Expert Opinions

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I suffer from monthly bloating and mood swings. Is the herb Vitex a good choice for PMS?

J.D., Brooklyn, N.Y.

PMS is no picnic. Thirty to 40% of menstruating women suffer from its symptoms--depression, anxiety, craving, bloating, and cramps, among others--during the week before their periods. Fortunately, new research supports the efficacy of an herb that has been alleviating women's premenstrual syndrome since the ancient Greek physician Hippocrates documented its use 2,500 years ago.

Popular with European women, the tiny black berries of the Vitex or chaste tree shrub contain powerful hormone-balancing compounds that ease PMS symptoms for many women. While scientists don't completely understand how the herb works, Jeanne Chiang, M.D., a family practitioner who specializes in women's health, says it probably acts on the pituitary gland at the base of the brain.

"The pituitary releases prolactin, a milk-producing hormone, that in excess can cause menstrual discomfort. Vitex, also commonly known as chasteberry, suppresses the excessive prolactin, readjusting the level of your two sex hormones, estrogen and progesterone," she says.

One recent German trial enlisted 857 gynecologists to assess the efficacy of Vitex on PMS symptoms in 1,634 patients who took 20 mg capsules of the active ingredient in the herb twice daily. At the end of three months, 42% of the women reported no longer suffering from PMS, and 51% experienced a decrease in such symptoms as breast tenderness and anxiety. The researchers noted that the herb is particularly useful because, unlike some other PMS medications, it alleviates both psychological and physical symptoms (Journal of Women's Health and Gender-based Medicine, 4/00).

A review of the herb found it quite effective, eliminating or significantly reducing PMS symptoms after about three menstrual cycles in approximately 85% of 4500 patients who took 40 drops of the liquid extract daily. Of the few side effects reported, all were minor (Journal of the American Pharmaceutical Association, Mar.-Apr. 2000). Another study found it to be an effective treatment for breast tenderness, a common PMS symptom (Ceska Gynekol, 10/98).

Vitex (chasteberry) preparations are made from the ripe, dried berries of the shrub and are available in capsules or tinctures. Both forms have been shown effective in studies, although some women find that because of its high alcohol content, the tincture in particular can cause stomach irritation unless it's diluted in plenty of water or taken with food.

Suggested dose: Take 400 to 500 mg of standardized extract (containing 0.5% agnusides) or 40 drops tincture once a day for up to 6 months. Due to differences in the standardization of U.S. and European Vitex products, two 225-mg capsules should give you approximately the same amount of active ingredient used in the studies. Agnolyt, a German Vitex preparation which showed efficacy in a number of trials, is marketed in the U.S. as Femaprin by Nature's Way (1 capsule per day).

Comments and cautions: Even though Vitex is a safe herb, use it with care. Do not take with hormone replacement medications or oral contraceptives without discussing it with your physician. Avoid taking it with the drug bromocriptine, which is also used to reduce prolactin levels, and do not take during pregnancy.

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