What is vitex chasteberry

Chasteberry (Vitex agnus-castus) or monk pepper is the fruit of the chaste tree, a genus of flowering plants in the family Lamiaceae, which is native to Central Asia and the Mediterranean region 1. Chasteberry has been used for more than 2,500 years to treat various conditions. In ancient Egypt, Greece, and Rome, it was used for a variety of gynecologic conditions and reproductive disorders. The plant was believed to promote chastity (hence its name). In medieval Europe, chasteberry was popular among celibate Monks for its purported ability to reduce unwanted sexual libido.

Over the past 50 years, chasteberry has been used widely in Europe for gynecologic conditions such as premenstrual syndrome (PMS), cyclical breast discomfort, menstrual cycle irregularities, and dysfunctional uterine bleeding. The German Commission E approves the use of chasteberry for irregularities of the menstrual cycle, cyclical breast discomfort, and premenstrual syndrome (PMS) 2 and it is widely prescribed by family physicians and gynecologists in Germany 3.

Today, chasteberry is used as a dietary supplement for menstrual problems, menopause symptoms, infertility, and other conditions.

Active Chemical Compounds in Chasteberry (Vitex agnus-castus)

The berry of the chaste tree contains a number of active constituents: flavonoids (i.e., casticin, kaempferol, orientin, quercetagetin, and isovitexin), iridoid glycosides (i.e., agnuside and aucubin), and essential oils (i.e., limonene, cineol, pinene, and sabinene) 4, 5, 6, 7, 8. Chasteberry shows central dopaminergic activity in vitro 9 and in vivo.11 This dopaminergic effect inhibits basal- and thyrotropin-releasing hormone–stimulated prolactin release 10, 11.

Chasteberry’s therapeutic effects are attributed to its indirect effects on various hormones, especially prolactin and progesterone. This hormonal effect appears to be dose-dependent: low doses of extract have resulted in decreased estrogen levels and increased progesterone and prolactin levels, possibly caused by an inhibition of the release of follicle-stimulating hormone (FSH) and stimulation of luteinizing hormone (LH) levels 12. However, in some studies of persons receiving higher doses, FSH and LH levels remained unchanged 10, while prolactin release was decreased 4. These effects may explain why lower doses of the herb might stimulate breast milk production, whereas higher doses seem to have the opposite effect.

Vitex benefits

There’s not a lot of good strong research on the effectiveness of chasteberry for any condition.

  • A few preliminary studies found that chasteberry may improve some symptoms of premenstrual syndrome but the evidence isn’t firm (see below on PMS and PMDD) 13, 14.
  • Researchers have studied chasteberry for breast pain and infertility, but there isn’t enough reliable scientific evidence to know if it helps.
  • There’s no evidence that chasteberry helps with menopausal symptoms 15, 16.

Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Syndrome (PMS)

What is Premenstrual Syndrome (PMS) ?

Premenstrual syndrome (PMS) refers to a wide range of symptoms. The symptoms start during the second half of the menstrual cycle (14 or more days after the first day of your last menstrual period). These usually go away 1 to 2 days after the menstrual period starts. The exact cause of premenstrual syndrome (PMS) is not known. Changes in brain hormone levels may play a role. However, this has not been proven. Women with premenstrual syndrome (PMS) may also respond differently to these hormones.

Premenstrual syndrome (PMS) may be related to social, cultural, biological, and psychological factors.

About 75% of women of childbearing age have some premenstrual syndrome (PMS) problems. About 2% to 10% of women in this age group have premenstrual dysphoric disorder (PMDD).

Most women experience premenstrual syndrome (PMS) symptoms during their childbearing years. premenstrual syndrome (PMS) occurs more often in women:

  • Between their late 20s and late 40s
  • Who have had at least one child
  • With a personal or family history of major depression
  • With a history of postpartum depression or an affective mood disorder

The symptoms often get worse in a woman’s late 30s and 40s as menopause approaches.

The most common symptoms of premenstrual syndrome (PMS) include:

  • Bloating or feeling gassy
  • Breast tenderness
  • Clumsiness
  • Constipation or diarrhea
  • Food cravings
  • Headache
  • Less tolerance for noises and lights

Other symptoms include:

  • Confusion, trouble concentrating, or forgetfulness
  • Fatigue and feeling slow or sluggish
  • Feelings of sadness or hopelessness
  • Feelings of tension, anxiety, or edginess
  • Irritable, hostile, or aggressive behavior, with outbursts of anger toward self or others
  • Loss of sex drive (may increase in some women)
  • Mood swings
  • Poor judgment
  • Poor self-image, feelings of guilt, or increased fears
  • Sleep problems (sleeping too much or too little).

