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Two Alternatives Show Promise for PMS, Mastalgia.

CHICAGO -- Evening primrose oil has shown some benefit for women whose most prominent symptom of premenstrual syndrome is mastalgia. Chaste tree berry extract may help women whose periods are irregular or too frequent, Dr. Victoria E. Rand said in a literature review at a conference on alternative and complementary medicine sponsored by the University of Chicago.

* Evening primrose oil. Seeds from the native American wildflower Oenothera biennis L. contain high levels of the essential fatty acids linoleic acid and gamma-linolenic acid, which are precursors of the anti-inflammatory prostaglandin E1. "Women with PMS often have low levels of gamma-linolenic acid," said Dr. Rand of the University of California, San Francisco.

European clinical trials of evening primrose oil have been methodologically flawed and showed inconsistent results. A meta analysis identified only two well-controlled, randomized studies neither of which showed an overall benefit (Control. Clin. Trials 17[1]:60-68, 1996). Mastalgia improved significantly in some studies, such as a trial comparing evening primrose oil with danazol, bromocriptine, progestins, and placebo (Lancet 2[8451]:373-77, 1985).

In this study of 291 women with menstruation-associated breast pain, 70% of the women randomized to receive danazol reported that the drug was effective, compared with 47% of those given bromocriptine and 45% of those given evening primrose oil. Adverse effects, however, were reported by 22% of the women in the danazol group and 33% in the bromocriptine group, compared with only 2% in the primrose oil group. "The evening primrose oil dearly was much better tolerated," Dr. Rand said.

Limited data suggest that caution should be used for patients at risk for seizures or who take anticonvulsant or antipsychotic drugs, she said.

* Chaste tree berry extract. Most of the research on this product so far has been in German, Dr. Rand said, adding that "we're going to see more research" on it because of the promising results. Derived from the dried ripe fruit of a tree indigenous to the Mediterranean, Vitex agnuscastus L., chaste tree berry extract exerts dopaminergic effects on the anterior pituitary, decreasing prolactin levels and increasing progesterone levels.

In two German observational studies that followed 500 women for 19 cycles, there was significant improvement in a variety of subjective measures of PMS, and side effects were minimal, she said. And in another study, 175 women were treated either with a proprietary chaste tree berry product, 3.5-4.2mg daily throughout the menstrual cycle, or pyridoxine, 100 mg twice daily during the second half of the cycle (Phytomedicine 4[3]:183-89, 1997). Similar statistically significant improvements were seen in both groups on a variety of pain scales.

Chaste tree berry extract is very well tolerated, and no drug-herb or herb-herb interactions have been seen with it. "But because of its dopaminergic and progesterone effects, if I had a woman already on birth control pills, I wouldn't want to use it," Dr. Rand added.

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Comment:Two Alternatives Show Promise for PMS, Mastalgia.
Publication:Family Practice News
Article Type:Brief Article
Geographic Code:1USA
Date:Mar 15, 2001
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