Vitex Agnus-castus for the treatment of cyclic mastalgia: a systematic review and meta-analysis

Abstract

Background. Cyclic mastalgia (CM) is premenstrual bilateral and diffuse breast pain that presents cyclically and affects women in their reproductive years. It may associate with latent hyperprolactinemia due to the insufficient inhibitory effect of dopamine on the pituitary gland. Vitex agnus-castus (VAC) is known for its dopaminergic activity and its possible actions on CM and latent hyperprolactinemia. However, the treatment effect of VAC on CM remains unclear.Materials and methods. To perform a systematic review and meta-analysis of clinical trials that report on the efficacy ofVAC treatment in CM patients, literature search was performed in major research databases.Results. This review includes 25 studies (17 randomized control trials plus eight nonrandomized trials). VAC was effective in relieving breast pain intensity and lowering the increased serum prolactin level in reproductive age CM patients (18-45 years) with or without premenstrual syndromes. Typical dosage was 20-40 mg/day with a treatment duration of 3 months. A conservative meta-analysis included only six studies (n = 718: VAC - 356, placebo - 362) and revealed a moderate effect size (SMD 0.67, 95% CI 0.5­0.85) favoring VAC over a placebo. Seven trials demonstrated VAC to be a noninferior alternative to pharmaceutical therapies for CM, including dopamine agonists, nonsteroidal anti-inflammatory drugs, serotonin reuptake inhibitors, and hormonal contraceptives. VAC was safe and associated with only mild and reversible adverse events. However, the risk of bias in most studies was unclear due to insufficient information.Conclusion. VAC is a safe and effective treatment option for CM. More high-qualityclinicaltrialsareneededto strengthentheevidencebase.

Does Vitex Agnus-Castus L. Have Deleterious Effect on Fertility and Pregnancy Outcome? An Experimental Study on Rats for Prediction of Its Safety

“…In addition, the dopaminergic effects of VAC are supposed to be beneficial in treating cyclic mastalgia [8]. In 2019, Niazi et al related this effect to antioxidant compounds with anti-inflammatory and analgesic effects [18].…”

“…This dosage was used because it is considered to interfere with the sexual cycle after 30 days of consumption in rats [7]. Also, in human beings, the effects of the drug can be seen after the first month of usage [8]. For mating, the female rats were caged for 24 h with a fertile matched male rat.…”

The management of premenstrual syndrome: results of a questionnaire survey of women in Lviv pharmacies, Ukraine

“…Therefore, the duration of nonsteroidal anti-inflammatory drugs usage (particularly in self-medication) should not exceed three days [29]. Herbal remedies with chasteberry (Vítex Agnus-castus) inhibit the secretion of dopamine and follicle-stimulating hormone, normalize the hormonal imbalance of the estrogen-progesterone system, and reduce prolactin secretion [30,31]. Medications containing St. John's wort (Hypericum perforatum) are effective in eliminating behavioral disorders in PMS (level of evidence C) [32][33][34].…”