Vitex (Chaste Tree) for Hormonal Health

Vitex Monograph

You’ve probably heard of Vitex (Vitex agnus-castus), also known as chaste tree or chaste berry. This herb has been used for centuries and now has an abundance of scientific studies supporting its reputation as a natural hormone balancer. Popular among women for reducing symptoms of PMS and even improving fertility and reducing the symptoms of menopause, it’s likely that you’ve seen supplements made from this herb on the shelves of your neighborhood pharmacy.

Botanical Information

According to the USDA plants website, Vitex was a member of the Verbenaceae family until it was reassigned to the mint family, Lamiaceae. It is a perennial shrub or tree, growing up to about 15 feet high and 10 feet wide. Its fragrant lilac flowers grow in a cone-shaped spike and bloom in late spring to early fall. It has smooth lance-shaped leaves and peppery fruits. It is native to the eastern Mediterannean and has since been introduced to the United States, Puerto Rico, and the Virgin Islands. In the United States, it can be found in the south and along the southern and central portions of both the east and west coasts.

Map from http://plants.usda.gov showing the geographical distribution of Vitex in the U.S.

Vitex in the Garden

Chaste trees prefer full sun and dry, well-drained inorganic soils such as pebbles or stones. Avoid organic soils that hold too much moisture near the roots. Once established, you’ll likely never need to water your chaste tree, and they do well in xeriscaped gardens where water is scarce. Chaste trees die back due to freezes in severe weather but quickly grow back from the roots. It is recommended to prune your chaste tree annually to control shape and size as well as to promote branching. Removing flowers after they’ve bloomed will encourage more blooms later in the season. If you’re looking to harvest the fruits, you’ll of course want to allow the seeds to mature into fruits and avoid trimming the flowers off once they’ve bloomed.

Evidence for Vitex’s Medicinal Properties

There is now an abundance of research that supports the effectiveness of Vitex in improving hormonal disorders such as PMS ( which boasts an array of over 150 associated symptoms), PMDD, PCOS, endometriosis, uterine fibroids, infertility, and menopausal symptoms (Romm, Tilgner, Zamani). Vitex has been shown not only to improve physical symptoms such as chronic mastalgia and menstrual cramps but mental symptoms such as depression as well (Zamani).

According to Dr. Sharol Tilgner’s Herbal ABC’s The Foundation of Herbal Medicine, the main constituents of the chaste tree fruits are vitexin, casticin, agnuside, alkaloids, diterpenoids, flavonoids, terpenoids, neolignans, and phenolic compounds. Dr. Tilgner classifies this herb as a phytoprogresterone due to its ability to increase progresterone and reduce estrogen. She recommends using this herb specifically for her patients with symptoms of excess estrogen and low progesterone. Dr. Tilgner notes that Vitex may need to be taken for 2-3 months before its effects can be observed, especially in cases such as reversing amenorrhea (lack of menstruation).

Dr. Aviva Romm, a medical doctor who has also been a practicing herbalist for decades, wrote at length on on her use of Vitex in a blog post called 5 Ways Vitex Can Help Your Hormones. She also recognizes that though effective, Vitex may need to be taken for weeks or months before noticing its impact. For this reason, she recommends combining Vitex with other more fast-acting herbs to improve symptoms of PMS.

Dr. Romm discusses how Vitex does not contain any hormones within it, but rather acts on the pituitary gland, HPA-axis, and specifically the production of luteinizing hormone. By acting on the pituitary, Vitex has been shown to keep prolactin levels in check, reduce estrogen, and increase progesterone, which is likely responsible for its ability to reduce symptoms associated with excess estrogen and prolactin. Vitex has also been shown to have dopaminergic affects, which may play a role in its ability to reduce hyperprolactinemia (Romm, Tilgner, Wuttke, Zamani).

For example, it is thought that hyperprolactinemia could be the cause of premenstural and chronic mastalgia (breast pain/tenderness) due to the reduced inhibitory effect of dopamine on the pituitary gland (Ooi). A meta-analysis that looked at the research on the effectiveness of Vitex in treating chronic mastalgia concluded that Vitex is effective in both reducing elevated prolactin levels and symptoms of chronic mastalgia. However, the authors noted that there was potential for bias amongst some of the studies analyzed, though insufficient information made this unclear (Ooi).

In a randomized, placebo-controlled, double-blind study, 128 women with PMS were split into a control group (62 women) and a placebo group (66 women) and then asked to fill out a questionnaire regarding their PMS symptoms. The questionnaire listed symptoms such as headache, breast pain, bloating, depression, restlessness, anxiety, and irritability during their last menstural cycle. They were then administered 40 drops of Vitex agnus-castus extract (or equivalent placebo) for 6 consecutive days prior to their next period for 6 consecutive cycles. After the 6th cycle, the women were asked to fill out the same questionnare again. The women in the Vitex group demonstrated significantly reduced symptoms of PMS when compared to the placebo (Zamani).

