Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study.

OBJECTIVES To compare the efficacy and tolerability of agnus castus fruit (Vitex agnus castus L extract Ze 440) with placebo for women with the premenstrual syndrome. DESIGN Randomised, double blind, placebo controlled, parallel group comparison over three menstrual cycles. SETTING General medicine community clinics. PARTICIPANTS 178 women were screened and 170 were evaluated (active 86; placebo 84). Mean age was 36 years, mean cycle length was 28 days, mean duration of menses was 4.5 days. INTERVENTIONS Agnus castus (dry extract tablets) one tablet daily or matching placebo, given for three consecutive cycles. MAIN OUTCOME MEASURES Main efficacy variable: change from baseline to end point (end of third cycle) in women's self assessment of irritability, mood alteration, anger, headache, breast fullness, and other menstrual symptoms including bloating. Secondary efficacy variables: changes in clinical global impression (severity of condition, global improvement, and risk or benefit) and responder rate (50% reduction in symptoms). RESULTS Improvement in the main variable was greater in the active group compared with placebo group (P<0.001). Analysis of the secondary variables showed significant (P<0.001) superiority of active treatment in each of the three global impression items. Responder rates were 52% and 24% for active and placebo, respectively. Seven women reported mild adverse events (four active; three placebo), none of which caused discontinuation of treatment. CONCLUSIONS Dry extract of agnus castus fruit is an effective and well tolerated treatment for the relief of symptoms of the premenstrual syndrome.