We are all familiar with the ups and downs of the monthly cycle. But sometimes the days leading up to our periods can be extra challenging. Premenstrual syndrome, better known as PMS, is a collection of symptoms you may experience in the week before your period. Women often experience painful or swollen breasts, headaches, back pain, depression, anxiety, irritability and other physical, emotional and behavioural changes that recur cyclically. About 40% of women suffer from PMS symptoms and as many as 5-8% of these experience severe PMS. So for many women, PMS can affect life considerably.
The role of prolactin in PMS
During our menstrual cycle, there is a fluctuation of our sex hormones oestrogen and progesterone that women with PMS seem to be more sensitive to. But women with PMS are also more likely to show higher levels of prolactin. Prolactin is a hormone produced by the pituitary gland, a small gland at the base of the brain that plays a crucial role in hormone regulation. The main function of prolactin is to stimulate the development of the mammary glands in the breasts of women during pregnancy and after childbirth. In menstruating women, prolactin also stimulates the mammary glands and in case of elevated prolactin levels, this can cause painful breasts (mastodynia).
Prolactin also has other functions that are still less well understood. For example, it may play a role in the regulation of fluid balance and reproduction, such as egg maturation in women. An increase in prolactin causes us to retain more fluid, which can lead to weight gain and bloating. In addition, prolactin can affect the release of our reproductive hormones (such as FSH, LH, oestrogen and progesterone). Too much prolactin can reduce egg maturation which can also cause an irregular menstrual cycle. In addition, prior to our periods, we have lower oestrogen and progesterone levels which combined with increased levels of prolactin cause depressive symptoms and symptoms of anxiety or irritability. Prolactin can also interact with serotonin receptors in the brain through which it affects mood and contributes to emotional symptoms such as anxiety and depression.
Research shows that lowering prolactin secretion reduces physical and mental symptoms of PMS. Prolactin release is mainly regulated by the hormone dopamine produced in another part of the brain; the hypothalamus. Dopamine inhibits the release of prolactin. When dopamine production decreases, the inhibition of prolactin decreases, causing the pituitary gland to produce more prolactin. The main reason for higher prolactin production is chronic stress and high cortisol levels.
Vitex Agnus Castus: origin and use
Vitex Agnus Castus, also known as chasteberry, is an herb native to the Mediterranean region that has properties that can help balance hormones and thus reduce PMS. It has a long history of use in traditional medicine with mentions of its use in ancient Greece and Rome.
Agnus Castus can be used as a natural remedy to reduce PMS symptoms, such as mood swings, irritability, bloating and painful breasts. It can also be useful for menstrual pain (dysmenorrhoea), irregular menstruation and symptoms of menopause. In Germany and Austria, herbal preparations containing Agnus Castus have been on the market for more than 30 years, and in Switzerland, Agnus Castus is part of the first-line treatment for PMS. The use of Agnus Castus has been approved by the Committee of Herbal Medicinal Products (HMPC), which is part of the European Medicines Agency (EMA).
Agnus Castus is a shrubby plant belonging to the Verbenaceae family that produces small, aromatic flowers that are usually purple in colour. The dried berries of Agnus Castus contain various bioactive substances that together have a harmonising effect on the (female) hormone balance.
Three ways Agnus Castus helps alleviate PMS symptoms:
Restoring hormonal imbalance: Agnus Castus is said to have an effect on the pituitary gland, which plays a crucial role in hormone regulation. By influencing the production of luteinising hormone (LH) and follicle-stimulating hormone (FSH), Agnus Castus can help restore hormonal balance, relieving PMS symptoms.
Mood stabilisation: One of the most challenging aspects of PMS is the emotional rollercoaster. Agnus Castus reportedly has a calming effect on the nervous system which may help stabilise mood swings, irritability and anxiety associated with PMS.
Relief of physical symptoms: Many women experience uncomfortable physical symptoms during PMS, such as bloating and sore breasts. Agnus Castus may have diuretic properties that can reduce fluid retention and bloating. In addition, its possible influence on hormone levels can help relieve painful breasts.
