Mastalgia is considered to relate to latent and increased basal prolactin levels; therefore, agents that reduce prolactin levels are anticipated to reduce symptoms. For this reason, vitex is a popular treatment for mastalgia.

In two randomised, double-blind studies, vitex (Mastodynon) effectively reduced premenstrual mastalgia (Halaska et al 1998, Splitt et al 1997, Wuttke et al 2003). Subjects completed a visual analogue scale (VAS) and rated their breast pain from 0 (lowest breast pain) to 10 (extremely strong breast pain). Active treatment reduced the mastalgia score by 35-40%, an effect significantly stronger than that of placebo (25%). One of these studies also demonstrated that treatment with vitex reduced serum prolactin levels (Splitt et al 1997, as reported in Wuttke et al 2003). According to Halaska et al (1998), symptom relief was experienced after the first month of treatment with continued improvements experienced after the second and third months.

Commission E approves the use of chasteberry for this indication. IRREGULARITIES OF THE MENSTRUAL CYCLE

Chasteberry is used to normalise menstruation in women with shortened, lengthened or infrequent menstruation, particularly when low progesterone and luteal phase defects are suspected. A randomised controlled trial of women with luteal phase defect due to latent hyperprolactinaemia demonstrated that vitex extract (20 mg daily) effectively reduced prolactin levels and normalised luteal phase length and progesterone levels after 3 months' treatment (Milewicz et al 1993). Commission E approves the use of chasteberry for this indication.

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