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The species name Agnus castus originates from the Greek agnos castus, meaning chaste, as the Greeks thought the plant calmed sexual passion. Its common name of caste berry and monks pepper also gives some indication of its historical usage.

Herbal medicines are now readily available not just from medical herbalists but from health food stores, high street chemists and even from supermarkets. Certain herbs have been adopted by the media, and articles on their uses, both real and imaginary abound. One such herb is Vitex agnus castus. This herb is probably one of the most important herbs used by Medical Herbalists to treat female hormonal disorders and is considered to be a hormonal modulator.[1]

The species name Agnus castus originates from the Greek agnos castus, meaning chaste, as the Greeks thought the plant calmed sexual passion. Its common name of caste berry and monks pepper also gives some indication of its historical usage.

Agnus Castus

Historical usage

Vitex agnus castus consists of the dried ripe fruits of a densely branched shrub that is indigenous to the Mediterranean and Central Asia. The commercial crops mainly come from Albania and Morocco. The plant blooms in the height of the summer and after pollination develops dark reddish brown to black fruits about the size of a pepper corn. It is this dried fruit that is used in medicine today.

Vitex agnus castus has been used in medicine for centuries, one of the first specific records of its medical use is by Hippocrates in the 4th Century BC. Both Hippocrates and later Dioscorides in his De Materia Medica written in AD 77 talk about using Vitex as a sitz bath for diseases of the uterus. Throughout the Middle Ages medical writers in Europe simply recopied the ancient Greek and Roman sources, and Vitex was used to treat female disorders. Gerard, one of the great Renaissance herbalists, gathered information about herbs from both Greek and Roman sources as well as from folk and professional Herbalists at the time. He and other writers on Herbal Medicine such as Turner, Dodoens and Parkinson recommend Vitex for inflammation of the uterus and as an emmenagogue.

After the early 1700s Vitex fell out of popularity in England where it wasn't rediscovered until it gathered new interest as a herb for female reproductive imbalances in the mid 1900s. The modern interest in Vitex began in Germany, where in 1930 Dr Gerhard Madaus conducted some of the first scientific research on the plant's effects on the female hormonal system. Madaus developed a patent medicine from an extract of dried Vitex fruits. This medicine trademarked as Agnolyt has subsequently been used in almost all scientific studies on Vitex.

The fruits were found to have 1.3–1.64% yield of essential oil, 22% sabinene, 20% 1.8 cineole, 6% alpha-pinene. The essential oil has an antibacterial activity.2 The fruits also contain flavonoids and iridoid glycosides. The iridoid glycosides have recently been quantified and consists of 0.3% acubin, 0.6% agnoside and 0.07% eurostoside.3 No individual constituent of Vitex has been shown to have an intrinsic hormonal activity, and the chemical composition responsible for its action has not yet been isolated.

Scientific studies

One of the most cited studies of the pharmacological effects of Vitex was carried out by Haller at the University of Gottingen in the early 1960s. Female Guinea pigs were given Vitex tincture orally at normal to high dose for 90 days.3 At the end of this time the animals were examined for any changes in organ structure or weight. It was concluded that at normal doses Vitex clearly demonstrated a decrease of oestrogen effects and an increase of progesterone effects. This effect was mediated through the pituitary gland: Follicle Stimulating Hormone secretion was decreased and Lutenizing Hormone and Prolactin secretion were increased. Consistent with this hypothesis, corpus luteal development and glandular proliferation in breast tissue were enhanced and follicular development and uterine weight were slightly decreased.

Indications for use of Vitex

Vitex has been traditionally used to treat a number of differing medical problems, but with particular emphasis on menstrual disorders and related hormonal problems. These are all situations that indicated corpus luteum insufficiency, and sub optimal ovarian function. This is usually defined as abnormal low progesterone levels three weeks after the onset of menstruation (serum progesterone below 10–12 ng/ml). This state is normal during puberty and at menopause, but it is considered abnormal when occurring in women between ages 20 to 40 years. This includes pre-menstrual syndrome, polymenorrhea, an ovulatory cycle, secondary amenorrhoea, infertility and hyperprolactinemia.

Pre-menstrual syndrome (PMS)

In clinical practice it is one of the most frequently discussed menstrual problems, either in isolation or in conjunction with other related problems. It has been estimated that 30 to 40% of menstruating women are affected by pre-menstrual syndrome. Even after menopause women can complain of cyclic mood swings that on investigation are shown to mirror their previous menstrual cycle.

There have been two large surveys done in Germany to study the effect of Vitex on 1542 women diagnosed as suffering from PMS.4 Theses patients were treated for both corpus luteum insufficiency and uterine fibroids. The trial lasted for 166 days using Vitex fluid extract Agnolyt. The treatment was assessed by both patient and practitioner and in 90% of cases symptoms were completely relieved. Physical symptoms such as headaches, sore breasts, bloating and fatigue and psychological changes such as increased appetite, sweet cravings, nervousness/ restlessness, anxiety, depression, mood swings and lack of concentration were all reduced. It was noted that improvement in symptoms began on average after 25.5days.

