Health Care Professional Information

Scientific Name
Vitex agnus castus
Common Name

Chaste tree fruit, monk’s pepper

Clinical Summary

The fruit of chasteberry is widely used to relieve symptoms associated with premenstrual syndrome and to treat infertility. It is said to have a normalizing action on the menstrual cycle. 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. Clinical studies in women suggest its efficacy in reducing symptoms associated with PMS (8) (9) (16), 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). Chasteberry has been reported to inhibit the release of prolactin (10) (18). It also has dopaminergic activity by modulating the dopamine (d2) receptors (7). In vitro studies, constituents isolated from chasteberry can stimulate estrogen receptors (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

Chasteberry may have estrogenic activity (11) (12) and should be avoided or used cautiously by patients with hormone-sensitive disease.

Adverse Reactions

Reported: The most frequent adverse events are nausea, headache, gastrointestinal disturbances, menstrual disorders, acne, pruritus and erythematous rash (3) (4).

Herb-Drug Interactions

Dopamine D2-Antagonists: Theoretically, chasteberry may interfere with the action of drugs that antagonize dopamine receptors (e.g. chlorpromazine, haloperidol, prochlorperazine) (5).
Cytochrome P450 substrates: Chasteberry inhibits CYP2C19 and CYP3A4 and may affect drugs metabolized by these enzymes (17).

Literature Summary and Critique

In this study 128 women were randomized to receive forty drops of Vitex extract or matching placebo administered for 6 days before their menstrual cycle for 6 consecutive cycles. The mean ages were 30.77 years in the active group and 30.89 (SD=4.02) years in the placebo group. Participants answered a self assessment questionnaire about headache, anger, irritability, depression, breast fullness and bloating and tympani before and after 6 menstrual cycles. Each item was rated using a visual analogue scale (VAS). There was a significant difference in the variables in both the group before and after the study (P<0.0001); and between the two groups (P<0.0001). Researches concluded that Vitex agnus may be an effective treatment for controlling symptoms associated with mild and moderate PMS.
Larger studies are warranted.

Dosage (Inside MSKCC Only)
This field is only visible to only OneMSK users.
References
  1. Schulz V, et al. Rational Phytotherapy, A Physician's Guide to Herbal Medicine, 3rd ed. New York: Springer; 1996.
  2. Newall C, et al. Herbal Medicines: A Guide for Health-Care Professionals. London: Pharmaceutical Press; l996.
  3. Daniele C, Thompson Coon J, Pittler MH, Ernst E. Vitex agnus castus: a systematic review of adverse events. Drug Saf. 2005;28(4):319-32.
  4. Mills S, et al. Principles and Practice of Phytotherapy. London: Churchill Livingstone; 2000.
  5. Brinker F. Herb Contraindications & Drug Interactions, 2nd ed. Sandy (OR): Eclectic Med Publications; 1998.
  6. Berger D, et al. Efficacy of Vitex agnus castus L. extract Ze 440 in patients with pre-menstrual syndrome (PMS). Arch Gyncecol Obstet 2000;264:150-3.
  7. Meier B, et al. Pharmacological activities of Vitex agnus-castus extracts in vitro. Phytomedicine 2000;7:373-81.
  8. Schellenberg R. Treatment for the premenstrual syndrom with agnus castus fruit extract: prospective, randomised, placebo controlled study. BMJ 2001;322:134-7.
  9. 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. 2009 May 20;63(1):99-103.
  10. Sliutz G, Speiser P, Schultz AM, et al. Agnus castus extracts inhibit prolactin secretion of rat pituitary cells. Horm Metab Res. 1993 May;25(5):253-5
  11. Jarry H, Spengler B, Porzel A, et al. Evidence for estrogen receptor beta-selective activity of Vitex agnus-castus and isolated flavones. Planta Med. 2003 Oct;69(10):945-7.
  12. 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. 2004 Jan;11(1):18-23.
  13. Weisskopf M, Schaffner W, Jundt G, Sulser T, Wyler S, Tullberg-Reinert H. A Vitex agnus-castus extract inhibits cell growth and induces apoptosis in prostate epithelial cell lines. Planta Med. 2005 Oct;71(10):910-6.
  14. Tandon VR, Khajuria V, Kapoor B, Kour D, Gupta S. Hepatoprotective activity of Vitex negundo leaf extract against anti-tubercular drugs induced hepatotoxicity. Fitoterapia. 2008 Dec;79(7-8):533-8.
  15. Carmichael AR. Can Vitex Agnus Castus be Used for the Treatment of Mastalgia? What is the Current Evidence? Evid Based Complement Alternat Med. 2008 Sep;5(3):247-50.
  16. Zamani M, Neghab N, Torabian S. Therapeutic effect of Vitex agnus castus in patients with premenstrual syndrome. Acta Med Iran. 2012;50(2):101-6.
  17. Ho SH, Singh M, Holloway AC, Crankshaw DJ. The effects of commercial preparations of herbal supplements commonly used by women on the biotransformation of fluorogenic substrates by human cytochromes p450. Phytother Res. 2011 Jul;25(7):983-9.
  18. Milewicz A, Gejdel E, Sworen H, et al. Vitex agnus castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia. Results of a randomized placebo-controlled double-blind study.  Arzneimittelforschung. 1993 Jul;43(7):752-6.

Consumer Information

How It Works

Bottom Line: There is evidence to suggest that chasteberry helps improve symptoms associated with premenstrual syndrome.

Chasteberry is used widely to treat infertility and for relief of symptoms of premenstrual syndrome (PMS). 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 an effect on the release of sex hormones (estrogen, progesterone, and testosterone) within the body.

Purported Uses
  • To ease difficult and painful menstruation
    A handful of clinical trials support this use in women aged 20-40 whose ovarian function was not greatly impaired and who had 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 evidence to support this claim. 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 few studies support this use in women aged 20-40 whose ovarian function was not greatly impaired and who had no other hormone imbalances.
  • To prevent dysfunctional uterine bleeding
    A few studies support this use.
Research Evidence

Premenstrual Syndrome
In this study 128 women were randomized to receive forty drops of Vitex agnus extract or matching placebo administered for 6 days before their menstrual cycle for 6 consecutive cycles. Participants answered a self assessment questionnaire about headache, anger, irritability, depression, breast fullness and bloating and tympani before and after 6 menstrual cycles. There was a significant difference in the variables in both the groups before and after the study; and between the two groups. Researches concluded that Vitex agnus may be an effective treatment for controlling symptoms associated with mild and moderate PMS.

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.
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).
  • You are taking drugs that are substrates of Cytochrome P450 enzymes CYP2C19 and CYP3A4 (chasteberry may increase the risk of side effects of these drugs).
Side Effects

Reported: Nausea, headache, gastrointestinal disturbances, menstrual disorders, acne, pruritus and erythematous rash.

E-mail your questions and comments to aboutherbs@mskcc.org.