Treatment for premenstrual syndrome (PMS)

A healthy lifestyle is the first step to managing premenstrual syndrome (PMS). For many women, lifestyle approaches are often enough to control symptoms. To manage PMS:

  • Drink plenty of fluids like water or juice. Do not drink soft drinks, alcohol, or other beverages with caffeine. This will help reduce bloating, fluid retention, and other symptoms.
  • Eat a balanced diet. Include extra whole grains, vegetables, and fruit in your diet. Limit your intake of salt and sugar.
  • Your provider may recommend that you take nutritional supplements. Vitamin B6, calcium, and magnesium are commonly used. Tryptophan, which is found in dairy products, may also be helpful.
  • Get regular aerobic exercise throughout the month. This helps in reducing the severity of PMS symptoms. Exercise more often and harder during the weeks when you have PMS.
  • Try changing your nighttime sleep habits before taking drugs for insomnia.

Symptoms such as headache, backache, menstrual cramping, and breast tenderness may be treated with:

  • Aspirin
  • Ibuprofen
  • Other NSAIDs

Birth control pills may decrease or increase premenstrual syndrome (PMS) symptoms.

In severe cases, medicines to treat depression may be helpful. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are often tried first. These have been shown to be very helpful. You may also want to seek the advice of a counselor or therapist.

Other medicines that you may use include:

  • Anti-anxiety drugs for severe anxiety
  • Diuretics, which may help with severe fluid retention, which causes bloating, breast tenderness, and weight gain

What is Premenstrual Dysphoric Disorder (PMDD) ?

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS). In premenstrual dysphoric disorder (PMDD) a woman often has severe depression symptoms, irritability, tension and more severe physical symptoms before menstruation.

Many women with premenstrual dysphoric disorder (PMDD) have:

  • Anxiety
  • Severe depression
  • Seasonal affective disorder (SAD)

Other factors that may play a role include:

  • Alcohol or substance abuse
  • Thyroid disorders
  • Being overweight
  • Having a mother with a history of the disorder
  • Lack of exercise.

The symptoms of premenstrual dysphoric disorder (PMDD) are similar to those of premenstrual syndrome (PMS). However, they are very often more severe and debilitating. They also include at least one mood or emotion-related symptom. Symptoms occur during the week just before menstrual bleeding. They most often get better within a few days after the period starts.

Here is a list of common premenstrual dysphoric disorder (PMDD) symptoms:

  • Lack of interest in daily activities and relationships
  • Fatigue or low energy
  • Sadness or hopelessness, possibly thoughts of suicide
  • Anxiety
  • Out of control feeling
  • Food cravings or binge eating
  • Mood swings with bouts of crying
  • Panic attacks
  • Irritability or anger that affects other people
  • Bloating, breast tenderness, headaches, and joint or muscle pain
  • Problems sleeping
  • Trouble concentrating.

Treatment for premenstrual dysphoric disorder (PMDD)

A healthy lifestyle is the first step to managing premenstrual dysphoric disorder (PMDD).

  • Eat healthy foods with whole grains, vegetables, fruit, and little or no salt, sugar, alcohol, and caffeine.
  • Get regular aerobic exercise throughout the month to reduce the severity of PMS symptoms.
  • If you have problems sleeping, try changing your sleep habits before taking medicines for insomnia.

Antidepressants may be helpful. The first option is most often an antidepressant known as a selective serotonin-reuptake inhibitor (SSRI). You can take SSRIs in the second part of your cycle up until your period starts. You may also take it the whole month. Ask your provider.

Cognitive behavioral therapy may be used either with or instead of antidepressants. During cognitive behavioral therapy, you have about 10 visits with a mental health professional over several weeks.

Other treatments that may help include:

  • Birth control pills typically help reduce PMS symptoms. Continuous dosing types are most effective, especially those that contain a hormone called drospirenone.
  • Diuretics may be useful for women who have significant short-term weight gain from fluid retention.
  • Other medicines (such as Depo-Lupron) suppress the ovaries and ovulation.
  • Pain relievers such as aspirin or ibuprofen may be prescribed for headache, backache, menstrual cramps, and breast tenderness.