A controlled clinical trial in England found a significant improvement in all types of PMS except PMS-C, which is characterised by headaches, sweet cravings, palpitations and dizziness.5 My own clinical experience over the past eight years leads me to believe that this is correct and I would suggest that to treat the symptoms of PMS-C the prescription should include other herbs as well as Vitex. Dietary therapy is also important in preventing incidences of low blood sugar that can trigger PMS-C symptoms. The surveys carried out in Germany make no mention of what other advice was or was not given to the patient.

Abnormal menstrual cycle

One of the first major clinical studies on Vitex was by Probst and Roth in 1954.6 Fifty seven women suffering from a variety of menstrual disorders were given Vitex on a daily basis. Fifty patients developed a cycle in Phase with menses, while seven women did not respond. Of these fifty women six with secondary amenorrhoea demonstrated one or more cyclic menstruation. Of the nine patients with scant or infrequent menstrual flow, six found that they had a shortening of the menstrual interval and an increase bleeding. Most significant was the result experienced by 40 patients suffering from cystic hyperplasia of the endometrium who all developed an improvement in menstrual regularity. This disorder is due to relative progesterone deficiency and mainly manifests as dysfunctional menstrual bleeding. No side effects of Vitex were observed.

Vitex and Breast feeding

Traditionally Vitex has been used to promote breast milk flow. Pliny the Greek natural historian (AD 23–79) spoke of using the plant to promote menstruation, to purge the uterus and to promote the flow of milk in new mothers. In the early 1950s several researchers used the Agnolyt preparation to confirm this age old belief. In study it was shown that of 100 nursing mothers, those that used Vitex rather than a placebo had increased milk flow and ease of milk release.4 This confirmed the findings of an earlier trial on lactating women with poor milk production, who when treated with Vitex were found to effectively increase milk production. Vitex took several weeks to show results, but was then used effectively for several months. No problems have been reported with the safety of Vitex for breast fed infants.

Vitex and Infertility

Literature produced by Mediherb7 combines the data from two trials on the influence of Vitex on the corpus luteum. Vitex was used by 45 infertile women between the ages of 23 and 39. The women were considered capable of reproduction and had normal prolactinaemia but showed pathologically low serum levels at day 20 of the menstrual cycle. After three months Vitex treatment was considered successful in 39 of the 45 women. Seven women became pregnant, 25 had normal serum progesterone levels at day 20 and another 7 tended toward normal. This generally coincides with a lengthening of the luteal phase and a positive change in the LHRH test dynamic. The findings indicate an enhancement of corpus luteal function.

Vitex and hyperprolactinemia

The modulating effect of Vitex on Prolactin was confirmed in a double blind placebo trial examining the effect of a proprietary Vitex preparation on 52 women. The daily doses of Vitex extract was 20mg and the study lasted for three months. Hormonal analysis was performed on day 5–8 and day 20 of the cycle both before and after three months of the therapy. Prolactin release was significantly reduced in the Vitex group. Shortened luteal phases and deficits in progesterone production were normalised. No side effects were noted.4

Vitex and menopause

Dr Madaus own therapeutic manual on the Agnolyt suggests that it can be used to treat menopausal symptoms. Within my own practice I have found Vitex useful in treating peri menopausal and menopausal symptoms, in particular hot flushes, and menstrual irregularities such as flooding, clotting and irregular cycle. Post menopausal women who still feel cyclic mood swings can also benefit. In some cases if large doses of Vitex are given women, who are experiencing menopausal depression may find that their symptoms get worse. This effect is reversed when the dose is reduced.

Vitex preparations

A standardised fluid extract of Vitex agnus castus 1:1 45% at a dose of 2 to 4 ml per day or a tincture 1:3 45% at a doses of 6 to 12 mls per day are the usual preparations given by a practitioner. Tablets of 280mg Vitex extract taken at a dose of two tablets in the morning. It is usually recommended by Medical Herbalists that Vitex be taken as a single daily dose first thing in the morning.

It is important to note that Vitex is not a fast acting medication and needs to be taken consistently for some time. The average length of treatment is six months. Patients should be guided by Medical Herbalists who are members of either the National Institute of Medical Herbalists or the Collage of Practitioners of Phytotherapy.

References

1: British Herbal Pharmacopoeia 1996, British Herbal Medicinal Association.
2: Kustrak D.et al, The composition of essential oil of Vitex agnus castus. Planta Medica 52 1992 Supplement Issue 1 A681.
3: Mediherb Newsletter February 1989, Mediherb Pty Ltd, Queensland, Australia.
4: Brown D, Herbal Research Review: Vitex agnus castus Clinical Monograph. Quarterly Review of Natural Medicine Summer 1994.
5: Gerard House, Promotional Literature 1988.
6: Probst V and Roth OA: On a plant extract with a hormone like effect. Dtsh Med Wschr 79: (935) 1271–4 1954.
7: Mediherb Newsletter, October 1994, Mediherb Phy Ltd, Queensland, Australia.

Further Reading

Madaus G: Agnolyt Promotional Brochure: Cologne
Griggs B: Green pharmacy>: A history of Herbal Medicine, 1981 Robert Hale Ltd. London
Weiss R.F.: Herbal Medicine, Ab, Arcanum, Sweden 1988
Mills. S. The Dictionary of Modern Herbalism. 1985, Thorsons Publishers Ltd. Northamptonshire.