A similar study that was also randomized, double-blind, and placebo-controlled measured the effectiveness of 20mg of dried Vitex extract taken daily over the course of 3 consecutive menstrual cycles for reducing PMS symptoms. Like the previous study, 170 women were divided into a Vitex group (86 women) and the placebo control group (84 women) and then asked to fill out a questionnaire relating to the PMS symptoms of their last menstrual cycles. They were then administered either 20mg dried Vitex extract or placebo daily for 3 cycles before completing the same questionnaire again. Once more, the women who took Vitex demonstrated a significant reduction in their PMS symptoms when compared to the placebo group. Further, the study mentions Vitex’s ability to modulate stress-induced prolactin via dopamine as a mechanism of action (Schellenburg).

Herbal Preparations and Dosages

According to Dr. Sharol Tilgner in her book Herbal ABC’s, an infusion of 1 tsp crushed chaste tree fruits in 1 cup of just-boiled water can be taken daily. If you prefer to work with a tincture, she recommends a ratio of 1:3 at 20-75 drops taken 1-3 times daily. Specifically for premenstural cramps, Tilgner recommends taking a tincture of Vitex in the dose of 5-30 drops for 3-5 days prior to menstruation (Tilgner). Dr. Aviva Romm states that taking the encapsulated powdered chaste berry at a dose of 20-40 mg/day is effective for those who prefer pill or capsule form (Romm). In Tilgner’s other book titled Herbal Medicine from the Heart of the Earth, she cites her use of chaste berry combined with burdock root, dong quai, calendula, red root, and cleavers in a formula specially designed for clients with cysts, endometriosis, or fibroids.

Traditional Chinese Medicine and Vitex

The Chinese have used Vitex for centuries, though the eastern varieties of chaste tree (v. trifolia and v. rotundifolia) have somewhat different uses. Also referred to as “Man Jing Zi,” the eastern varieties of Vitex are thought to have a cooling energetic effect and an acrid and bitter flavor. Man Jing Zi is used to clear liver heat and relieve wind heat, acting on the liver, stomach, and urinary bladder meridians of the body. The Chinese variety is especilally good for treating headaches, eye pain, dizziness, and muscle aches and pains, while the western variety that we’re discussing here is used as a female hormone regulator (Tierra).

Considerations

Dr. Romm and Dr. Tilgner both describe Vitex as being a relatively safe herb with only a few potential side effects. It is not recommended to be taken during pregnancy due to its emmenagogue properties and it could counteract the effectiveness of birth control or some hormone therapies. Additionally, because it has been shown to bind directly to dopamine receptors, it has potential interactions with dopamine antagonist drugs (dopamine blockers). Finally, vitex may aggravate estrogen-deficient conditions due to its ability to reduce estrogen and increase progesterone secretion. (Tilgner)

Works Cited

1. “5 Ways Vitex Can Help Your Hormones.” Aviva Romm MD, 6 Mar. 2019, https://avivaromm.com/vitex-hormones/.

2. Ooi, Soo Liang, et al. “Vitex Agnus-Castus for the Treatment of Cyclic Mastalgia: A Systematic Review and Meta-Analysis.” Mary Ann Liebert, Inc., Publishers, 29 Aug. 2019, https://www.liebertpub.com/doi/abs/10.1089/jwh.2019.7770.

3. Schellenberg, R. “Treatment for the Premenstrual Syndrome with Agnus Castus Fruit Extract: Prospective, Randomised, Placebo Controlled Study.” BMJ (Clinical Research Ed.), BMJ, 20 Jan. 2001, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC26589/.

4. Tierra, Michael. The Way of Chinese Herbs. New York, NY: Pocket Books, 1998.

5. Tilgner, Dr. Sharol. Herbal ABC’s The Foundation of Herbal Medicine. Pleasant Hill, OR: Wise Acres LLC., 2018.

6. Wuttke, W, et al. “Chaste Tree (Vitex Agnus-Castus)--Pharmacology and Clinical Indications.” Phytomedicine : International Journal of Phytotherapy and Phytopharmacology, U.S. National Library of Medicine, May 2003, https://www.ncbi.nlm.nih.gov/pubmed/12809367/.

7. Zamani, M., N. Neghab, and S. Torabian. “Therapeutic Effect of Vitex Agnus Castus in Patients With Premenstrual Syndrome”. Acta Medica Iranica, Vol. 50, no. 2, 1, pp. 101-6, http://acta.tums.ac.ir/index.php/acta/article/view/3866.