A recent systematic review 14 on randomized controlled trials using Chasteberry (Vitex agnus-castus) to treat premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). A total of eight randomized controlled trials were included in this review. Most studies focused on premenstrual syndrome (PMS), and the diagnostic criteria of PMS and PMDD changed over the years. Three different preparations of Chasteberry (Vitex agnus-castus) were tested and there was significant variability in the measurement of treatment outcomes between the studies. Nevertheless, all eight studies were positive for Chasteberry (Vitex agnus-castus) in the treatment of PMS or PMDD and Chasteberry (Vitex agnus-castus) was overall well tolerated. Main limitations were differences in definition of diagnostic criteria, the instruments used as main outcome measures, and different preparations of Chasteberry (Vitex agnus-castus) extracts limit the comparison of results between studies. In conclusion, the randomized controlled trials using Chasteberry (Vitex agnus-castus) for treatment of PMS/PMDD suggested that the Chasteberry (Vitex agnus-castus) extract is a safe and efficacious alternative to be considered for the treatment of PMS/PMDD symptoms 14.

Premenstrual syndrome (PMS) and Cyclical Breast Discomfort

In clinical trials for the treatment of PMS, chasteberry reduced some symptoms, especially breast pain or tenderness, edema, constipation, irritability, depressed mood, anger, and headache 17, 18.

Numerous double-blind randomized controlled trials have evaluated different chasteberry preparations for treating the symptoms of PMS. Two trials were of lesser quality 19, 18 and found little difference or small improvement of breast pain. A recent higher-quality, prospective double-blind randomized controlled trial 20 showed significant improvement in self-assessed symptoms associated with PMS and in physician-assessed clinical global impressions scores measuring severity of condition, global improvement, and overall benefit versus risk (number need to treat = 4). The study, which specifically addressed breast fullness but not pain, involved 170 women with a diagnosis of PMS who received a standardized extract of chasteberry fruit (Ze 440, standardized to casticin) or placebo for three menstrual cycles. More than one half of the women experienced a 50 percent or greater reduction in symptoms 20. Patient acceptance was high, and side effects were few and mild. Another placebo-controlled, double-blind trial 21 of 104 women examined the effects of two forms of chasteberry (liquid and tablet) for at least three menstrual cycles. The women in the treatment group showed improvement of cyclical breast discomfort 21.

A previous study 22 found comparable efficacy for chasteberry and vitamin B6, both of which decreased symptoms by almost 50 percent. This study was placebo controlled, but not double blinded, and was of suboptimal sample size. Three open trials 23, 24, 25 involving between 400 and 1,600 patients also showed significant improvement of various PMS symptoms but were not controlled and were of lesser quality.

Menstrual Disorders, Amenorrhea and Fertility

Patients use chasteberry for a variety of menstrual irregularities and fertility disorders 26; in Germany, physicians prescribe the herb for luteal phase disorders.

Results of a small randomized clinical trial 27 involving 96 women with fertility disorders (38 women with secondary amenorrhea, 31 with luteal insufficiency, and 27 with idiopathic infertility) suggested that patients receiving chasteberry achieved pregnancy more readily than did women in the placebo group. The subjects received chasteberry or placebo twice daily for three months. Hormone levels did not differ, but in women with amenorrhea or luteal insufficiency, pregnancy occurred in the active treatment group more than twice as often as in the group receiving placebo. However, the total number of patients conceiving was small (15 women), the treatment was only administered for three months, and the product used (Mastodynon, not currently available in the United States) contains five additional herbs that are not approved by the German Commission E reports 28.

In another small randomized clinical trial 29 involving 52 patients with luteal phase defects, women in the active treatment group were found to have reduced prolactin release, normalized luteal phases, improved luteal phase progesterone synthesis, and increased luteal phase estradiol. This study appears to support the use of chasteberry for luteal phase disorders, but the actual effect on fertility was not mentioned. A recent double-blind placebo-controlled pilot study 27 of 30 women showed an increasing trend in midluteal phase progesterone level and an increased number of pregnancies in the 15 women who took a nutritional supplement containing chasteberry for five months.

