Vitex (Chasteberry), Fertility
Vitex agnus-castus (chaste tree berry) is a well-known herb that has been used for centuries in Europe for hormonal imbalances in women.
It may help women with PCOS who are lacking a normal menstrual cycle and thus don't ovulate or menstruate.
A high percentage of these menstrual problems are related to insufficient progesterone during the luteal phase of the menstrual cycle. This condition is called a luteal phase defect or corpus luteum insufficiency. A corpus luteum insufficiency is defined as an abnormally low progesterone level 3 weeks after the onset of menstruation. Insufficient levels of progesterone may result in the formation of ovarian cysts.
In addition, some PCOS women have too much prolactin, which can inhibit fertility. Vitex may help with both of these problems
"I've spent thousands of dollars, been to five different gynecologists and had no results from their treatment for PCOS for the past ten years. It was one of your success stories that gave me the courage to try the alternative.
I'm happy to tell you that I took the vitex tablets and I am now 3 months pregnant. My husband and I are very happy. I now definitely believe that alternative medicine is the best way to go."
- Janet Beckford
How does Vitex Work?
Chaste tree berry acts on the hypothalamus and pituitary glands inside your brain by increasing luteinizing hormone (LH) production and mildly inhibiting the release of follicle stimulating hormone (FSH). The result is a shift in the ratio of estrogen to progesterone, in favor of progesterone. The ability of chaste tree berry to raise progesterone levels in the body is an indirect effect, so the herb itself is not a hormone.
When you don't ovulate to start the second half of your monthly cycle, your body does not produce enough progesterone. The resulting progesterone deficiency contributes to symptoms of PCOS. It also contributes to a hormone imbalance called "estrogen dominance". Women with polycystic ovary syndrome frequently have estrogen dominance combined with a progesterone insufficiency. This is part of the hormonal imbalance typically associated with this disorder.
If you were to take oral progesterone or apply progesterone cream to your skin, and a normal cycle occurs, then you can suspect that you have a problem producing enough progesterone.
Chaste tree berry helps your body to solve this problem.
A progesterone-induced menses indicates an intact reproductive system that just isn't going through its cycle. It suggests that the body is producing enough FSH to stimulate the ovaries, and that the ovaries are able develop follicles. It also indicates that production of estrogen by the follicles is sufficient to cause the lining of the uterus (endometrium) to grow and that the sloughed endometrium is able to pass through the cervical opening and the vagina.
Therefore it's possible that the problem is a dysfunction in your hypothalamus or pituitary glands in your brain. The ability of chaste tree to influence the hypothalamus or pituitary then makes this herb a good possibility for treating infertility associated with lack of a normal monthly cycle.
Also, high levels of the hormone prolactin are commonly found with corpus luteum insufficiency. Vitex is useful for reducing high prolactin levels. It inhibits prolactin release by the pituitary gland, especially when you are under stress.
Is Vitex a Hormone?
Chasteberry is not a hormone, nor does it contain hormones. It is a gentle and slow-acting herbal extract as opposed to a hormone prescription that can be expected to have a forceful and immediate impact on your glands and organs.
It does not have the side effects that synthetic hormones have.
There's not a huge body of research about the chaste tree berry in relation to PCOS. However, there is enough evidence to suggest that it could be useful for issues associated with polycystic ovary syndrome such as infertility, acne, hyperprolactemia, female hair loss, and chronic inflammation.
Fertility and Progesterone Production
A number of research studies suggest that consumption of vitex increased production of progesterone. For example, Stony Brook University in New York reported that wild monkeys consuming vitex leaves and fruits excreted more progesterone that other monkeys. They were also more likely to conceive.
In another study, a chasteberry preparation was used in a study of 3,162 women to assess the effectiveness of vitex for corpus luteum insufficiency. 77.4% had menstrual cycle disturbances of various types and the others suffered from a range of gynecological problems which included symptoms of corpus luteum insufficiency. The average length of treatment was 5 months. Hormone cytology and symptoms were used to assess the treatment.
The women reported the treatment as completely effective (33%), significant improvement (55%), and no change (7%). Their doctors reported very good results in 68% of cases, adequate in 22%, and no change in 7%.
