Hypericum perforatum for the treatment of premenstrual syndrome

Abstract

Premenstrual syndrome (PMS) refers to a set of emotional and physiologic symptoms occurring during the last week of the premenstrual phase and diminishing by the end of menstruation [1]. Hypericum perforatum (St John's wort) is a traditional herbal remedy that has been found to be effective at alleviating the symptoms of mild–moderate depression in those experiencing PMS [2–4]. The aim of the present study was to investigate the efficacy of H. perforatum in the treatment of PMS. In total, 170 women with PMS (for at least 6 months) who were referred to Zeinabieh Hospital, Shiraz University of Medical Sciences, Shiraz, Iran, were included in the present prospective, randomized, double-blind, placebo-controlled study. Women with current major psychiatric disorders, recent history of serious health problems, use of psychotropic medication, concomitant treatment for PMS (e.g. vitamins and supplements), current or planned pregnancy, current lactation, lack of appropriate contraception, irregular menstrual cycles, and those using oral contraceptives were excluded from the study. The American College of Obstetrics and Gynecology standard diagnostic criteria [1] were used to define PMS. Ethics approval was provided by the Institutional Review Board and the Ethics Committee of Shiraz University of Medical Sciences, and all participants gave written informed consent. The participants were randomly divided into 2 groups: those receiving H. perforatum (2 680-μg hypericin tablets per day [n=85]) and those receiving placebo (2 cellulose tablets per day [n=85]) for 8 weeks (2 menstrual cycles). Anxiety (mood swings, anxiety, or nervous tension/irritability), hydration (breast tenderness, swelling of extremities, or weight gain), depression (depression, crying, forgetfulness, or insomnia), and craving (increased appetite, headache, or fatigue) were evaluated daily on scale of 1 (not at all) to 6 (extreme). The 28-item General Health Questionnaire was used to evaluate the psychologic status of participants, all of whom completed the questionnaire prospectively during the intervention cycles and reported any adverse effects. Statistical analyses were performed using SPSS version 15.0 (SPSS, Chicago, IL, USA). The χ or Fisher exact test was applied for comparison between frequencies. Paired and independent sample t tests were used to compare means within and between groups, respectively. All tests were 2-sided and the level of significance was set at Pb0.05. There were no significant differences in baseline characteristics between the groups (Table 1). Those receiving H. perforatum had significantly lower PMS scores compared with baseline (Pb0.001) and the control group (Pb0.001). The biggest improvements in score occurred for crying (71%) and depression (52%) in the study group. More participants from the study group than the control group dropped out because of adverse events (P=0.02), although there were no significant differences in adverse events caused by the 2 preparations. H. perforatum seems to reduce premenstrual symptoms at 8 weeks of treatment, consistent with previous studies [2–4]. In their pilot study, Stevinson and Ernst [2] observed that daily intake of H. perforatum was associated with a 51% reduction in symptom ratings—consistent with the 40% reduction in the present study. Canning et al. [3] reported thatH. perforatumwasmore effective than placebo in the treatment of PMS. By measuring levels of serum sex hormones and inflammatory cytokines, they also excluded inflammatory or hormone regulation as a possible mechanism of action [3]. Consistent with the present results, Hicks et al. [4] observed that PMS mood symptoms (anxiety and depression) improved more than did other symptoms. The present study provides further evidence that H. perforatum— which is cheap and commonly available—is a well-tolerated and effective drug for the treatment ofwomenwithmoderate–severe PMS.