Lactation and Libido

There is insufficient evidence to support chasteberry’s traditional use to enhance breast milk production (i.e., as a galactagogue). Some evidence suggests that low doses might increase milk production in women who are lactating 4, 7. A small study 30 involving 20 healthy men showed increased prolactin levels in those receiving a low dose of chasteberry (120 mg per day) but a decrease of prolactin secretion with higher doses (480 mg per day).

Chasteberry also has been used to modify libido, most often to reduce sexual desire,28 but sometimes to improve decreased libido 4. However, no clinical data exist to support these indications.

Dosage and Preparations of Chasteberry

The dosages and preparations of chasteberry used in different clinical trials vary widely. In many studies, 4 mg per day of an extract standardized to 6 percent of the constituent agnuside (a chemical compound found in Vitex agnus-castus) has been used. In the United States, this formulation is available as Femaprin from Nature’s Way.

Dosage of the fruit extract is 20 to 40 mg per day 2, 20, although higher doses (up to 1,800 mg per day) also have been used 4. Fluid extract (40 drops daily) 4 and tincture (35 to 45 drops, three times daily) also have been used 5.

Vitex side effects

The most frequent adverse events are nausea, headache, dry mouth, dizziness, tiredness, gastrointestinal disturbances, menstrual disorders, acne, pruritus and erythematous rash 31, 32. No drug interactions were reported.

  • Use of Chasteberry (Vitex agnus-castus) should be avoided during pregnancy or lactation. In the case of lactation, theoretical and expert opinion conflict as to whether chaste tree increases or decreases lactation 33, 34, 35, 36.
  • Theoretically, Chasteberry (Vitex agnus-castus) might also interfere with dopaminergic antagonists. People taking dopamine-related medications, such as certain antipsychotic drugs and Parkinson’s disease medications should avoid using chasteberry.
  • Women on birth control pills or hormone replacement therapy, or who have a hormone-sensitive condition (such as breast cancer) should not use chasteberry.

Although further rigorous studies are needed to assess the safety of Chasteberry (Vitex agnus-castus), the data available seem to indicate that Chasteberry (Vitex agnus-castus) is a safe herbal medicine.