In a third study, 20 women with secondary amenorrhea took a chasteberry extract for 6 months. Lab testing was done to measure progesterone, FSH, and LH, and pap smears were done at the beginning of the study, at 3 months, and at 6 months. At the end of the study, the researchers were able to evaluate 15 of the women. Ten out of the 15 women had a return of their menstrual cycles. Testing showed that values for progesterone and LH increased, and FSH values either did not change or decreased slightly.
In a fourth study, 18 women with abnormally low progesterone levels were given vitex daily. After 3 months of treatment, 13 showed increases in progesterone and 2 became pregnant.
Possibly 15% or so of women who have PCOS also have excessively high levels of the hormone prolactin. This is called "hyperprolactinemia".
Why would too much prolactin be a problem?
Prolactin is known mostly for helping your create breast milk.
But actually, prolactin is almost bewildering in its complexity. Thus far, more than 300 distinct biological activities of prolactin have been identified.
Prolactin plays a central regulatory role in your body, including the placenta, uterus, ovaries, immune system, and the skin, just to name a few.
High levels of prolactin are commonly found with corpus luteum insufficiency as well as hypothyroidism, which is another common attribute of PCOS.
So attaining an optimal level of prolactin is very important if you're going to reduce infertility and other symptoms of PCOS such as acne or hair loss.
Fortunately, components of vitex have been shown to reduce prolactin levels if they are high. It inhibits prolactin release by the pituitary gland.
By reducing prolactin availability, vitex can help to improve your fertility and possibly also relieve skin conditions such as acne or hair loss.
In a study from Medizinische Hochschule in Germany, 52 women with luteal phase defects due to latent hyperprolactinemia (high prolactin levels) were given either chastetree berry extract or a placebo. Prolactin levels were normalized after three months in the treatment group and deficits in luteal progesterone production were eliminated. Two of the women became pregnant.
In another study, 13 women with high prolactin levels and irregular cycles were given a vitex compound. Their prolactin levels fell, and a normal menstrual cycle returned to all of the women.
What about Acne?
We haven't seen any recently published research studies to show that vitex helps to reduce acne. More research is needed.
However, there are a couple of older reports of acne being help by the used of this extract.
In one study, a chasteberry preparation was used in women with menstrual cycle abnormalities. Acne was either eliminated or improved during treatment.
In another study, 117 women with four different types of acne were treated with a chasteberry preparation for 1-2 years. Improvement was seen after 6 weeks and by 3 months, about 70% were free of acne. Some treatment relapses were observed after 3-6 weeks.
Is It Helpful for Hair Loss?
Medical research is now showing that prolactin inhibits hair growth. It inhibits hair shaft elongation, shifts hair follicles from the active phase to the resting phase, and impairs the function of cells in the hair bulb in your scalp.
In other words, too much prolactin is a contributor to hair loss. Chronic inflammation is also detrimental to hair growth.
To the extent that vitex can help to reduce high levels of prolactin and act as an anti-inflammatory, it might help to slow down hair loss.
Vitex is Anti-Inflammatory
Chronic inflammation and oxidant stress is a major problem for women with PCOS. Inflammation and oxidant stress worsen symptoms and disturb hormone balance.
In addition to its other benefits, vitex also appears to have anti-inflammatory properties, including inhibition of lipoxygenase, which is a central player in the inflammatory process.
It also appears to be an antioxidant, thus reducing oxidant stress. Oxidant stress is a condition where you have unstable molecules in your body that cause cell damage.
Also, some number of women with PCOS have "estrogen dominance", which means they have way too much estrogen in relation to progesterone. When levels of estrogen are too high, oxidant stress occurs in the hypothalamus gland in the brain, which in turn appears to cause excess prolactin to be produced.
Chronic inflammation also causes your ovaries to produce more male hormones. An excess of male hormones cause hair problems such as hirsutism and hair loss, and interferes with ovulation.
Will It Increase Luteinizing Hormone (LH)?
By Amy Day, ND
Question: Im experiencing irregular cycles and infertility and I want to try Vitex, but Im concerned about it increasing luteinizing hormone (LH).
Ive heard that it increases LH and one of the hallmarks of PCOS is a high LH to FSH ratio. Isnt that just adding fuel to the fire?
Answer: Many women wonder whether they should use the herb Vitex agnus castus, or chaste tree berry, to help with their PCOS symptoms.
