- Chaste tree fruit
- monk’s pepper
For Patients & Caregivers
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 premenstrual syndrome (PMS) symptoms. Laboratory analysis has shown that chasteberry contains hormonal precursors that can prompt hormone changes within the body by activating those receptors. Various studies have found chasteberry to be effective in reducing breast pain and other PMS symptoms, but not for symptoms of menopause.
Because of its ability to influence hormone levels in the body, chasteberry should be avoided by patients with hormone-sensitive diseases including certain types of cancers.
- 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 prevent premenstrual symptoms
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 treat breast pain
A few clinical trials support this use for breast pain associated with menstruation.
- To prevent menopausal symptoms
There is no evidence to support this claim. One study that evaluated chasteberry in combination with St. John’s wort did not find it effective for menopausal symptoms. Because chasteberry contains sex hormones like progesterone, it is not known whether it would be a safe alternative to hormone replacement therapy.
In this study 128 women were randomized to receive 40 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 were significant differences in variables for both groups before and after the study as well as between the two groups. Researchers concluded that Vitex agnus may be an effective treatment for controlling symptoms associated with mild and moderate PMS.
In this study, 100 women experiencing hot flashes and other menopausal symptoms were randomly divided into 2 groups: those who received a combination of chasteberry and St. John’s wort, and a second group who received a placebo. This combination was tested because it reflected current popular use of these herbs. Among 93 women who completed the study, there were no significant differences between the two groups. However, both placebo and active treatment groups had similar improvements throughout the study, meaning this herbal combination was comparable to placebo in treating menopausal symptoms.
- You have hormone-sensitive cancer: Chasteberry has hormonal activity and can stimulate cancer.
- 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.
- You are taking medicines used to treat serious mental and emotional disorders (chlorpromazine, haloperidol, prochlorperazine): Chasteberry may interfere with the action of these drugs or enhance their side effects.
- You are taking medicines for Parkinson’s disease: Chasteberry may interfere with the action of these drugs or enhance their side effects.
- You are taking any hormonal medications, such as oral contraceptives (birth control pills): Chasteberry may interfere with their effects.
- You are pregnant or nursing.
For Healthcare Professionals
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 and contains non-steroidal progestins that can interact with and activate hormone receptors in the body (1).
Chasteberry has opioidergic (2), dopaminergic (3), hepatoprotective(4), and antiproliferative (5) properties in vitro. Clinical studies suggest its efficacy in reducing symptoms associated with PMS (6)(7)(8), and for the treatment of mastalgia (9). However, in combination with St. John’s wort, chasteberry was not found effective for treating menopausal symptoms (10).
In vitro studies have identified several flavonoids in chasteberry, especially casticin, which exert opioidergic effects through the activation of mu- and delta-opioid receptor subtypes (MOR and DOR respectively) (2). Dopaminergic compounds, particularly clerodadienols, dose-dependently inhibit pituitary prolactin release, which could explain its effect during the premenstrual cycle when serum prolactin levels can be chronically elevated (3). Other diterpenes including rotundifuran also modulate dopamine (d2) receptors (14). Linoleic acid from chasteberry binds to estrogen receptors (ER) and can induce certain estrogen genes (12). The flavonoid apigenin was identified as the most active ER isoform-selective phytoestrogen (11), and can also induce progestogenic activity (13).
In human studies, chasteberry restores progesterone concentrations, prolongs the hyperthermic phase in the basal temperature curve, and restores the luteinizing hormone (LH)-releasing hormone (LHRH) test to normal. It is thought to act on the pituitary-hypothalamic axis rather than directly on the ovaries (11).
Antipsychotics (Phenothiazines, Dopamine D2-Antagonists): Chasteberry may interfere with the action of these drugs or enhance their side effects (17)(20).
Antiparkinson agents (Dopamine agonists): Chasteberry may interfere with the action of these drugs or enhance their side effects (17)(20).
Cytochrome P450 substrates: Chasteberry inhibits CYP2C19 and CYP3A4 and may affect drugs metabolized by these enzymes (21).
Hormonal therapies: Chasteberry may decrease the effects of hormone therapies (11)(12)(18).
Oral contraceptives: Chasteberry may decrease the effects of contraceptives (18).
In this study, 128 women were randomized to receive 40 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 groups before and after the study (P<0.0001), as well as between groups (P<0.0001). Researchers concluded that Vitex agnus may be an effective treatment for controlling symptoms associated with mild and moderate PMS, and that larger studies are warranted.
van Die MD, et al. Hypericum perforatum with Vitex agnus-castus in menopausal symptoms: a randomized, controlled trial. Menopause. 2009;16:156-163.
Chasteberry in combination with St. John’s wort was evaluated for effects on menopausal symptoms in a double-blind, randomized, controlled trial (RCT). A total of 100 women who were either late-perimenopausal or postmenopausal and experiencing hot flushes and other related symptoms received either chasteberry 500 mg twice daily and St. John’s wort 300 mg 3 tablets daily, or placebo. The combination regimen was determined by referring to previous RCTs and current popular usage of these herbs. Frequency and severity of hot flush episodes was used as the primary endpoint, with secondary endpoints including Greene Climacteric Scale scores, Hamilton Depression Inventory scores, and Utian Quality of Life Scale scores. Among 93 women who completed the study, there were no significant between-group differences for any endpoint over the 16 week period, and no significant differences at interim weeks 4, 8, or 12 for daily weighted flushes or secondary endpoint scores. However, across the treatment phase, both placebo and active treatment groups did experience significant improvements for these endpoints, leading investigators to conclude that this herbal combination was not superior to placebo in treating menopausal symptoms. The active treatment regimen was also well tolerated among participants.