Most women recognise the characteristic signs and symptoms of the onset of menstruation, yet for 40% with premenstrual syndrome (PMS) this can be predictable misery. Further, up to 8% will experience the more severe and life-affecting emotional and psychological distress of premenstrual dysphoric disorder (PMDD) with marked depression, anxiety, irritability, brain fog and fatigue, with altered sleep and appetite. ^1,2

Painful breast tenderness, or mastalgia, accompanying PMS affects 41% to 79% of women, is a common reason for women presenting to clinic. Whilst mastalgia may interfere with relationships, activities and quality of life, ³ like PMS and PMDD, cyclical mastalgia typically occurs during the luteal phase and resolves during menses.

Whilst medical management primarily manages PMS/PMDD with hormonal interventions and/or antidepressants, many women are turning to complementary therapies. ¹ Whilst considered a more conservative approach, strong scientific evidence supports the use of herbs and nutrients, including Vitex agnus castus (Vitex), Withania somnifera (Withania), and vitamin B6 for these conditions.

Vitex has been trusted to support women’s health for over 2,500 years. ⁴Today, clinical trials and systematic reviews validates its role in significantly reducing the constellation of mood, behavioural and physical symptoms, including mastalgia, in women with PMS. ^1,5 Overall, the evidence concludes that women taking a daily dose of 20 mg to 40 mg of Vitex are 2.57 times more likely to send their PMS symptoms into remission, compared to placebo. ^1,6–9

Vitex has also been compared to fluoxetine for PMDD. ¹⁰ At a dose 20 mg to 40 mg of either Vitex or fluoxetine over two menstrual cycles, both strategies improved symptom severity, and frequency. Of interest, fluoxetine was found to be more effective for psychological symptoms whilst Vitex was more effective on physical symptoms.

Supporting a woman’s baseline stress response is also critical, as stress can wreak havoc on both hormonal and mental health. ^11,12 Enter the herb Withania and vitamin B6, which are shown to boost resilience in PMS and PMDD.

Withania emerges as a valuable candidate for managing PMS. When paired with structured Ayurvedic psychotherapy, the duo effectively managed cognitive, affective, and behavioural symptoms of PMS. ¹³ Withania helps modulate serum cortisol levels, boosting stress resilience ² and lowering its impact on a woman’s hormones.

Vitamin B6 is another hero in this story. As an essential cofactor for the neurotransmitters gamma-aminobutyric acid (GABA) and serotonin, B6 blunts the impact of stress hormones and supports a healthy mood. ¹⁴ The positive effects of vitamin B6 in reducing the severity of PMS symptoms are well documented. ^14–16 In just two months, women taking 40 mg daily experienced marked improvements in irritability, anger, boredom, and breast pain and tenderness. ¹⁷ When prescribed to women with cyclic mastalgia, 40 mg daily for two months lead to a 76% decrease in mean pain severity. Further, numbers of women in the moderate and severe groups fell by 84% and 70% after just one month of supplementation. ³

When hormonal imbalances are disrupting daily life, empower your patients with effective and natural solutions. Vitex, Withania and vitamin B6, as contained in Vitex, Ginger and Withania to Increase Progesterone, are powerful allies, well positioned to support the menstrual cycle, and improve symptoms of PMS, PMDD and cyclical mastalgia.