS symptoms and health-related QoL. Additional studies are warranted to confirm these findings. Be well! JP

  14. JP Says:

    Updated 1/21/18:


    Arch Gynecol Obstet. 2018 Jan 19.

    Effect of swimming exercise on premenstrual syndrome.

    OBJECTIVE: To study the effectiveness of performing swimming on the severity of symptoms of premenstrual syndrome (PMS).

    MATERIALS AND METHODS: A randomized controlled trial that was conducted on 70 women diagnosed with PMS divided randomly into two equal groups: Group I included women who engaged into exercise and group II controls. Daily Symptoms Report was filled at the start and at end of the study.

    RESULTS: At the posttreatment evaluation, there was a highly significant difference between the study and control groups regarding anxiety (0 vs. 5), depression (3 vs. 12), tension (3 vs. 12), mood changes (0 vs. 7), feeling out of control (0 vs. 7), weak coordination (0 vs. 10), confusion (2 vs. 9), headache (3 vs. 15), tiredness (4 vs. 12), pains (5 vs. 11), tenderness of the breast (2 vs. 8), and cramps (6 vs. 17) (P < 0.001), but no such difference was found regarding irritability, insomnia, crying, swelling, or food craving. Regarding the percentage of symptoms changes, there was a highly significant difference between the study and control groups regarding anxiety (- 33.3 vs. 0), depression (- 79.29 vs. 15.56), tension (- 81.18 vs. - 6.79), mood changes (- 33.33 vs. 0), feeling out of control (- 91.67 vs. 0), weak coordination (- 100 vs. - 9.55), sleeplessness (- 71.43 vs. 0), confusion (- 84.17 vs. - 9.55), headache (- 77.78 vs. - 6.94), fatigue (- 65.69 vs. 0), pains (- 65.83 vs. - 8.93), breast tenderness (- 87.87 vs. 4.55), cramps (- 60.77 vs. 4.55), and swellings (- 55.05 vs. - 8.33), but no such difference was found regarding irritability, crying, or food craving. CONCLUSIONS: There is beneficial effect of swimming on most of the physical and psychological symptoms of PMS. Be well! JP

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