why would I use Vitex, and What is it?
To determine what supplements women might use to try and restore missing periods, I did a quick survey of women in my “No Period. Now What?” Facebook support group. The most common herb/supplement mentioned was Vitex, taken by over a third of those who responded to my survey (21/53). Vitex is a shortened name for Vitex Agnus Castus also known as Chasteberry. Most women reported taking “vitex’, but some said “agnus castus” or “chasteberry” – as far as I can tell they are synonyms. It’s a small, bushy plant, with pretty purple flowers and small brown berries.
I did a search of the medical literature using the following queries in pubmed to find research relevant to understanding whether vitex can help restore a missing period.
Vitex fertility Vitex amenorrhea Vitex oligomenorrhea Vitex luteal phase Vitex follicular phase Vitex progesterone Vitex estrogen Vitex osteoporosis
The searches came up with between 5-25 results, many overlapping between searches. I read through abstracts where available (a few articles were in languages I don’t speak, or had no abstract available) and the full article if the abstract seemed relevant and I wanted to learn more.
My conclusion is that Vitex Agnus Castus does NOT lead to restoration of cycles in someone experiencing hypothalamic amenorrhea (unless that amenorrhea is due to elevated levels of prolactin), and may in fact be hindering the return of a missing period.
Vitex elevated prolactin and PMS
There is quite a lot of evidence to support the use of Vitex in reducing PMS and hyperprolactinemia. Controlled clinical studies have been performed, and meta-analyses or reviews that examined data from multiple clinical trials found that there was good evidence for these two indications. Hyperprolactinemia causes amenorrhea by suppressing estrogen and progesterone, as happens when a woman is nursing. Aside from breastfeeding, hyperprolactinemia can occur when someone has a benign pituitary tumor (called a microadenoma) – bromocriptine is another drug sometimes prescribed to help in these cases, Vitex seems to work just as well. So if someone has amenorrhea due to elevated prolactin, yes, vitex can help. Prolactin is not elevated in hypothalamic amenorrhea and therefore this mechanism isn’t in play.
The studies I looked at were:
Review of six herbal medicines, including Vitex, in PCOS
Review of Vitex clinical trials examining female reproductive disorders (PMS, PMDD (premenstrual dysphoric disorder), hyperprolactinemia)
Vitex and HA/No periods
I found zero evidence for Vitex helping restore cycles after hypothalamic amenorrhea. There were some interesting observations in primates where vitex actually caused infertility in monkeys taking large amounts because the Vitex elevated their progesterone, thus preventing ovulation. I have often read the suggestion to take Vitex to help increase progesterone, but in a normal cycle progesterone is only elevated after ovulation, so consistently higher levels would not be helpful. Just as Provera (synthetic progesterone) or bioidentical progesterone do not “jumpstart” cycles, increasing progesterone through taking Vitex likewise does not change hormones in such a way as to lead to ovulation and thus cycle restoration. (What does work is removing food restrictions and cutting high intensity exercise…)
Vitex fischeri significantly increases progesterone in chimpanzees
Vitex doniana significantly increases progestogen (progesterone metabolite) in baboons and prevents sexual swelling and associated ovulation
How Vitex Works
There are suggestions that Vitex works in the following ways:
Binding dopamine receptors, thereby reducing pituitary secretion of prolactin, which in turn inhibits estrogen and progesterone.
Binding the opioid receptors, similar to b-endorphins. This would decrease secretion of gonadotropin releasing hormone, which is already suppressed with HA, therefore the Vitex could very well be prolonging time to recovery.
Containings many estrogenic compounds. However, taking estrogen/progesterone/bcp do not restore menstrual cycles, there is no reason to believe that vitex will.
B-endorphins and hypothalamus
There were a couple of women who reported on my survey that while Vitex did not help with restoring periods, it did help with alleviating anxiety. Binding to the dopamine and opioid receptors might explain this stress relief. But just as with exercise, while the beta-endorphins make it feel stress relieving, the hypothalamus is actually suppressed by the binding of the endorphin receptors.
Figure from “Exercise and the Stress System”, George Mastorakos et al., HORMONES 2005, 4(2):73-89
Vitex and bone density?
One interesting side note was that there were a few papers that suggested perhaps a positive effect of Vitex on bone density /fracture repair but those studies were performed in animals so I would want to see additional studies in humans before considering recommending Vitex for that reason (especially given the ways in which it might prevent the return of cycles). There was one paper that found increased markers of bone repair after fracture in women taking Vitex + Magnesium…
Recommendations on Vitex and missing periods
All in all my conclusion is Vitex is NOT helpful for someone trying to recover missing periods and I would not recommend it.
If you find any evidence from controlled studies, or a mechanistic explanation of Vitex helping with cycle restoration, please share with me! I am happy to revise these recommendations if there is something I missed or new evidence comes to light.