In my practice, it has been very effective at encouraging ovulation, managing PMS, regulating the cycle and improving fertility, even in women with polycystic ovary syndrome.
There are two important factors to keep in mind when deciding whether to use this extract.
First, it is not appropriate for every woman with PCOS. I think of it less as a PCOS treatment and more as a treatment for irregular cycles and infertility. If you have PCOS symptoms but are not concerned about fertility or ovulation, then there are other treatments that would be a better fit.
However, if you are struggling with irregular cycles, infertility, a lack of ovulation and low progesterone levels, then Vitex could work wonderfully for you.
The second factor to keep in mind is timing.
Your hormone levels are changing every day of your cycle. The PCOS blood test for LH:FSH ratio is usually run on Day 3 of the cycle. This is a time when LH is supposed to be low, so a high number indicates a problem.
However, as a woman approaches mid-cycle, LH must spike higher in order to stimulate a normal ovulation and then appropriate progesterone production.
Vitex does not simply elevate LH; it works at a regulatory level and helps to orchestrate this whole process.
If you are hoping to ovulate, you want a high LH but you want it to happen at the right time, and Vitex can help make that happen.
So, I do not see polycystic ovarian syndrome as a contraindication to using this product. In fact, Ive seen it help many women with PCOS to achieve successful pregnancies.
Vitex and Progesterone Cream
By Amy Day, ND
Question: "I have started taking vitex almost over a month ago. And I also just started using natural progesterone cream. I have PCOS and didn't menstruate without some treatment. I noticed since I have started using the both the above I have menstruated twice this month and now after 2 weeks I'm spotting again! Is that normal? Any suggestions? I am freaking out! Please respond as soon as possible."
Answer: It must feel strange to go from having no periods to having two per month. The good news is that you know your body is really responding to these natural therapies. To help you get your cycle to normalize, let's first help you understand the actions of the treatments that you are using. Vitex and progesterone cream have related but separate effects on the menstrual cycle.
Vitex is like a master regulator. It encourages the pituitary in the brain to produce the hormones that orchestrate the whole cycle. It helps to tell the ovaries when to produce estrogen and progesterone, and when to ovulate. After ovulation, the ovaries naturally increase production of progesterone for the second half of the cycle (i.e., luteal phase). So vitex encourages the body to produce its own progesterone.
Progesterone cream may be given as a therapy when trying to augment the natural production and stimulate the body to cycle. I'm not sure what dose or timing you were using, but in order to mimic a natural cycle, progesterone cream is usually given for two weeks on and then two weeks off, only using it during the luteal phase. Though it is a relatively safe hormone, it needs to be dosed carefully and used properly. When using progesterone in this way, you should have one bleed per month, right after stopping the cream.
Since you are responding so strongly, it sounds to me like you may not need both of these therapies at once. I most often start with herbal support to encourage the body to learn its own rhythm, adding in hormones only as needed. Vitex can take a few months to get its rhythms working optimally so it's best to give that a little more time on it's own before deciding what else you might need.
How Much Should You Take?
Everyone is unique, so the amount and form you need won't be the same as for someone else.
Chasteberry can be taken daily for up to 18 continuous months, unless pregnancy occurs. It can be taken once or twice a day. It may take 2-7 months before any results become evident.
As a general guideline, your daily dose could be 175 mg. or more of standardized vitex extract, standardized to contain 0.6% agusides (or 60 drops of tincture, standardized to contain 0.6% agusides).
It's not the same as taking progesterone. You don't take it, stop it, and then expect a withdrawal bleed a few days later as you would if you were taking progesterone or synthetic progestins.
Vitex agnus castus is exceptionally safe. In one study, chaste tree berry was given up to 9 years with very few side effects. But it's advisable to not take it if you are pregnant.
Please note: The quality of botanical supplements is unreliable. Don't buy any herbal or botanical product unless it has a "standardized" amount of the active component listed on the label. A "standardized" product has a consistent amount of active ingredients from one bottle to the next. If you buy a product that is not standardized, you have no clue as to what you are actually getting and are probably wasting your money.
If you're taking hormone replacement therapy, oral contraceptives or dopamine agonists, let your doctor know if you're taking this extract.
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