Mechanism of action
Agnus Castus appears to affect the pituitary-hypothalamic axis, two areas in the brain involved in hormone secretion and hormone regulation. The exact mechanism of action of Agnus Castus is not fully known, but studies suggest that its main mechanism of action is the stimulation of dopamine receptors that inhibit overproduction of the hormone prolactin.
Pay attention to before taking
There are a few things to be considerate of before taking Agnus Castus. Its use is not recommended for women who are pregnant, breastfeeding or have (had) or are at higher risk of hormone-sensitive cancer (breast, uterus, ovaries). Agnus Castus acts on the neuroendocrine system and can therefore influence the effect of hormone-regulating medication, such as the contraceptive pill and hormone IUD. It can also influence the effect of dopamine agonists and antagonists, such as antipsychotics and medication against Parkinson’s disease. Therefore, always consult your GP before taking Vitex Agnus Castus to see if this natural remedy for PMS is right for you.
Dose and duration of usage
There is no standard recommended dosage when using Agnus Castus. Most studies showing effective results against PMS used a daily dosage between 4-40 mg of dried extract. The effective amount may vary depending on the product, concentration and purpose of use. There are many herbal supplements on the market where a dosage well above 40 mg is offered and recommended, but there is no scientific evidence for this. Therefore, consult your doctor about the dosage before using the product. Holland & Barrett has a supplement on the market with capsules of 40 mg that you could take once a day, instead of 4 times a day as recommended on the packaging.
We also recommend consulting your doctor about the duration of intake. With herbal supplements, both habituation and irritation of the body can occur, therefore it may be desirable to stop after a few months or switch to a maintenance dose. The study by Di Pierro et al (2009) showed that after a 90-day period, taking 40mg of Vitex Agnus Castus daily, PMS symptoms decreased significantly and a maintenance dose of 7 days/per month in the week prior to menstruation was sufficient to maintain the decrease.
Understanding the complex hormonal dance of PMS and the role of prolactin offers a new perspective on understanding and addressing this challenging phase. Vitex Agnus Castus is a natural aid to relieve imbalance and improve quality of life during the menstrual cycle. While the herb attracts attention as a potentially effective solution, it is vital to seek medical advice and consider individual needs and reactions. With proper care and knowledge, you can find a path to relief from PMS and better longterm wellbeing.
References
(1) Green, LJ, O’Brien, PMS, Panay, N, Craig, M on behalf of the Royal College of Obstetricians and Gynaecologists. Management of premenstrual syndrome. BJOG 2017; 124: e73–e105.
(2) Girman, A., Lee, R., & Kligler, B. (2003). An integrative medicine approach to premenstrual syndrome. American journal of obstetrics and gynecology, 188(5 Suppl), S56–S65. https://doi.org/10.1067/mob.2003.403
(3) Carroll, B. J., & Steiner, M. (1978). The psychobiology of premenstrual dysphoria: the role of prolactin. Psychoneuroendocrinology, 3(2), 171–180. https://doi.org/10.1016/0306-4530(78)90005-7
(4) van Die, M. D., Burger, H. G., Teede, H. J., & Bone, K. M. (2013). Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials. Planta medica, 79(7), 562–575. https://doi.org/10.1055/s-0032-1327831
(5) Stute, P., Bodmer, C., Ehlert, U., Eltbogen, R., Ging, A., Streuli, I., & von Wolff, M. (2017). Interdisciplinary consensus on management of premenstrual disorders in Switzerland. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 33(5), 342–348. https://doi.org/10.1080/09513590.2017.1284788
(6) Assessment report on Vitex agnus-castus L., fructus (europa.eu)
(7) Di Pierro, Francesco & Prazzoli, Roberta & Candidi, C. & Attolico, M.. (2009). Premenstrual syndrome: Controlled clinical trial with a fast acting form of a highly standardized extract of Vitex agnus castus. Giornale Italiano di Ostetricia e Ginecologia. 31. 153-157.
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