Chaste Tree

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The dried fruit or berry of the chaste tree is often referred to as Monk's pepper or chasteberry; it was historically thought to reduce libido or promote chastity. Chaste tree is also commonly referred to as vitex.

Uses and Benefits:

Standardized extracts of the chaste tree berry are popular in Europe, and now in North America, for a variety of women's problems primarily related to the menstrual cycle. These disorders include menstrual cycle irregularities, the premenstrual syndrome (PMS), cyclic breast pain, dysfunctional uterine bleeding, and infertility. Historically, vitex has also been used for inflammatory conditions, diarrhea, flatulence, insufficient lactation, and menstruation induction.

Pharmacology:

The major herbal constituents of the berry in�clude terpenoids (e.g., vitexilactone), flavonoids (e.g., casticin), iridoid glycosides (e.g., agnuside and aucubin), and a volatile oi1. Small amounts of compounds related to androgenic steroids have been reported to be isolated from leaves and flowers, but these plant parts generally are not used medicinally.

Clinical Trials:

Vitex has been reported to correct symptoms of menstrual and related disorders in over 30 European clinical trials during the last 50 years. Beneficial effects have been described for patients with PMS, mastalgia, irregular menstrual cycles, dysfunctional uterine bleeding, infertility, decreased lactation, and acne. Most of these studies are uncontrolled or un�blinded, including many large post-market surveillance studies. In this review, only double-blind randomized controlled trials (RCTs) are described; several are only available in German-language journals, and are reviewed in secondary sources.
Cyclic Breast Pain-Cyclic mastalgia is often associated with the PMS complex of symptoms. Three double-blind, controlled trials have reported beneficial results with a standardized European preparation, Mastodynon (vitex combined with several homeopathic herbs), using drops and/or tablets. In a trial of 160 women with premenstrual mastalgia, vitex was reported to pro�vide good symptomatic relief more often than placebo (74.5% vs. 36.8%, respectively), and was equivalent to a progestational agent, Iynestranol (82.1 %). Two similar RCTs, each lasting three menstrual cycles (n = 97 and 104 women), also reported almost identical, statistically significant reductions in symptoms com�pared to placebo.

Adverse Effects:

Vitex appears to be very well tolerated. Reported side effects in the clinical studies are rare and transient (often similar in frequency to placebo), and primarily include mild gastrointestinal complaints, allergic reactions, or headaches. A single case of unexplained nocturnal seizures in a patient taking chaste tree berry, black cohosh, and evening primrose oil has been reported ; a cause-and-effect relationship with vitex is doubtful.

Side Effects and Interactions:

There are no reported interactions with vitex. Due to its potential effects on dopamine and prolactin, it is relatively contraindicated with other drugs that are dopamine agonists or antagonists (e.g., bromocriptine, metoclopramide, antiParkinson's drugs).

Cautions:

Use during pregnancy and lactation should generally be avoided, although vitex has been employed to enhance fertility and stimulate lactation. In a case report of a woman undergoing unstimulated in vitro fertilization treatment, a combination herbal preparation containing vitex was associated with folliculogenesis and increased FSH, LH, and progesterone levels. In addition, the patient complained of symptoms suggestive of mild ovarian hyperstimulation syndrome.

Preparations & Doses:

Vitex preparations and doses vary considerably; only the standardized European products have been demonstrated to be effective. In the German clinical trials, small doses of standardized extract preparations (Agnolyte, Mastodynon, and Straton) are equivalent to about 30-40 mg of dried or crude herb, and are usually administered each morning. Agnolyte is marketed in the U.S. as Femaprin (Nature's Way), and is usually qiven as one 4-mg tablet or 40 drops of extract per day. Herbalists in Britain and other English-speaking countries tend to use much larger doses of noncommercial preparations, equivalent to about 500-2000 mg/day of dried herb, often in liquid extracts and tinctures. A more recent European product (Ze 440; available as a 20-mg extract) is equivalent to about 120-240 mg of crude herb.

Summary Evaluation

Vitex may affect the endocrine and reproductive systems by decreasing prolactin via dopaminergic stimulation, although these pharmacologic properties are not fully characterized in humans. Uncontrolled trials and decades of use in Europe suggest beneficial effects for a wide variety of menstrual-related disorders. Well�designed, randomized, controlled trials are limited, but do support beneficial effects for the treatment of PMS (one trial) and cyclic mastalgia (three trials). Because vitex appears safe and well tolerated, and there are few effective treatments for these conditions, it is reasonable for women with these disorders to give vitex a therapeutic trial. There is insufficient evidence to make recom�mendations for other indications.

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Author: Peter Thomas
Peter Thomas is a writer, who writes many great articles on herbal medicines and ayurvedic medicines for common ailments and diseases. Visit us for more information on herbal remediesand ayurvedic medicines.

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