Michael Thomsen Blog
Vitex and cyclic mastalgia
It usually presents mid to late in the luteal phase and is associated with latent hyperprolactinemia due to the insufficient inhibitory effect of dopamine on the pituitary gland.
The hypersecretion of prolactin by the pituitary gland before menstruation or in response to stressful daily stimuli can occur when the inhibitory effect of dopamine on the pituitary gland is insufficient to modulate its release.
Vitex agnus-castus is known for its dopaminergic activity and actions on latent hyperprolactinemia.
Vitex binds to dopamine-2 receptors in the brain, downregulating the activity of the the prolactin-producing cells of the anterior pituitary known as lactotropes.
It is through this dopaminergic activity that vitex indirectly enhances corpus luteum development, alleviating symptoms of premenstrual syndrome.
A systematic review AND meta-analysis published last year (2020) reviewed 25 studies (17 randomized control trials plus eight nonrandomized trials).(Ooi, Watts et al. 2020)
Vitex was effective in relieving breast pain and lowering the increased serum prolactin level in women with or without premenstrual syndromes.
The meta-analysis included only six studies (n = 718, VAC = 356, placebo = 362) and revealed a moderate effect size (SMD: 0.67, 95% CI: 0.5-0.85) favouring vitex over a placebo.
Seven trials demonstrated vitex to be a non-inferior alternative to pharmaceutical therapies for cyclic mastalgia, including dopamine agonists, nonsteroidal anti-inflammatory drugs, serotonin reuptake inhibitors, and hormonal contraceptives.
Vitex was safe and associated with only mild and reversible adverse events.
Vitex berries contain essential oils (e.g., limonene, sabinene, 1,8-cineole, iridoid glycosides (e.g., agnoside, aucubin), diterpines (e.g., vitexilactone, rotundifuran), and flavonoids (e.g., apigenin, casticin, orientin, isovitexin).
- The European Union vitex herbal monograph recommends 6–12:1 dry extract with ethanol solvent (60%).
- In Australia, and other English-speaking countries, 1:5 tinctures or 1:2 extracts are more common.
- The main active dopaminergic compounds are thought to be the diterpenes. Companies may use the flavonoids agnuside and casticin as marker compounds to ensure consistency.
A review of 17 vitex products found a wide range of variation in agnuside (14% to 5054%) and casticin (3% to 1272%) content (Fukahori, Kobayashi et al. 2014)
It is hard to reconcile this finding. Surely there is an optimal quality and dosage for vitex in the treatment of PMS, mastalgia etc.
Product, Company, Extract name, mg Vitex extract:
- Mastodynon* , Bionorica - mother tincture
- Agnucaston, Bionorica, BNO 1095, 4 mg
- Prefemin (Premular in Australia), Zeller, ZE 440, 20 mg
- Monoselect Pharmextracta, 40 mg
- Femicur Schaper & Brümmer, 4 mg
• Mastodynon is a homoeopathic remedy containing: Agnus castus ø 162.0 mg, Caulophyllum thalictroides Dil. D 4 81.0 mg, Cyclamen Dil. D 4 81.0 mg, Ignatia Dil.D 6 81.0 mg, Iris Dil. D 2 162.0 mg, Lilium tigrinum Dil. D 3 81.0 mg.
- Dosages varied 4-40 mg/day with a treatment duration of 3 months in the studies included in the systemic review and meta-analysis.
- The typical liquid extract dose used in English speaking countries including Australia is 5 to 20 ml per week, or 2 ml in the morning.
- 2 ml of a 1:2 extract is 1000 mg which is a 50-fold higher dose compared to the Zeller extract Ze 440.
It is difficult to comprehend such large differences in dosing between German and English-speaking traditions. It may be due to the quality of the raw material. The Swiss company, Zeller, control the entire process from farm to finished product.
Earlier tinctures and extracts may have been based on poor quality starting materials. Australian vitex extracts are probably of high quality now but the dosing has remained high, probably just due to habitual prescribing.
The products used in clinical trials have mostly been the German and Swiss products listed above. Prefemin from Zeller is available in Australia as Premular from Flordis. If you want to use a clinically proven vitex, Premular is the obvious choice.
PMS, mastodynia/mastalgia, luteal insufficiency, menstrual bleeding disorders, amenorrhoea, oligomenorrhoea, polymenorrhoea, menorrhagia, and acne vulgaris.
Fukahori, M., S. Kobayashi, Y. Naraki, T. Sasaki, H. Oka, M. Seki, S. Masada-Atsumi, T. Hakamatsuka and Y. Goda (2014). "Quality evaluation of medicinal products and health foods containing chaste berry (Vitex agnus-castus) in Japanese, European and American markets." Chem Pharm Bull (Tokyo) 62(4): 379-385.
When you subscribe to the blog, we will send you an e-mail when there are new updates on the site so you wouldn't miss them.
Book Review: Phytotherapy Desk Reference
Reviewed by Mim Beim
My original copy of Michael Thomsen’s Phytotherapy Desk Reference is herb-stained and dog-eared. So it was with much excitement that I received the latest edition of this little gem.
The book, as with the previous editions, has been designed not as an exhaustive materia medica but rather as a desk reference for the busy herbalist. It contains short, precise descriptions of 236 of the most commonly used herbs in Australia and New Zealand.
The extensively revised and updated 5th edition of the Phytotherapy Desk Reference
Phytotherapy Desk Reference 5th Edition ISBN: 978-0-646-82443-7 Soft-cover, spiral bound. 200 pages. 233 Monographs.