- How It Works
- Purported Uses
- Research Evidence
- Patient Warnings
- Do Not Take If
- Side Effects
- Special Point
- Dosage (Inside MSKCC Only)
Scientific Name
Vitex agnus castus
Common Name
Chaste tree fruit, monk's pepper
Clinical Summary
Derived from the fruit of the tree, chasteberry contains steroidal precursors and active moieties including progesterone, testosterone, and androstenedione. It was shown to have antiproliferative (13) and hepatoprotective (14) properties in vitro. Several clinical studies in women suggest its efficacy in reducing symptoms associated with PMS (8) (9), and for the treatment of mastalgia (15).
Chasteberry may interact with oral contraceptives, hormonal therapy, and dopamine antagonists (such as haloperidol and prochlorperazine) (5). It also demonstrated estrogenic activity (11) (12) and should be avoided by patients with hormone-sensitive disease.
Purported Uses
- Dysmenorrhea
- Mastalgia
- Menopausal symptoms
- Uterine bleeding
Constituents
- Flavonoids: Casticin, penduletin and chrysophanol D
- Iridoid alkaloids: Viticin, angnoside and aucubin
- Progestins: Progesterone, hydroxyprogesterone, testosterone, epitestosterone, androstenedione
- Volatile oils
(1)
Mechanism of Action
Chasteberry may exert opioidergic effects through the activation of mu opioid receptors (MOR) and delta opioid receptors (DOR), but not kappa opioid receptors (KOR) (9). In animal studies, chasteberry has been reported to diminish release of follicle-stimulating hormone from the anterior pituitary while increasing the release of luteinizing hormone and prolactin. It also contains constituents that bind to dopamine (d1 and d2) receptors and seem to inhibit prolactin release (10). In vitro studies, constituents isolated from chasteberry can stimulate estrogen receptors (7) (8). In human studies, it has been found to restore progesterone concentrations, prolong the hyperthermic phase in the basal temperature curve, and restore the LH-RH test to normal. It is thought to act on the pituitary-hypothalamic axis rather than directly on the ovaries (11) (4).
Contraindications
Adverse Reactions
Herb-Drug Interactions
Oral Contraceptives: Theoretically, Chasteberry may interfere with efficacy due to its hormone-regulating activity.
Dopamine D2-Antagonists: Theoretically, chasteberry may interfere with the action of drugs that antagonize dopamine receptors (e.g. chlorpromazine, haloperidol, prochlorperazine).(5)
Literature Summary and Critique
Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomized, placebo controlled study over three menstrual cycles. BMJ 2001;322:134-7.
A double-blind, placebo-controlled study of 178 women found that treatment with chasteberry over three menstrual cycles significantly reduced PMS symptoms. Responder rates were 52% and 24% for active and placebo, respectively. The dose used was one tablet of chasteberry dry extract three times a day. Women in the treatment group experienced significant improvements in symptoms, including depression, headache, irritability, and breast tenderness.
Loch EG, Selle H, Boblitz N. Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing vitex agnus castus. J Womens Health Gend Based Med 2000;9:315-20.
A non-interventional review of 1,634 female German patients suffering from PMS who were treated with a vitex preparation. Questionnaires, completed by the physician at baseline and after three menstrual cycles, evaluated the symptoms of PMS and efficacy of herbal supplement. Results indicate that a reduction in PMS symptoms including depression, anxiety, bloating, and headache occurred. Reported adverse events included 13 cases of skin symptoms (pruritus, rash, eczema, hair loss) and 6 reports of mild gastrointestinal complaints (nausea, vomiting, diarrhea, stomach pain).
References
- Weisskopf M, Schaffner W, Jundt G, et al. A Vitex agnus-castus extract inhibits cell growth and induces apoptosis in prostate epithelial cell lines. Planta Med. Oct 2005;71(10):910-916.
- Tandon VR, Khajuria V, Kapoor B, et al. Hepatoprotective activity of Vitex negundo leaf extract against anti-tubercular drugs induced hepatotoxicity. Fitoterapia. Dec 2008;79(7-8):533-538.
- He Z, Chen R, Zhou Y, et al. Treatment for premenstrual syndrome with Vitex agnus castus: A prospective, randomized, multi-center placebo controlled study in China. Maturitas. May 20 2009;63(1):99-103.
- Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study. BMJ. Jan 20 2001;322(7279):134-137.
- Carmichael AR. Can Vitex Agnus Castus be Used for the Treatment of Mastalgia? What is the Current Evidence? Evid Based Complement Alternat Med. Sep 2008;5(3):247-250.
- F. B. Herb Contraindications & Drug Interactions. 2nd ed ed. Sandy (OR): Eclectic Med Publications; 1998.
- Jarry H, Spengler B, Porzel A, et al. Evidence for estrogen receptor beta-selective activity of Vitex agnus-castus and isolated flavones. Planta Med. Oct 2003;69(10):945-947.
