Premenstrual symptoms

6 remedies

Reference, not prescription. Nothing here is medical advice. Herbs can interact with medicines and be dangerous in pregnancy; tell your doctor or pharmacist about anything you take.

Moderate evidence

Several trials, mostly positive, or an EMA ‘well-established use’ monograph.

Chaste tree

Vitex agnus-castus

Moderate

EMA accepts one dry extract (DER 6–12:1, ethanol 60%) as well-established use for premenstrual syndrome, based mainly on a trial in 178 women (170 evaluated) in which irritability, mood change, anger, headache and breast fullness improved more than with placebo over three cycles. A 2019 meta-analysis of three well-characterised double-blind trials (520 women) found women on the extract 2.57 times more likely to respond than on placebo; a 2017 meta-analysis found a large pooled effect but called it exploratory because of high bias, heterogeneity and likely publication bias. Other preparations are registered only as traditional use for minor premenstrual symptoms.

Limited evidence

Small or few trials, mixed results, or mainly lab and animal work.

Chaste tree

Vitex agnus-castus

Limited

Cyclic breast pain (mastalgia): a 2020 systematic review of 25 studies found a moderate effect over placebo in a conservative meta-analysis of six trials (718 women; SMD 0.67), at typical doses of 20–40 mg a day for 3 months, but the risk of bias in most studies was unclear. NCCIH describes the evidence on breast pain and other PMS symptoms as low-to-moderate quality.

Evening primrose

Oenothera biennis

Limited

WHO calls trial results in premenstrual syndrome conflicting; NCCIH finds insufficient evidence either way.

Saffron crocus

Crocus sativus

Limited

A double-blind trial in 50 women found saffron (30 mg/day) reduced premenstrual symptoms more than placebo over two cycles.

Senegal mahogany

Khaya senegalensis

Limited

The same trial found improvements in emotional wellbeing and possibly less use of rescue painkillers, a finding the authors say needs confirmation.

Traditional use

Long recorded use, essentially untested in clinical trials.

Black cohosh

Actaea racemosa

Traditional

WHO lists premenstrual syndrome among uses described in pharmacopoeias and traditional systems; it cites only uncontrolled case series. NCCIH says there are not enough reliable data for uses beyond menopause.