  1. Chasteberry.
  2. Blumenthal M. German Federal Institute for Drugs and Medical Devices. Commission E. Herbal Medicine: expanded Commission E monographs. 1st ed. Newton, Mass.: Integrative Medicine Communications, 2000.
  3. Schilcher H. Phytotherapy and classical medicine. Journal of Herbs, Spices, and Medicinal Plants. 1994;2:71–80.
  4. Mills S, Bone K. Principles and practice of phytotherapy: modern herbal medicine. Edinburgh: Churchill Livingstone, 2000.
  5. Upton R. Chaste tree fruit: Vitex agnus-castus: standards of analysis, quality control, and therapeutics. American Herbal Pharmacopoeia and therapeutic compendium. Santa Cruz, Calif,: American Herbal Pharmacopoeia, 2001.
  6. Schulz V. Rational phytotherapy: a physician’s guide to herbal medicine. 3d ed. Berlin: Springer, 1998.
  7. Brown D. Vitex agnus castus clinical monograph. Quarterly Review of Natural Medicine. 1994;2:111–21.
  8. Jellin JM, Gregory P, Batz F, Hitchens K, et al, eds. Pharmacist’s letter/prescriber’s letter. Natural Medicines Comprehensive Database. 3d ed. Stockton, Calif.: Therapeutic Research Faculty, 2000.
  9. Meier B, Berger D, Hoberg E, Sticher O, Schaffner W. Pharmacological activities of Vitex agnus-castus extracts in vitro. Phytomedicine. 2000;7:373–81.
  10. Jarry H, Leonhardt S, Gorkow C, Wuttke W. In vitro prolactin but not LH and FSH release is inhibited by compounds in extracts of Agnus castus: direct evidence for a dopaminergic principle by the dopamine receptor assay. Exp Clin Endocrinol. 1994;102:448–54.
  11. Wuttke W. Dopaminergic action of extracts of Agnus Castus. Forschende Komplementarmedizen. 1996;3:329–30.
  12. Merz PG, Gorkow C, Schrodter A, Rietbrock S, Sieder C, Loew D, et al. The effects of a special Agnus castus extract (BP1095E1) on prolactin secretion in healthy male subjects. Exp Clin Endocrinol Diabetes. 1996;104:447–53
  13. Dante G, Facchinetti F. Herbal treatments for alleviating premenstrual symptoms: a systematic review. Journal of Psychosomatic Obstetrics & Gynecology. 2011;32(1):42-51.
  14. Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Cerqueira, R.O., Frey, B.N., Leclerc, E. et al. Arch Womens Ment Health (2017).
  15. Laakmann E, Grajecki D, Doege K, et al. Efficacy of Cimicifuga racemosa, Hypericum perforatum and Agnus castus in the treatment of climacteric complaints: a systematic review. Gynecological Endocrinology. 2012;28(9):703-709.
  16. van Die MD, Burger HG, Bone KM, et al. Hypericum perforatum with Vitex agnus-castus in menopausal symptoms: a randomized, controlled trial. Menopause. 2009;16(1):156-163.
  17. Blumenthal M. German Federal Institute for Drugs and Medical Devices. Commission E. The complete German Commission E monographs: therapeutic guide to herbal medicines. Austin, Tex.: American Botanical Council, 1998.
  18. Halaska M, Raus K, Beles P, Martan A, Paithner KG. Treatment of cyclical mastodynia using an extract of Vitex agnus castus: results of a double-blind comparison with a placebo [in Czech]. Ceska Gynekol. 1998;63:388–92.
  19. Turner S, Mills S. A double-blind clinical trail on a herbal remedy for premenstrual syndrome: a case study. Complement Ther Med. 1993;1:73–7.
  20. Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study. BMJ. 2001;322:134–7.
  21. Wuttke W, Splitt G, Gorkow C, et al. Treatment of cyclical mastalgia: results of a randomised, placebo-controlled, double-blind study [in German]. Geburtshilfe Frauenheilkd. 1997;57:569–74.
  22. Lauritzen C, Reuter HD, Repges R, Bohnert KJ, Schmidt U. Treatment of premenstrual tension syndrome with Vitex agnus castus. Controlled, double-blind study versus pyridoxine. Phytomedicine. 1997;4:183–9.
  23. 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.
  24. Peteres-Welter C, Albrecht M. Menstrual abnormalities and PMS. Vitex agnus-castus in a study of application. Therapiewoche Gynäkol. 1994;7:49–52.
  25. Dittmar F, Böhnert K, Peeters M, et al. Premenstrual syndrome: treatment with a phytopharmaceutical. Therapiewoche Gynäkol. 1992;5:60–8.
  26. Tyler VE. Herbs of choice: the therapeutic use of phytomedicinals. New York: Pharmaceutical Products Press, 1994.
  27. Gerhard I, Patek A, Monga B, Blank A, Gorkow C. Mastodynon (R) bei weiblicher Sterilitat. Forsch Komplementarmed. 1998;5:272–8.
  28. Blumenthal M. German Federal Institute for Drugs and Medical Devices. Commission E. Herbal Medicine: expanded Commission E monographs. 1st ed. Newton, Mass.: Integrative Medicine Communications, 2000
  29. Milewicz A, Gejdel E, Sworen H, Sienkiewicz K, Jedrzejak J, Teucher T, 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 [in German]. Arzneimittelforschung. 1993;43:752–6.
  30. Merz PG, Gorkow C, Schrodter A, Rietbrock S, Sieder C, Loew D, et al. The effects of a special Agnus castus extract (BP1095E1) on prolactin secretion in healthy male subjects. Exp Clin Endocrinol Diabetes. 1996;104:447–53.
  31. Vitex agnus castus: a systematic review of adverse events. Drug Safety 2005;28(4):319-32.
  32. Rani A, Sharma A. The genus Vitex: A review. Pharmacognosy Reviews. 2013;7(14):188-198. doi:10.4103/0973-7847.120522.
  33. Dugoua JJ, Seely D, Perri D, Koren G, Mills E. Safety and efficacy of chastetree (Vitex agnus-castus) during pregnancy and lactation. Can J Clin Pharmacol. 2008;15:e74–9.
  34. Assunta H. Vitex agnus castus chaste tree berry/Monk’s pepper: What’s in a name? Aust Center Complement Med. 2006;25:888.
  35. Roemheld-Hamm B. Chasteberry. Am Fam Physician. 2005;72:821–4.
  36. Daniele C, Thompson Coon J, Pittler MH, Ernst E. Vitex agnus castus: A systematic review of adverse events. Drug Safety. 2005;28:319–32.
Health Jade Team

The author Health Jade Team

Health Jade