- Liu J, Burdette JE, Sun Y, et al. Isolation of linoleic acid as an estrogenic compound from the fruits of Vitex agnus-castus L. (chaste-berry). Phytomedicine. Jan 2004;11(1):18-23.
- Webster DE, He Y, Chen SN, et al. Opioidergic mechanisms underlying the actions of Vitex agnus-castus L. Biochem Pharmacol. Jan 1 2011;81(1):170-177.
- Newall C ea. Herbal Medicines: A Guide for Health-Care Professionals. London: Pharmaceutical Press; l996.
- Berger D, Schaffner W, Schrader E, et al. Efficacy of Vitex agnus castus L. extract Ze 440 in patients with pre-menstrual syndrome (PMS). Arch Gynecol Obstet. Nov 2000;264(3):150-153.
- Daniele C, Thompson Coon J, Pittler MH, et al. Vitex agnus castus: a systematic review of adverse events. Drug Saf. 2005;28(4):319-332.
How It Works
Bottom Line: There is evidence to suggest that chasteberry helps improve symptoms associated with premenstrual syndrome.
Chasteberry is a fruit extract. Laboratory analysis has shown that chasteberry contains active hormones that are also produced by the human body, such as progesterone, testosterone, and androstenedione. In studies in both laboratory animals and humans, chasteberry has been found to alter the release of gonadotropins (hormones that stimulate secretion of sex hormones from the ovaries and testes) from the pituitary gland in the brain. It is hypothesized that this has a downstream effect on the release of sex hormones (estrogen, progesterone, and testosterone) within the body, but scientists are unsure exactly how chasteberry works.
Purported Uses
- To ease difficult and painful menstruation
A handful of clinical trials support this use in women aged 20-40 whose ovarian function is not greatly impaired and who have no other hormone imbalances. - To treat breast pain
A few clinical trials support this use for breast pain associated with menstruation. - To prevent menopausal symptoms such as hot flashes, vaginal dryness, sleep disturbances, and mood disorders
There is no proof from clinical trials that chasteberry can treat menopausal symptoms. Because chasteberry contains sex hormones like progesterone, it is not known whether it would be a safe alternative to hormone replacement therapy. - To prevent premenstrual symptoms such as depression, bloating, anxiety, breast tenderness, and headaches
A handful of clinical trials support this use in women aged 20-40 whose ovarian function is not greatly impaired and who have no other hormone imbalances. - To prevent dysfunctional uterine bleeding
A handful of clinical trials support this use in women aged 20-40 whose ovarian function is not greatly impaired and who have no other hormone imbalances.
Research Evidence
Premenstrual syndrome (PMS):
A randomized controlled trial studied whether chasteberry could relieve premenstrual symptoms in 178 women. For three menstrual cycles, 86 women took one chasteberry extract tablet three times daily, while 84 women took three placebo pills daily. Compared to women taking the placebo, women taking chasteberry reported significant reductions in PMS symptoms, including depression, headache, irritability, and breast tenderness. 24% of the placebo group and 52% of the chasteberry group reported such improvements.
Researchers followed 1,634 female German patients who were taking a chasteberry extract to treat premenstrual symptoms. After three months of taking the extract, 93% of patients reported a decrease in the number of symptoms, including depression, anxiety, craving, and bloating. Some women reported an end of PMS complaints altogether. However, this study lacks a control group (a group taking a placebo pill) to which the researchers could compare their results with chasteberry. About 1% of women had side effects, including itching, rash, eczema, hair loss, and gastrointestinal complaints.
Patient Warnings
- Chasteberry contains sex hormones such as progesterone. Therefore, it is not yet known whether chasteberry is a safe alternative to hormone replacement therapy.
- This product is regulated by the F.D.A. as a dietary supplement. Unlike approved drugs, supplements are not required to be manufactured under specific standardized conditions. This product may not contain the labeled amount or may be contaminated. In addition, it may not have been tested for safety or effectiveness.
Do Not Take If
- You are pregnant.
- You are taking any hormonal medications, such as oral contraceptives (birth control pills) (chasteberry may interfere with their effects).
- You have hormone-sensitive cancer (chasteberry has estrogenic activity and can stimulate cancer)
- You are taking dopamine D2-antagonists, such as chlorpromazine, haloperidol, or prochlorperazine) (chasteberry may interfere with these medications).
Side Effects
Reported: The most frequent adverse events are nausea, headache, gastrointestinal disturbances, menstrual disorders, acne, pruritus and erythematous rash.
Special Point
Scientists are unsure of the effects of long-term use of herbs that contain sex hormones, such as chasteberry.
Dosage (Inside MSKCC Only)
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Aliases
Agnus castus
Vitex®
E-mail your questions and comments to aboutherbs@mskcc.org.
